New study reveals common misunderstandings among tobacco and e-cigarette users related to the risk of harm from nicotine

Those with serious mental health conditions were more likely to overemphasise the risk of harm from nicotine, potentially discouraging the switch from tobacco cigarettes to nicotine-containing products.

17 September 2021

A new SPECTRUM-funded study from researchers at King’s College London and Public Health England has revealed common misconceptions about the risk of harm from nicotine among UK adults with a history of tobacco and/or e-cigarette use.

The study analysed responses to an online survey of 3400 adults who smoke cigarettes and/or use e-cigarettes, or had recently stopped.

Researchers found that a large proportion of those surveyed incorrectly understood the risk of harm from nicotine in cigarettes and from other products that contain nicotine, including e-cigarettes and nicotine replacement therapies. This was particularly evident in those with serious mental health conditions.

Inaccurate perceptions of harm

According to the study, less than 10% of those with serious mental distress correctly identified that none/very small amount of the health risks of smoking cigarettes come from nicotine.

Compared with respondents with no/low mental distress, those with serious mental distress were also less likely to think of nicotine replacement therapies as less harmful than tobacco cigarettes.

Rates of smoking and related morbidity and mortality are known to be higher among those experiencing mental ill-health. The authors emphasise the importance of correcting misconceptions related to the risk of harm from nicotine, in order to help those who smoke and experience mental ill-health to switch to less harmful nicotine-containing products.

Sources of information

The most popular sources of information on the health effects of smoking, vaping and nicotine, for people with and without serious mental health conditions, was scientific experts’ opinions and through reports in the media.

The paper highlights the importance of ensuring clear and accurate information from scientists and in media to correct misconceptions of risk and harm from nicotine. Based on the study findings, the authors also suggest that additional information and support is required for those with mental health conditions.


Our findings show that there is a lot of misunderstanding among smokers and e-cigarettes users about how harmful nicotine is. This is particularly true of people with mental ill health. This is a concern as products that can help people to quit smoking, such as e-cigarettes and nicotine replacement therapies, contain nicotine and misunderstandings of the harm nicotine causes may discourage their use.

We need to ensure that scientists and the media are providing clear and accurate information about the risk of harm from nicotine. It is particularly important that information about the risk of using e-cigarettes is accurate, as there is a lot of misinformation about the harm they cause. There should be a focus on providing tailored information and support for those with mental ill health who are more likely to smoke and experience harm from smoking than the general population but who are also more likely to overestimate the harm of nicotine and nicotine-containing products.

Cite the paper

Perman-Howe PR, Horton M, Robson D, McDermott MS, McNeill A, Brose LS. Harm perceptions of nicotine-containing products, and associated sources of information, in UK adults with and without mental ill-health: a cross-sectional survey. Addiction. 2021 Aug 2. doi: 10.1111/add.15657. Epub ahead of print. PMID: 34338387.