Reactions to a hypothetical reduced nicotine content cigarette policy among sexual- and gender-minoritized communities: a concept mapping study.

Background: People who identify as sexual- and/or gender-minoritized (SGM) individuals have high prevalence of cigarette smoking. This study used concept mapping to examine anticipated reactions to a hypothetical cigarette nicotine reduction policy among SGM individuals in the United States.

Methods: In 2022, SGM individuals who reported past-month cigarette smoking (mean age=33.3) were recruited from 44 U.S. states through Craigslist advertisements to complete an online study. Participants brainstormed statements completing the prompt, "If all cigarettes sold in the United States only had half the nicotine in them that they do now, a specific action I would take or a specific reaction I would have is..." Participants sorted statements by theme and rated statements based on how likely each reaction would be for them. Ninety participants completed at least one part of the study (56, 64, and 73 participants completing brainstorming, sorting, and rating respectively).

Results: Participants generated 100 statements that were organized into 7 thematic clusters using multidimensional scaling and hierarchical cluster analysis. The clusters fell into three broad categories: 1) Thoughts and Reactions to the Ban, 2) Positive Preparations and Action Strategies, and 2) Maintaining Substance Use. The highest-rated clusters among participants were Questioning and Wondering (M=4.63), Negative Reactions (M=4.38), and Increasing Intake (4.30), while the lowest-rated cluster was Improving Public Health (M=3.56).

Conclusions: A policy reducing nicotine content in cigarettes may have a positive impact on SGM individuals who smoke. Health communication campaigns highlighting the purpose and goals of the policy may increase receptiveness to a policy.

Implications: People who identify as sexual- and gender-minoritized (SGM) individuals have higher prevalence of cigarette smoking compared to those who do not identify as SGM individuals. A policy reducing the nicotine content in cigarettes may promote smoking cessation or prevent cigarette initiation, and thus may have a greater impact on SGM people who smoke. However, data from the current study indicate that SGM individuals may be suspicious of the intentions of a policy setting a reduced nicotine content cigarette product standard. This study demonstrates that, while a reduced-nicotine content cigarette policy may have positive public health impacts, regulators should consider how the policy will be communicated to the public to increase the acceptability and effectiveness of the policy.