Most people know smoking is risky, by now it is something of an IQ test if you take up that habit. There is no amount of awareness that will stop all people from doing all things, young people like to rebel and if they get hooked on nicotine, it can be difficult to pull away after they come to their senses.

But both harm reduction and smoking cessation can help once people decide to quit: There are other tobacco products, like snus or chewing tobacco, and then there are nicotine replacements, like gums, patches and e-cigarettes.

Yet they are all made by corporations and each corporation believes it will benefit by confusion, so a large number of people aren’t aware of the differences. Unfortunately, overly broad US Food and Drug Administration labels don't help.

Writing in the July issue of the journal Harm Reduction, scholars report that 75 percent of U.S. adults misperceive smokeless tobacco products as being as harmful as cigarettes, calling it “both a considerable lack of knowledge and a serious public health problem.” Smokeless varieties of tobacco in the U.S. include chewing tobacco and snuff. 

The researchers analyzed data from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of U.S. adults conducted between October 2012 and January 2013.

Among the paper’s findings:

  • 35 percent of U.S. adults did not know that various cigarettes are equal in risk.
  • Current smokers were twice as likely as former smokers to believe that some cigarettes are safer than others.
  • 13 percent of U.S. adults believe that some types of cigarettes are less harmful than others. Perceptions varied among smokers,former smokers and people who’ve never smoked. For example,current smokers were more likely than former smokers to perceive some cigarettes as being less risky.
  • 90 percent of U.S. adults aren’t aware that smokeless tobacco products are less hazardous than cigarettes.
  • 51 percent think e-cigarettes are less harmful than regular cigarettes.

“Even for e-cigarettes, half of the public incorrectly believed them to be just as dangerous as cigarettes and an overwhelming majority of respondents incorrectly believed smokeless tobacco to be just as dangerous as traditional cigarettes,” says Marc Kiviniemi, associate professor in the Department of Community Health and Health Behavior in  University at Buffalo’s School of Public Health and Health Professions, who co-authored the paper with Lynn Kozlowski, a professor of community health and health behavior.

Of course, that doesn’t mean these products are safe—just safer when compared to cigarettes.

“Nobody is saying there’s no risk associated with smokeless tobacco use or e-cigarettes,” says Kozlowski. “There’s an analogy here. If you think about the difference between crossing the street in the middle of the block at rush hour versus crossing at a crosswalk with the stop signs,you could say these are both not safe because in some sense there’s a chance that you can get hit by a car. But there’s very real differences in the amount of risk."

Kiviniemi and Kozlowski’s paper also found that a“concerning number” of adults think that some cigarettes, such as light and mild varieties, are safer than so-called full flavor. While the FDA banned such descriptors, the color coding on the packages remains.

“It’s easy to say ‘This is safe, this isn’t safe,’ but reality is more nuanced,” says Kiviniemi. “If you really are considering switching from traditional cigarettes to another product, or if you’re a non-smoker and you’re thinking about starting it because you think they’re safe, then you really owe it to yourself to dig a little deeper and get the more nuanced knowledge.”