Variation in Relative Risk Perceptions and Tobacco Use by Race and Socioeconomic Status among Older Adults who Smoke: Evidence from the Population Assessment of Tobacco and Health (PATH) Study.

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Older adults who smoke face significant risk of tobacco-related disease and hold misperceptions about health risks posed by nicotine product use. This study examined whether socioeconomic status and race are associated with variation in cigarette/e-cigarette relative risk perceptions, whether relative risk perceptions are associated with tobacco use behaviors, and whether socioeconomic status and race moderate associations between perceptions and use behaviors. Five waves of PATH Study yielded data from 1,879 adults >55 who smoked within the past 30 days during Wave 1. Adjusted longitudinal logistic models estimated associations between higher vs. lower SES ("low-SES": less than high school diploma/GED. and annual household income<$25,000) and race (White vs. Black/African American; AA) and e-cigarette/cigarette relative risk perceptions, behavioral intentions, and e-cigarette use. Lower-SES adults were more likely to report e-cigarettes were very/extremely harmful to health (AOR: 1.74, p<0.01) and less likely to report e-cigarettes were less harmful than cigarettes (AOR: 0.65, p<0.01). Black/AA adults were less likely to report that e-cigarettes were less harmful than cigarettes. Participants rating e-cigarettes as equally/more harmful than cigarettes exhibited lower odds of intending to quit smoking or switch to e-cigarettes. Finally, Black/AA adults who also perceived e-cigarettes equally/more harmful than cigarettes exhibited greater odds of trying to reduce rather than quit smoking (AOR: 1.58, p=0.02). Many older adults who smoke perceive e-cigarettes as equally or more harmful than cigarettes, particularly low-SES and Black/AA older adults. Differences in relative risk perceptions among high priority populations could negatively influence cessation attempts and switching behaviors. This study found that Black/AA and low-SES older adults who smoke cigarettes were more likely to perceive e-cigarettes as harmful or more harmful than cigarettes. The absence of accurate, evidence-based information regarding the relative health risks associated with the long-term use of various tobacco products may impede policy efforts to reduce disparities in smoking-related disease through increased cessation and/or harm reduction.