In a recent study published in JAMA Network Openresearchers looked at trends in perceptions of harm caused by e-cigarettes (e-cigarettes) compared to combustible cigarettes among smokers in England.
E-cigarettes are less harmful than cigarettes and can help people quit smoking. However, many adult smokers believe that e-cigarettes are just as harmful as cigarettes. Several factors could have led to confusion about e-cigarettes. Media reports have often exaggerated the dangers of e-cigarettes, with evidence suggesting that this may exacerbate misperceptions.
Study: Trends in perceptions of the harm of e-cigarettes versus cigarettes among adult smokers in England, 2014-2023. Image credit: Andrey_Popov / Shutterstock
Danger messages can also influence perceptions of harm. For example, an outbreak of acute lung injuries in 2019 was wrongly attributed to vaping, even before the cause was identified, and labeled as e-cigarette or vaping product-associated lung injury (EVALI). Further, concerns were raised that e-cigarettes may increase the risk of coronavirus disease 2019 (COVID-19) and its severity, although there was little evidence.
There were short-term spikes in perceptions of e-cigarette harm after the EVALI outbreak. However, how perceptions of the harms of e-cigarettes have evolved after 2020 and how changes vary across population subgroups remains unclear. It is necessary to determine whether changes in perceptions have occurred over time among adult smokers because it has implications for accurate support and messaging.
About the study
In the present study, researchers investigated trends in perceptions of the harms of e-cigarettes in England relative to cigarettes. They obtained data from an ongoing cross-sectional survey of adults between November 2014 and June 2023. The sample was limited to people aged 18 years and older who were current smokers because the component of the survey assessing perceptions of e-cigarette harm was limited to them.
Smokers were asked to determine their perception of whether e-cigarettes are less, more or equally harmful to health as cigarettes. The primary outcome was the proportion of smokers who thought e-cigarettes were less harmful. Secondary outcomes included proportions responding more harmful, equally harmful, or don’t know.
Vaping status was determined by questions asking subjects if they used a vaping product or e-cigarette to quit or reduce smoking, or for other reasons. Those who responded to e-cigarette use were considered current vapers. The team applied logistic regression to assess associations between survey waves and perceptions of e-cigarettes.
Foundings
Of more than 169,400 people surveyed, 28,393 were smokers, including 13,253 women. They were 43.5 years old on average and 5,879 people were current vapers. Overall, 35.2% of smokers believed that e-cigarettes were less harmful to health than cigarettes. 36.7% reported it as equally harmful and 13.4% perceived it as more harmful, while 14.8% did not know.
Furthermore, the proportion who perceived it to be less harmful than cigarettes was higher among current vapers and the 35-64 age group. Almost a third of dual users, that is, smokers and vapers, perceive e-cigarettes as more or equally harmful. In addition, there were significant changes over time in perceptions of harm. Specifically, in November 2014, the most common perception was that e-cigarettes were less harmful (44.4%). However, this view has declined by 40% by June 2023.
The proportion of smokers who thought it was less harmful fell to 33.2% between November 2014 and July 2019, while the proportion who thought it was equally harmful rose to 42.5%. In particular, there were notable changes in perceptions at the end of 2019, with a sharp decline in the proportion who thought it was harmful in the first quarter of 2020.
Meanwhile, the percentage who believe e-cigarettes are more or just as harmful rose to 50.6%. The decline in the proportion of smokers viewing e-cigarettes as less harmful was similar across age groups. The increase in the proportion of people who believe e-cigarettes are more harmful was sharpest in the younger age group. The proportion who believed that e-cigarettes were less harmful was consistently lower among non-vapers.
conclusions
In summary, perceptions of the harm of e-cigarettes among adult smokers in England have worsened significantly over the past decade. While the most common perception in 2014 was that e-cigarettes were less harmful, the proportion holding this view had fallen by 40% by June 2023. On the other hand, the proportion who believed e-cigarettes were more harmful had more than doubled . Overall, most adult smokers and non-vapers currently do not believe that e-cigarettes are less harmful than cigarettes.
