Measuring support for requiring reduced nicotine cigarettes: Issues with questions, answers, and respondents

Objective: In this study, we assessed the effect of question type and answer options on support for lowering nicotine levels in cigarettes to make them less addictive. Methods: We surveyed 540 US adults using Prime Panels. Participants randomly received: (1) one of 2 Likert-type questions and (2) a forced-choice question on a range of policy options, with responses in one of 2 orders. Generalized linear models examined policy support using a latent outcome variable. Results: Overall, 53% of smokers and 77%-81% of former/never smokers supported the policy. With Likert questions, support was higher when ‘support’ options were presented first; with the forced-choice question, there were no answer order effects. Few smokers (21%) supported the policy consistently, compared to 47% of former and 52% of never smokers. In the multivariate latent model, current smokers (b =-0.13, 95% CI:-0.24,-0.02) and former smokers (b =-0.48, 95% CI:-0.58,-0.38) were significantly less likely to support the low nicotine policy compared to never smokers. Conclusions: Survey design, including question type and the response order, resulted in a substantial difference in participant responses. Better and multiple questions may be needed before drawing conclusions about mandatory reduced nicotine cigarettes support, especially among smokers.