Abstract
BackgroundThere is a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes across the UK, Europe and the US. It is important to assess whether this may influence the use of e-cigarettes. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade.MethodsRespondents were from the Smoking Toolkit Study, which involves monthly cross-sectional household surveys of individuals aged 16+ years in England. Data were aggregated monthly on ~ 300 current tobacco smokers between 2014 and 2019. The outcome variable was the prevalence of e-cigarette use. The explanatory variable was the proportion of smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes. Covariates were cigarette (vs. non-cigarette combustible) current smoking prevalence, past-year quit attempt prevalence and national smoking mass media expenditure. Unadjusted and adjusted autoregressive integrated moving average with exogeneous variables (ARIMAX) models were fitted.ResultsFor every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48% (βadj = 0.48, 95% CI = 0.25–0.71, p < .001). Marginal age and sex differences were observed, whereby significant associations were observed in older (but not in young) adults and in men (but not in women). No differences by social grade were detected.ConclusionsBetween 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use.
Highlights
Cigarette smoking is one of the leading causes of premature morbidity and mortality; each year, 8 million people worldwide die of smoking-related disease [1]
A total of 16,009 (96.6%) respondents had complete data on all variables of interest. Those with missing data were significantly less likely to use e-cigarettes (14.3% vs. 19.3%; p < .01) but not to endorse the belief that e-cigarettes are less harmful than combustible cigarettes (34.6% vs. 38.5%; p = .06)
The proportion of respondents who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes declined significantly (B = − 0.19, p < .001) from 45.6% at the start of the study period to 36.1% in the last month of the study period (M = 38.8%, SD = 4.8%; see Additional file 2: Fig. S1 for descriptive plots of smokers’ harm perceptions using the original 4-level coding)
Summary
Cigarette smoking is one of the leading causes of premature morbidity and mortality; each year, 8 million people worldwide die of smoking-related disease [1]. A growing body of research has studied the prevalence and correlates of e-cigarette harm perceptions, with a focus on the perceived relative harm of e-cigarettes compared with conventional, combustible cigarettes These perceptions are associated with the trial and use of ecigarettes cross-sectionally [8,9,10,11,12] and prospectively [13]. It is assumed that negative media portrayals of e-cigarettes reduce accurate harm perceptions Consistent with this concern, during a period of numerous ecigarette news stories focusing on absolute risks, longitudinal surveys of nationally representative samples report a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes [17, 20, 21, 25,26,27,28]. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade
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