1 of 3
Misunderstandings about nicotine’s role in smoking-related disease remain deeply rooted, persistent, and global. Photo credit: Ahsanjaya, Pexels.
2 of 3
Large majorities of adults underestimate the risk gap between cigarettes and non-combustible nicotine products, often wrongly blaming nicotine itself for the harms caused by burning tobacco. Photo credit: REB Center - Moscow, CC2.0.
3 of 3
Adults who are misinformed about nicotine are significantly less likely to switch to reduced risk alternatives. Photo credit: 2happy, CC0.
Nicotine DOES NOT Cause Cancer. Period.
Nicotine remains one of the most misunderstood chemicals in modern public health—and the consequences are now directly impacting nicotine and tobacco product regulation worldwide. A plethora of new evidence finds that tobacco and nicotine policymakers, regulators, and scientific stakeholders continue to hold mostly incorrect beliefs about nicotine’s role in smoking-related diseases. The misunderstandings directly influence product standards, slow down adult switching, and distort debates around reduced-risk nicotine delivery alternatives.
A series of recent reports—ranging from international policy expert surveys to peer-reviewed behavioral studies and industry-led communication research—conclude that nicotine misinformation is deeply rooted, persistent, and global. As governments impose strict restrictions on next-generation products, new data shows that most officials incorrectly identify nicotine as “the primary cause” of smoking-related harm, creating what British American Tobacco (BAT) calls “a fundamental barrier” to effective harm reduction policy.
Policy misunderstanding
BAT’s 2025 multi-market survey, conducted in collaboration with the public policy advisory firm Public First and released alongside its scientific insights briefing, provides one of the clearest measures of the issue. The survey included policy experts from 15 countries across the US, Europe, Asia, and Latin America and found that 70% of respondents still believe nicotine causes cancer. BAT clearly stated: “Most experts misidentify nicotine as the primary cause of smoking-related diseases, despite scientific consensus that smoke (tar)—not nicotine—is responsible for the overwhelming majority of harm.”
BAT’s chief strategy and growth officer, Kingsley Wheaton, stated that the findings highlight how deeply misinformation is ingrained among influential decision-makers. “These results reveal a critical knowledge gap among policy influencers,” he said. “When nicotine is incorrectly blamed for smoking-related disease, it becomes harder for adult smokers to access accurate information about alternatives that significantly reduce exposure to toxicants.”
The Public First analysis found this issue consistent across markets, regardless of regulatory maturity. In some countries, more than three-quarters of policy respondents believed nicotine itself causes cancer. BAT’s report states that this misperception remains “a major obstacle to evidence-based regulation.”
Several independent scientific studies reveal the same pattern. A peer-reviewed article in Scientific Reports (2025) found that large majorities of adults underestimate the risk difference between cigarettes and non-combustible nicotine products, and that many participants “incorrectly attributed the harms of burning tobacco to nicotine itself.” According to the study’s authors, this misunderstanding “persists despite decades of evidence showing nicotine is not the primary driver of smoking-related mortality.”
Altria’s scientific communications review arrived at nearly identical conclusions. The company stated that “even among health professionals, confusion about nicotine’s role remains widespread,” citing multiple surveys that found that medical providers incorrectly judged nicotine’s role in causing cancer. Altria’s researchers noted that persistent misunderstanding “can reduce smokers’ willingness to try smoke-free alternatives” and “undermine the public health potential of less harmful products.”
Why misperceptions persist
Across all the reports reviewed for this article, the causes of nicotine misperception are remarkably consistent.
First, the persistence of decades-old messaging remains a decisive factor. The Scientific Reports article notes that for many adults, “nicotine” became synonymous with “smoking danger” due to historical anti-tobacco campaigns that rarely distinguished between the drug and the tar that the smoke delivers. The authors conclude that, “Participants demonstrated difficulty separating nicotine as a substance from the toxicants produced by combustion.”
BAT’s analysis also highlights the cumulative impact of legacy messaging: “Nicotine has long been portrayed as the cause of smoking-related diseases in public narratives, creating lasting misconceptions that persist even as scientific understanding has advanced.”
Second, inconsistent regulatory language leads to confusion. Public First’s findings show that in many countries, laws and regulatory guidance documents fail to distinguish between nicotine and combustible harm. BAT summarized: “When regulations treat all nicotine products uniformly, it reinforces the false belief that they are equally harmful.”
A third driver is the amplification of incorrect claims online. According to the Scientific Reports study, exposure to “misleading risk information in digital environments” significantly reduces risk-differentiation accuracy. The authors state that such exposure “creates a durable effect that persists even when corrective information is later provided.”
Fourth, the Altria “Correcting Misperceptions” report highlights an important insight: people often use fear-based shortcuts when assessing nicotine, a mental pattern the authors call “risk-generalization.” In Altria’s words, “When individuals perceive a product category as dangerous, they tend to project all related risks onto all components, including nicotine, regardless of actual toxicological data.”
Finally, several reports highlight that many scientific and clinical educators have not received updated training on nicotine toxicology. According to BAT, “misperceptions among health care professionals remain one of the most significant sources of misinformation for the public.”
Altria similarly stated: “Without access to accurate scientific content, clinicians may inadvertently reinforce nicotine misunderstandings.”
Impacts on public health and regulation
The consequences of misunderstanding nicotine are significant—and consistently highlighted in all referenced reports.
Public First’s policy analysis warns that the misperceptions “directly shape the regulatory landscape,” leading to restrictions or bans on non-combustible products even when the evidence supports risk-based frameworks. BAT stated: “When policymakers misunderstand nicotine, they misunderstand harm reduction.”
The Scientific Reports paper highlights a population-level effect, stating that adults who are misinformed about nicotine are significantly less likely to switch to reduced-risk alternatives. The authors found that inaccurate beliefs “reduced willingness to substitute combustible cigarettes with non-combustible nicotine products, even among smokers expressing interest in quitting.” They concluded that correcting misperceptions “could meaningfully increase switching rates.”
Altria’s report emphasizes the associated economic and behavioral impacts. It states that misinformation discourages innovation and lowers adult acceptance of potentially less harmful products. “Persistent inaccuracies about nicotine suppress the uptake of smoke-free alternatives designed to reduce toxicant exposure,” the company stated.
BAT stressed that misunderstandings also impact trust in public health messaging. “When key stakeholders communicate inaccurate information about nicotine, it undermines confidence in evidence-based harm-reduction strategies,” Wheaton said. “Clear, science-aligned communication is essential if adult smokers are to make informed decisions.”
Several reports also examined how young adults perceive nicotine use. Although nicotine is addictive, BAT notes that confusing nicotine itself with the cause of smoking-related disease does not help prevent youth initiation and could increase confusion about the relative harms of various products. The BAT report states, “Effective youth-prevention efforts should be grounded in accurate science, not misconceptions.”
Correcting the problem
All reports—regardless of source—provide factual information on correcting nicotine misperceptions. The Scientific Reports study tested corrective messages directly and found that scientifically accurate explanations “significantly improved understanding,” especially when they clearly distinguished combustion from nicotine. The authors note that “explicit statements identifying smoke as the primary driver of harm” were the most effective.
Altria’s communication analysis identifies similar patterns, stressing that evidence-based framing must be clear and straight-forward. “Clear statements that nicotine is not the primary cause of smoking-related disease increase comprehension and reduce misperception,” the report states, adding that consistency across channels is vital.
BAT emphasizes the importance of clear regulations and frameworks that match the level of risk. “Aligning regulations with the continuum of risk can help correct longstanding misperceptions and encourage informed decision-making,” the company wrote. Wheaton explained, “Policy should reflect science. Without correcting nicotine misunderstandings, progress on harm reduction will remain limited.”
Public First’s findings show that regulators and policymakers respond well to clear and transparent scientific information. The report concludes that “accurate, accessible information is essential for improving understanding among policy influencers and supporting regulation that reflects the evidence.”
Every report examined shows the same evidence: until nicotine misinformation is corrected, regulations will continue to diverge from science — and millions of adult smokers will be left without clear, fact-based choices about the rapidly increasing number of nicotine delivery systems.