Misperceptions about the effectiveness of cutting down and low-rate daily smoking for reducing the risk of tobacco-caused harm.

Introduction: Reducing the amount smoked per day, or smoking at a low rate, confers limited protection from smoking harms. We aimed to quantify the prevalence of misperceptions about cutting down and low-rate smoking among Australian adults who smoke.

Method: Cross-sectional online survey in April/May 2022 (N=2,740). Participants were asked whether they agreed (misperception) or disagreed that "Reducing the number of cigarettes smoked per day is an effective way to reduce the risk of experiencing the health harms of smoking". They were also asked whether the statement "Smoking 1 cigarette per day is about 1/20th as dangerous as smoking a pack of 20 cigarettes per day" sounded about right (misperception) or if it was less dangerous (misperception) or more dangerous than that.

Results: The misperception that reducing the number of cigarettes smoked is an effective way to reduce risk was held by 72.0% of people who smoke overall, but was more common among those who smoked <5 cigarettes daily (76.3%; Adj PR=1.11 [95% CI 1.01-1.21]) or only occasionally (79.7%; Adj PR=1.14 [1.06-1.23]) compared with those who smoked 5+ cigarettes daily (66.7%). Over two-thirds (67.9%) underestimated the dangers of smoking 1 cigarette per day, and this misperception was also more common among low-rate smokers (77.6%, Adj PR=1.14 [95% CI 1.04-1.26]) compared to those who smoked 5+ cigarettes daily (63.1%).

Conclusions: Misperceptions about the value of cutting down and low-rate smoking for reducing the risk of tobacco-caused harm are pervasive, especially among those who currently smoke at a low-rate or only occasionally.

Implications: Recent epidemiological evidence confirms that the risks of harm associated with low-rate smoking and cutting down are much higher than would be expected if the relationship between consumption and harm was linear. Findings from this study indicate that misperceptions about the benefits conferred by these smoking patterns are pervasive among people who smoke, particularly among those who currently smoke at a low rate. Corrective education that explains the mechanisms for the increased risk posed by these behaviours could be delivered via package health warnings and/or public health campaigns and may provide low-rate and occasional smokers with additional reasons to quit.