Nicotine Risk Education and Its Impact on Knowledge, Perceptions, and Behavioral Intentions: A Scoping Review of U.S. Studies

Smoking combustible cigarettes causes an enormous health and financial burden in the U.S. Across tobacco and nicotine products, cigarettes are ranked as the most toxic. Any harm reduction efforts rely on smokers understanding nicotine's absolute and relative health risk potential, but many studies reveal widespread misperceptions. To inform policies focused on reducing the public health burden of smoking, it is essential to understand whether conveying accurate absolute and relative risk information about nicotine and its delivery methods may shift risk perceptions and impact use behaviors. To fill this gap, we conducted a systematic search, using PubMed, PsycINFO, and Google Scholar, for original U.S. studies investigating effects of exposure to educational messages about (1) nicotine's addictive and health risk properties or (2) relative risk information on participants' nicotine knowledge, perceptions, behavioral attentions, and/or use behaviors. Across studies of predominantly fair methodological quality, message exposure was consistently associated with improvements in knowledge and risk perceptions; however, findings were mixed regarding behavioral intentions, and the evidence base is limited by short-term experimental designs without longitudinal follow-up. Our results highlight the potential for educational interventions to increase nicotine knowledge more broadly and reveal important considerations for using education to try to shift behavior among individuals who smoke.