Assessing Public Opinion for Very Low Nicotine Policies: Using Open-Ended Responses to Evaluate Quantitative Survey Data and Better Inform Communication Strategies

Objective: The US Food and Drug Administration (FDA) announced plans to establish a maximum allowable nicotine level in cigarettes. Understanding public views on very low nicotine cigarettes (VLNC) is important for policymaking and message development. To provide more reliable insights than those drawn from closed-ended survey items alone, we compared policy preference results from the full survey sample with those from respondents whose open-ended justifications logically aligned with their forced-choice policy selection, treating this alignment as a proxy for more considered opinions. Method: Our sample of US adults (N = 519) was recruited using the crowdsourcing tool, Prime Panels. We asked participants to choose which nicotine policy they would prefer, ranging from policies banning all levels of nicotine to allowing all levels of nicotine. Following that response, participants wrote a justification for their choice. We coded the open-ended responses and constructed a “thoughtfulness” variable; a thoughtful response meant the open-ended response logically matched that participants’ policy choice. We used Chi-square tests of independence to analyze policy choice stratified by thoughtfulness and smoking status. Results: Thoughtfulness of response was significantly associated with smoking status (p <.001); current smokers had the lowest proportion of thoughtful responses (53.3%, n = 88), former smokers had the highest proportion (79.1%, n = 72), and never smokers were more intermediate (66.7%, n = 178). The proportion of current smokers supporting no nicotine/VLNC drops to 23% in the thoughtful sub-sample (n = 88) from 39% (n = 77) in the unthoughtful sub-sample (p =.024). Conclusions: To accurately understand smoker opinions on potential VLNC policies for informed policymaking and education/communication efforts, structured interviews or short answer questions may be warranted. VLNC policy support among current smokers may be lower than previously thought based on analyses among only those who likely deliberated and thought about their policy choice, and communication strategies could be better guided by recognizing that true support among smokers may be more limited than earlier surveys suggested.