The Perception of Harm of e-Cigarettes Relative to Cigarettes Has Increased

The proportion of US adults who perceived e-cigarettes to be as harmful, or more harmful than cigarettes increased dramatically from 2012 to 2017, according to new findings published in JAMA.

Study researchers used data from two multiyear cross-sectional nationally surveys (the Tobacco Products and Risk Perceptions Surveys [TPRPS], as well as the Health Information National Trends Surveys [HINTS]) – to evaluate the perceived detriments of e-cigarettes relative to cigarettes among US adults in 2012 through 2017.

The analytical samples of TPRPS included 2,800 adults in 2012 (cumulative response rate, 7.3%), 5,668 in 2014 (cumulative response rate, 6.6%), 5,372 in 2015 (cumulative response rate, 6.8%), 5,245 in 2016 (cumulative response rate, 6.4%), and 5,357 in 2017 (cumulative response rate, 5.8%). The analytical samples of HINTS consisted of 2,609 adults in 2012 (response rate, 39.9%), 3,301 in 2014 (response rate, 34.4%), 2,224 in 2015 (response rate, 33.0%), and 2,683 in 2017 (response rate, 32.4%).  The study’s respondents consisted of adults 18 years older and were chosen via address-based sampling or random-digit dialing. Researchers conducted analyses from February 2018 through April 2018.

e-Cigarettes Perceived as Detrimental

Findings of the study suggest a proportion of adults who perceived e-cigarettes as less harmful than cigarettes decreased from 39.4% (95% CI, 36.9% to 41.9%) in 2012 to 33.9% (95% CI, 32.7% to 35.2%) in 2017 in TPRPS, and reduced from 50.7% (95% CI, 48.8% to 52.7%) in 2012 to 34.5% (95% CI, 32.7% to 36.3%) in 2017 in HINTS. Moreover, in the same time duration, the proportion of adults who perceived e-cigarettes to be as detrimental as cigarettes increased from 11.5% (95% CI, 10.0% to 13.2%) in 2012 to 36.4% (95% CI, 35.1% to 37.7%) in 2017 for TPRPS, and from 46.4% (95% CI, 44.5% to 48.3%) in 2012 to 55.6% (95% CI, 53.7% to 57.5%) in 2017 for HINTS. Furthermore, those who perceived e-cigarettes to be more harmful than cigarettes increased from 1.3% (95% CI, 0.8% to 2.2%) in 2012 to 4.3% (95% CI, 3.8% to 4.9%) in 2017 for TPRPS, and from 2.8% (95% CI, 2.2% to 3.5%) in 2012 to 9.9% (95% CI, 8.8% to 11.1%) in 2017 for HINTS.

“Given the demonstration by previous studies that perception of risk plays a critical role in decisions to use tobacco, our results imply that at least some smokers may have been deterred from using or switching to e-cigarettes due to the growing perception that e-cigarettes are equally harmful or more harmful than cigarettes,” the authors wrote regarding the results.

The researchers noted that they felt that the confusion between relative risk and absolute risk of e-cigarettes may contribute to framing bias in risk communication, resulting in partial media coverage in which absolute harm is overstated, and relative harm is downplayed.

“Our results underscore the urgent need for accurate communication of the scientific evidence on the health risks of e-cigarettes and the importance of clearly differentiating the absolute harm from the relative harm of e-cigarettes.”