Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017

Huang, Jidong; Feng, Bo; Weaver, Scott R.; Pechacek, Terry F.; Slovic, Paul; Eriksen, Michael P.

doi:10.1001/jamanetworkopen.2019.1047

Cited by 151 publications

(121 citation statements)

References 32 publications

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“…11,13 Prior studies also indicate that risk perception is associated with product use. 10,21 In this study, relative to cigarette-only users, those with a high-risk perception of both products had lower odds of dualuse than those with a low-risk perception of both products. Participants with high perceived risk could be concerned about the possibility of increased nicotine dependence or other risks associated with dual-use.…”

Section: Discussionmentioning

confidence: 54%

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

2020

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Introduction: The popularity of e-cigarettes has increased significantly in recent years. E-cigarettes are perceived as less harmful than cigarettes, and both dual-use of cigarette and e-cigarette use is common among adolescents. This study assessed cigarette and e-cigarette risk perception and associations with dual-product use among Canadian adolescents. Methods: We used data from the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Perceived risks of cigarette and e-cigarette use were classified into 4 categories: “high-risk perception,” “high-e-cigarette-risk and low-cigarette-risk perception,” “low-e-cigarette-risk and high-cigarette-risk perception,” and “low-risk perception.” Adjusted odds ratios (aOR) were estimated from multinomial logistic regression. Results: Of the population, 92% perceived high risk from cigarettes, and 65% from e-cigarettes. Compared to students with low-risk perception, those with high-risk perception of both products had lower odds of dual-use (aOR: 0.21; 95% confidence interval [CI]: 0.15, 0.28), cigarette-only use (aOR: 0.33; 95% CI: 0.25, 0.45), and e-cigarette-only use (aOR: 0.64; 95% CI: 0.51, 0.79) relative to nonusers. Adolescents with high-e-cigarette and low-cigarette-risk perception had higher odds of e-cigarette-only use, relative to nonusers. Those with high-risk perception were more likely to be e-cigarette-only users relative to cigarette-only users. Conclusion: Results highlight that high perceived risk is associated with lower odds of use. However, those with a high-risk perception of both products had higher odds of e-cigarette use relative to cigarette-only users; as did those with high-e-cigarette and low-cigarette-risk perception, relative to nonusers. Future research should assess ways of communicating the risks of adolescent tobacco use.

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Section: Discussionmentioning

confidence: 54%

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

2020

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“…Dual users' rates of switching to exclusive e‐cigarette or cigarette use may be influenced by their perceptions of the health risks of each product type. Over time, fewer US adult smokers have perceived e‐cigarettes to be less harmful than cigarettes: in 2012, 45% held this perception , declining to 38–40% in 2014 , 36–37% in 2015 and 34% in 2017 . Researchers have argued that these perceptions may discourage smokers from completely substituting e‐cigarettes for cigarettes .…”

Section: Introductionmentioning

confidence: 99%

Perceived relative harm of using e‐cigarettes predicts future product switching among US adult cigarette and e‐cigarette dual users

2019

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Background and aims People's perceptions of the harmfulness of e‐cigarettes, compared with cigarettes, may influence their product use decisions. We tested if perceiving e‐cigarettes as less harmful than cigarettes predicted whether cigarette and e‐cigarette dual users switched their product use status 1 year later, becoming exclusive e‐cigarette users, exclusive cigarette smokers, or non‐users of both product types. Design Longitudinal analyses of waves 2 (2014–15) and 3 (2015–16) of the prospective, national Population Assessment of Tobacco and Health (PATH) Study. Setting United States. Participants Adults who reported using both cigarettes and e‐cigarettes within the past 30 days at wave 2 reported their perceptions of e‐cigarette harm at wave 2, and reported whether they used cigarettes and e‐cigarettes within the past 30 days at wave 3 (n = 2211). Measurements The key predictor was wave 2 perceptions of e‐cigarette harm compared with cigarettes (‘less harmful,' ‘about the same', ‘more harmful' or ‘don't know'). The key outcome was wave 3 past 30‐day use of e‐cigarettes and cigarettes, classified into four categories: exclusive e‐cigarette use (i.e. use of e‐cigarettes but not cigarettes), exclusive cigarette smoking (i.e. use of cigarettes but not e‐cigarettes), dual use of both product types and non‐use of both product types. Findings At wave 2, 59.4% of dual users perceived e‐cigarettes as less harmful than cigarettes [95% confidence interval (CI) = 56.9, 61.9]. Compared with those with other perceptions of e‐cigarette harm, dual users who perceived e‐cigarettes as less harmful than cigarettes were more likely to become exclusive e‐cigarette users 1 year later [7.5 versus 2.7%; adjusted odds ratio (aOR) = 2.9, 95% CI = 1.7–4.8], more likely to remain dual users (39.6 versus 29.9%; aOR = 1.5, 95% CI = 1.2–1.8), less likely to become exclusive cigarette smokers (44.8 versus 59.4%; aOR = 0.6, 95% CI = 0.5–0.7) and similarly likely to become non‐users of both product types (8.2 versus 8.0%; aOR = 1.1, 95% CI = 0.7–1.7). Conclusions US adult dual users of e‐cigarettes and cigarettes who perceive e‐cigarettes as less harmful than cigarettes appear to be more likely to switch to exclusive e‐cigarette use, more likely to remain dual users and less likely to switch to exclusive cigarette use 1 year later than dual users with other perceptions of e‐cigarette harm.

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“…However, there are contrasting claims associated with e-cigarettes being considered as a safer alternative to conventional cigarettes. The bottom-line according to the Centers for Disease Control and Prevention remains that e-cigarettes are possibly a less harmful alternative for current smokers addicted to combustible cigarettes [ 4 ••]. E-cigarettes are not for people who have never smoked in their life, and even establishing their efficacy as a smoking cessation tool needs thorough and long-term research [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Public Health Policies on E-Cigarettes

et al. 2019

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Tobacco continues to kill about 0.48 million Americans per year and there are currently 34.3 million smokers in the USA. As a consequence of the First Surgeon General's Report on Tobacco in 1964, tobacco control interventions on part of the government led to a significant decline in conventional tobacco product usage over the last few decades. However, more recently, a new entity in the form of electronic cigarettes has risen rapidly and has exposed a younger population to a plethora of dangerous consequences. Looking at e-cigarettes from the perspective of tobacco control however raises a lot of challenges. There is little doubt that existing smokers of combustible cigarettes who switch to e-cigarettes will be switching to a less harmful product. However, if the younger generation begins using e-cigarettes as a result of targeted marketing, appealing flavors and 'safer alternative' perception, decades of progress made in conventional tobacco control will be negated. Governments at the federal, state, and local levels have a mandate to once again implement new public health policies to ensure that non-conventional tobacco products like e-cigarettes are available as smoking cessation tools for existing smokers but at the same time do not play a role in ruining the health of future generations through addiction and disease. Purpose of Review To review the present scenario of regulations and policies impacting public health with respect to electronic nicotine delivery systems (ENDS) with the objective of providing a meaningful and balanced view of the challenges at hand with plausible recommendations. Recent Findings Nicotine in tobacco is known to cause addiction and dependence. It is particularly potent in children and young adults. E-cigarettes can deliver high concentrations of nicotine, and these concentrations can vary depending on the numerous constituents within the e-cigarette which vary greatly from one another. Use of e-cigarettes is implicated as a risk factor for future cigarette use in young adults. Moreover, e-cigarette usage patterns also depend on several sociodemographic factors. Banning tobacco products has shown to reduce smoking risk in youth and as such, strong e-cigarette regulation measures are needed for prevention. Summary Effective regulation of ENDS faces a multitude of challenges. One such challenge is to prevent youth and nonsmokers from getting habituated to nicotine through e-cigarettes. The intention of tobacco companies to sustain sales through harmful marketing strategies that tone down the risks and highlight e-cigarettes as a "much safer alternative" while promoting flavors appealing to children should be immediately prohibited. Another hazard is the endorsement of ENDS as devices meant for enhancing social interaction which opens a path for youth to make erroneous choices under peer pressure. On the other hand, several studies have reported that e-cigarettes significantly reduce an existing smoker's risk of being exposed to toxic tobacco smoke constituents that are normally pres...

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Changing Perceptions of Harm of e-Cigarette vs Cigarette Use Among Adults in 2 US National Surveys From 2012 to 2017

Cited by 151 publications

References 32 publications

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

Perceived relative harm of using e‐cigarettes predicts future product switching among US adult cigarette and e‐cigarette dual users

Public Health Policies on E-Cigarettes

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