In, 2018, the U.S. Food and Drug Administration (FDA) issued an Advanced Notice of Proposed Rulemaking to inform the public of their potential decision to limit nicotine content in cigarettes to minimally or non-addictive levels (US Food and Drug Administration, 2018). In 2022, the Biden administration announced intentions to implement this policy, and media coverage of this topic has increased (e.g., Maloney, 2022). Extensive research suggests this policy may help eliminate smoking addiction (Markou, 2008; Tseng et al., 2021) and thereby reduce severe disease linked to smoking (Hatsukami et al., 2008; Vineis et al., 2004; Zuo et al., 2014). Smoking remains the leading cause of preventable death in the U.S. and internationally (National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health, 2014); therefore, this policy can produce substantial public health benefits if it reduces initiation and addiction to smoking among people who do not smoke and increases quitting or adoption of less harmful alternatives among people who smoke.

Although public support has been generally favorable toward the policy, almost half of people who smoke (approximately 40%; Connolly et al., 2012; Smith et al., 2021) have reported they do not support it. This opposition may stem from widespread concerns about the policy (Byron et al., 2018; Differding et al., 2022; Henderson et al., 2022; Loud et al., 2022), including doubts about its effectiveness (Fraser and Kira, 2017), its unintended consequences (e.g., increasing cigarette smoking among current and new users), and the trustworthiness of regulators, such as the FDA (Henderson et al., 2022; Reynolds et al., 2022a).

Although the FDA has Congressionally-granted authority to regulate nicotine levels in tobacco products, the ultimate policy decisions may be influenced by Congressional oversight, which is swayed by public opinion. Thus, it is important to understand factors associated with public support or opposition to the policy. Prior studies have examined predictors of support for this policy, finding that older people, females, those who do not smoke, and those who perceive smoking as more harmful are more likely to support the policy (Denlinger-Apte et al., 2019; Smith et al., 2021). Although demographic predictors have been identified, the role of perceived policy effects remains an unexplored but likely driver of policy support. Research on smoke-free policy support (e.g., Thrasher et al., 2010) and other public health contexts have shown that expected policy outcomes are a substantial correlate of support and opposition (Stecula et al., 2020). Research on communication campaigns also suggests that the effectiveness of campaigns can be enhanced by targeting beliefs strongly linked to policy support (e.g., Jones et al., 2015).

Prior studies in this area have not consistently sampled relevant tobacco-use groups. For example, Kulak et al. (2020) included “Current Smokers”, “Former Smokers”, and “Never Smokers”; however, they did not distinguish people who smoke exclusively from people who “dual use” both cigarettes and non-combusted alternative nicotine delivery products (e.g., e-cigarettes). A recent review of dual use behavior found that 1–2% of the U.S. adult population fits into this category, in excess of two million people (Coleman et al., 2022; Mayer et al., 2020). Meanwhile, emerging evidence suggests that dual use is associated with more severe health outcomes, including cardiovascular disease, compared to smoking cigarettes exclusively (Pisinger and Rasmussen, 2022). Reducing nicotine in smoked tobacco likely affects dual-using individuals differently because they have already adopted an alternative nicotine product that is not affected by reducing nicotine in combustible tobacco. Prior focus group studies suggest that individuals who dual-use rather than smoke exclusively are more receptive to switching away from cigarettes (Duong et al., 2021).

The present study aims to fill these gaps by analyzing data including nationally-representative samples to estimate the prevalence of beliefs about a reduced nicotine policy across key subpopulations who could be influenced by the policy. Determination of which beliefs are most strongly associated with support for or opposition toward the policy will provide insight into the most effective targets for messaging strategies that aim to promote public support (Hornik and Woolf, 1999).