{"doi":"10.1093/ntr/ntaf215","title":"Impact of Survey Item Wording and Response Options on Prevalence of Beliefs About Nicotine Causing Cancer: A Randomized Survey Experiment","abstract":"INTRODUCTION: Misperceptions of nicotine's role in health harms among US adults have increased. This study examined how survey item wording affects estimates of the misperception that nicotine itself causes cancer. METHODS: Two thousand five hundred twenty-six US adults aged 18-45 completed a randomized split-sample experiment through Cloud Research in August 2022. After receiving one of 10 existing and novel survey items about the role of nicotine in causing cancer, participants completed an open-ended question explaining their response. Analyses examined prevalence of beliefs by study condition and open-ended responses. RESULTS: Overall, 36% of participants believed that nicotine does not cause cancer (coded as \"correct\"), but this varied by condition (10%-81%). Prevalence of this belief was similar when using magnitude-of-harm items from existing national surveys (HINTS, PATH; 44%) but lower with more direct wording (ie, \"nicotine is a cause of cancer\"; 23%). Changing response options (including/excluding don't know; true/false versus Likert scale) did not alter prevalence of a correct belief. Open-ended responses were distributed across four themes: (1) EXPOSURE to other chemicals or smoke cause cancer, not nicotine (n = 598, 23.7%), (2) Nicotine on its own DIRECTLY causes cancer (n = 705, 28.0%), (3) Nicotine only causes cancer by keeping people ADDICTED to tobacco (n = 796, 31.6%), and (4) Other (n = 419, 16.6%); study condition was associated with theme (p < .001). CONCLUSIONS: Question wording influences the prevalence of agreement that nicotine itself causes cancer. Including \"don't know,\" \"probably yes,\" and \"probably not\" options may identify a broader group of people who could benefit from nicotine education. IMPLICATIONS: Ensuring accuracy in estimating misperceptions about nicotine has implications for tobacco control in two important ways: first, these measures may identify the people or groups whose misperceptions may put them at greater risk for tobacco-related disease and death, and second, the prevalence of nicotine misperceptions and people affected may determine the prioritization and tailoring of interventions aimed at correcting misperceptions.","journal":"Nicotine & Tobacco Research","year":2025,"id":549529,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9277,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":337296,"name":"Michelle T. Bover Manderski","orcid":"0000-0003-0000-221X","position":1,"is_corresponding":false},{"id":949558,"name":"Marisa Tomaino","orcid":null,"position":2,"is_corresponding":false},{"id":1072309,"name":"Caitlin Uriarte","orcid":null,"position":3,"is_corresponding":false},{"id":1073706,"name":"Caitlin Weiger","orcid":"0000-0002-6029-0033","position":4,"is_corresponding":false},{"id":310224,"name":"Olivia A Wackowski","orcid":"0000-0001-9159-5473","position":5,"is_corresponding":false},{"id":304694,"name":"Cristine D. Delnevo","orcid":"0000-0001-9597-4307","position":6,"is_corresponding":false},{"id":1153007,"name":"Emily Peterson","orcid":"0000-0001-5234-038X","position":7,"is_corresponding":false},{"id":236749,"name":"Andrea C. Villanti","orcid":"0000-0003-3104-966X","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:54:07.823422Z","pmid":"41405956","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}