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

Persoskie, Alexander; O’Brien, Erin Keely; Poonai, Karl

doi:10.1111/add.14730

Cited by 56 publications

(47 citation statements)

References 24 publications

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“…Consumer perceptions of HTP harmfulness relative to cigarettes may be a key predictor of initiation and continued use of HTPs. For example, smokers are more likely to switch to or initiate use of other alternative nicotine products (e.g., e-cigarettes) if they believe them to be less harmful than cigarettes [21][22][23]; however, few studies have addressed this for HTPs. A recent qualitative study of current and former IQOS users in the United Kingdom found that one of the main reasons for initiating HTP use and continued use was because it is 'less harmful', 'less hazardous', and 'less damaging' for their health than cigarettes [24].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

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Fong

Sutanto

et al. 2020

IJERPH

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In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes.

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Section: Discussionmentioning

confidence: 99%

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Gravely

Fong

Sutanto

et al. 2020

IJERPH

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“…Measurement of e-cigarette risk and harm perceptions is important given their association with product use [ 1 , 3 , 16 , 17 ]. Ideally, studies should use multiple items to increase the validity of perception measurement and researchers have also recommended research comparing risk/harm measures with more specific conditional wording to those with more general wording.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the measures we examined were of absolute harm from e-cigarettes rather than relative harm compared to cigarettes. Future research may benefit from additional study of the wording of relative risk/relative harm measures given that some work suggests these measures may better predict e-cigarette use than absolute harm/risk measures [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tobacco and nicotine product risk and harm perceptions have been associated with tobacco use, and as such, tobacco risk measures are important and frequently included in research studies [ 1 , 2 , 3 ]. However, these measures are often asked in a general way (e.g., “how harmful do you think e-cigarettes are to health?”) [ 1 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of a General and Conditional Measure of E-Cigarette Harm Perceptions

Wackowski

Jeong

2020

IJERPH

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Measures of tobacco product harm perceptions are important in research, given their association with tobacco use. Despite recommendations to use more specific harm and risk perception measures, limited research exists comparing different wordings. We present exploratory survey data comparing young adults’ (ages 18–29) responses to a general e-cigarette harm perception measure (“How harmful, if at all, do you think vaping/using an e-cigarette is to a user’s health?”) with a more specific conditional measure, which personalized the behavior/harm (“imagine you vaped,” “your health”) and presented a specific use condition (exclusive daily vaping) and timeframe (10 years). Data were collected in January 2019 (n = 1006). Measures were highly correlated (r = 0.76, Cronbach’s α = 0.86), and most (65%) provided consistent responses, although more participants rated e-cigarettes as very or extremely harmful using the conditional (51.6%) versus the general (43.9%) harm measure. However, significant differences in harm ratings were not observed among young adults who currently vaped. Correlations between each harm perception measure and measures of e-cigarette use intentions were similar. More specifically worded harm perception measures may result in somewhat higher e-cigarette harm ratings than general measures for some young adults. Additional research on best practices for measuring e-cigarette and other tobacco harm perceptions is warranted.

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“… 12 , 15 , 17–20 One recent study from the Population Assessment of Tobacco and Health (PATH) Study in the USA found that adult dual users of e-cigarettes and cigarettes who perceived e-cigarettes to be less harmful than combustible cigarettes were more likely to switch to exclusive e-cigarette use, more likely to remain dual users and less likely to relapse back to exclusive cigarette smoking 1 year later compared to dual users with other perceptions of e-cigarette harm. 21 Therefore, inaccurate perceptions of the relative risk of e-cigarettes and combustible cigarettes, particularly among smokers who are unable or unwilling to completely give up nicotine, may deter smokers from switching to using e-cigarettes.…”

Section: Introductionmentioning

confidence: 99%

European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys

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Driezen

Kyriakos

et al. 2020

European Journal of Public Health

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Background This study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD. Methods Data were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (≥18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N = 6011) and 2018 (post-TPD: N = 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’). Results In 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P > 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P = 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P = .001). Conclusions The majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.

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

Cited by 56 publications

References 24 publications

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Comparison of a General and Conditional Measure of E-Cigarette Harm Perceptions

European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys

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