Abstract
The Food and Drug Administration (FDA) proposed to reduce nicotine in cigarettes to minimally addictive levels. To understand how individuals process messages about this policy, we conducted a content analysis of open-ended thought-listing responses to messages about very low nicotine cigarettes (VLNCs). Data were from a 2022 to 2023 randomized clinical trial with a probability sample of 1,901 U.S. adults. Participants viewed messages explaining that under a reduced nicotine policy, all cigarettes will have less nicotine but the same harmful chemicals as regular cigarettes. Afterward, participants were prompted to type in their thoughts. Responses were coded for cognitive reactions (pro-arguing, counter-arguing, message acceptance, message rejection) and emotional reactions (positive, negative). We assessed association between these coded reactions and message-related outcomes. In the sample of 944 coded responses, pro-arguing was most common (42.4%), followed by message acceptance (31.9%), message rejection (19.3%), negative emotions (15.8%), counter-arguing (12.4%), and positive emotions (1.2%). Among people who smoke, message acceptance was associated with higher quit intentions. Overall, pro-arguing and message acceptance were associated with higher support for nicotine reduction policy; counter-arguing and message rejection were associated with lower support (all ps < .01). Two weeks after exposure, participants who expressed negative emotions (OR = 2.58, 95% CI = 1.56, 4.26) were more likely to report having spoken with others about quitting smoking and people who expressed message acceptance were more likely to have made a quit attempt since exposure (OR = 1.98, 95% CI = 1.12, 3.27). Spontaneous cognitive and emotional reactions can indicate message effectiveness and predict behavior, suggesting they should be considered when designing tobacco-related messages.