Abstract
Debate is ongoing about whether the scientific evidence of the health risks of electronic cigarettes (e-cigarettes) compared with combustible cigarettes (hereinafter referred to as cigarettes) has been accurately communicated to the public. Large representative surveys are needed to examine how the public perceives the health risk of e-cigarettes and how their perceptions change over time. To examine how US adults perceived the harm of e-cigarettes relative to cigarettes and how their perception has changed from 2012 to 2017. Survey study using data from 2 multiyear cross-sectional nationally representative surveys-the Tobacco Products and Risk Perceptions Surveys (TPRPS) and the Health Information National Trends Surveys (HINTS)-to assess perceived harm of e-cigarettes relative to cigarettes among US adults in 2012, 2014, 2015, 2016, and 2017. Respondents were selected via address-based sampling or random-digit dialing and consisted of adults 18 years or older. Analyses were conducted from February through April 2018. Self-reported perceived harm of e-cigarettes relative to cigarettes. The analytical samples of TPRPS consisted of 2800 adults in 2012 (cumulative response rate, 7.3%), 5668 in 2014 (cumulative response rate, 6.6%), 5372 in 2015 (cumulative response rate, 6.8%), 5245 in 2016 (cumulative response rate, 6.4%), and 5357 in 2017 (cumulative response rate, 5.8%). The analytical samples of HINTS consisted of 2609 adults in 2012 (response rate, 39.9%), 3301 in 2014 (response rate, 34.4%), 2224 in 2015 (response rate, 33.0%), and 2683 in 2017 (response rate, 32.4%). The proportion of adults who perceived e-cigarettes as less harmful than cigarettes decreased from 39.4% (95% CI, 36.9%-41.9%) in 2012 to 33.9% (95% CI, 32.7%-35.2%) in 2017 in TPRPS and decreased from 50.7% (95% CI, 48.8%-52.7%) in 2012 to 34.5% (95% CI, 32.7%-36.3%) in 2017 in HINTS. During the same period, the proportion of adults who perceived e-cigarettes to be as harmful as cigarettes increased from 11.5% (95% CI, 10.0%-13.2%) in 2012 to 36.4% (95% CI, 35.1%-37.7%) in 2017 (TPRPS) and from 46.4% (95% CI, 44.5%-48.3%) in 2012 to 55.6% (95% CI, 53.7%-57.5%) in 2017 (HINTS). Those who perceived e-cigarettes to be more harmful than cigarettes increased from 1.3% (95% CI, 0.8%-2.2%) in 2012 to 4.3% (95% CI, 3.8%-4.9%) in 2017 (TPRPS) and from 2.8% (95% CI, 2.2%-3.5%) in 2012 to 9.9% (95% CI, 8.8%-11.1%) in 2017 (HINTS). In this study, the proportion of US adults who perceived e-cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017. The findings of this study underscore the urgent need to accurately communicate the risks of e-cigarettes to the public, which should clearly differentiate the absolute from the relative harms of e-cigarettes.
Highlights
The proportion of adults who perceived e-cigarettes as less harmful than cigarettes decreased from 39.4% in 2012 to 33.9% in 2017 in Tobacco Products and Risk Perceptions Surveys (TPRPS) and decreased from 50.7% in 2012 to 34.5% in 2017 in Health Information National Trends Surveys (HINTS)
The proportion of adults who perceived e-cigarettes to be as harmful as cigarettes increased from 11.5% in 2012 to 36.4% in 2017 (TPRPS) and from 46.4% in 2012 to 55.6% in 2017 (HINTS)
Those who perceived e-cigarettes to be more harmful than cigarettes increased from 1.3% in 2012 to 4.3% in 2017 (TPRPS) and from 2.8% in 2012 to 9.9% in 2017 (HINTS)
Summary
Combustible cigarettes (hereinafter referred to as cigarettes) continue to dominate the tobacco product market in the United States, the emergence and rapid growth of electronic cigarettes (e-cigarettes) in the past decade has led to a transformative change in the US tobacco market—a rapid increase in awareness and use of e-cigarettes among youth and adults that coincided with a decline in cigarette smoking.[1,2,3] This transformation has been accelerated in recent years by the emergence of new generations of e-cigarettes, such as JUUL e-cigarettes (JUUL Labs).[4,5] The exponential growth in e-cigarettes has prompted a renewed interest in the tobacco harm reduction approach, which aims to curb the smoking epidemic rapidly by encouraging smokers to switch to low-risk tobacco products such as e-cigarettes.[6]. The long-term health effects of e-cigarettes are still unknown, growing evidence and consensus among scientists and researchers suggest that the short-term health risks of completely switching to e-cigarettes are substantially less than those of continued smoking for adults who are unable or unwilling to quit cigarette smoking. A recent comprehensive review concluded that, for adult smokers, a complete switch to e-cigarettes would impose substantially less harm than continuing to smoke cigarettes,[8] which remain the deadliest tobacco product.[9] Despite the growing scientific evidence, whether the short-term relative health risks of using e-cigarettes compared with cigarette smoking have been accurately communicated to the public is unclear. The risk communication of different tobacco and nicotine products was largely left in the hands of tobacco industry, the e-cigarette industry, and the media
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