Smoking remains disproportionately high among people with serious psychological distress (SPD) and low socioeconomic status (SES). The US Food and Drug Administration proposed reducing nicotine in combusted tobacco products to minimally addictive levels. Effective messaging is needed to explain very low nicotine cigarettes (VLNCs) and to motivate these priority groups to use the policy to quit.
In 2024, we conducted 12 focus groups (n=70) in Atlanta, GA, with adults who smoked: individuals experiencing SPD (n=18), low SES (n=27) and neither (n=25). Participants reviewed and discussed 12–14 VLNC messages, including two targeted themes (anxiety/medication for SPD; financial cost for low SES) and three general themes (quitting benefits, regaining control and managing cravings). Data were analysed in NVivo 14.0 using thematic analysis.
Across groups, financial cost messages motivated participants to consider quitting, particularly when emphasising that VLNCs would cost the same as current cigarettes. Participants with SPD found SPD-targeted messages relatable, but some questioned whether nicotine worsens anxiety. General messages resonated broadly, promoting hope, empowerment and self-reflection. Craving management messages were seen as practical and spurred personal discussions. Visuals featuring relatable characters and believable scenarios enhanced receptivity.
Under a reduced nicotine policy, general messages highlighting quitting benefits, regaining control and managing cravings could anchor cessation campaigns. Targeted elements should still address salient barriers for people with SPD (contextualising nicotine’s relationship to anxiety), but mixed responses suggest further refinement is needed. Financial cost messages, although designed for low SES audiences, resonated across all groups and could be used broadly.