Beliefs That E-Cigarettes Are As Or More Harmful Than Cigarettes Are Increasing Among Americans

ATLANTA—An increasing number of American adults believe e-cigarettes are as or more harmful to health than cigarettes, according to a study by researchers at Georgia State University’s School of Public Health.

The study, published in JAMA Network Open, found the proportion of U.S. adults who perceived e-cigarettes to be more harmful than cigarettes more than tripled from 2012 to 2017. During the same period, the percentage of U.S. adults who perceived e-cigarettes to be equally as harmful as cigarettes also increased significantly.

The study authors analyzed self-reported perceived harm of e-cigarettes relative to cigarettes from 2012 to 2017 using two large national surveys: The Tobacco Products and Risk Perceptions Surveys and the Health Information National Trends Surveys. The researchers found that in 2017, more than 40 percent of American adults who participated in Tobacco Products and Risk Perceptions Surveys believed that e-cigarettes were as or more harmful than cigarettes. In the 2017 Health Information National Trends Surveys, more than 60 percent of respondents believed that e-cigarettes were as or more harmful than cigarettes. (The reported number was lower in the Tobacco Products and Risk Perceptions Surveys because the respondents were allowed to report they were not sure or did not know the risks of e-cigarettes, which was not a response option offered in the Health Information National Trends Surveys.)

Compared to cigarette smokers, e-cigarette users are more likely to perceive e-cigarettes as less harmful than cigarettes. However, even among e-cigarette users, the percentage of those who perceived e-cigarettes to be more harmful than cigarettes increased significantly from 2012 to 2017. The study also found a quarter of American adults were still uncertain about how e-cigarettes and combustible cigarettes compare with regard to health risks in 2017, even though e-cigarettes have been in the U.S. marketplace for more than a decade.

Jidong Huang, lead author of the study and associate professor of health policy and behavioral sciences at the School of Public Health, said several reasons may explain the increase in adults’ perception that e-cigarettes are as harmful or more harmful than cigarettes.

“This may reflect consumers’ concerns about the risk of addiction and/or the uncertainty about e-cigarette’s long-term health effects,” he said. “It may reflect the emergence of new evidence of substantial risk of heart and lung diseases associated with e-cigarette use, as well as high levels of pulmonary toxicity in e-cigarettes. But these concerns should always be considered in comparison to the massive harm of continued smoking.”

Huang noted that media reports linking e-cigarettes to exposure to toxins, serious injuries and other health issues may also be a factor. The confusion between the relative risk of e-cigarettes compared to cigarettes and the absolute risk of e-cigarettes may contribute to framing bias in media reports and press releases in which absolute harm is emphasized and relative harm is downplayed, the researchers said.

Although the long-term health effects of e-cigarettes are still unknown, a recent comprehensive review conducted by the National Academy of Science, Engineering and Medicine provided growing evidence that the short-term health risks are substantially less than those of continued smoking for adults who are unable or unwilling to quit.

Huang suggested that the increased perception of e-cigarettes as harmful may deter some adult smokers from switching to e-cigarettes.

“The results of this study,” he said, “underscore the urgent need for accurate communication of the scientific evidence on the health risks of e-cigarettes to American public, and the importance of differentiating the products’ absolute harm from their relative harm compared to cigarettes.”

The Tobacco Products and Risk Perceptions Surveys were conducted by Georgia State’s School of Public Health among about 5,000 American adults in 2012, 2014, 2015, 2016 and 2017. The Health Information National Trends Surveys were conducted by the National Cancer Institute among 3,000 American adults in 2012, 2014, 2015 and 2017.

The study was supported by grant P50DA036128 from the National Institutes of Health, National Institute on Drug Abuse and the Food and Drug Administration’s Center for Tobacco Products.

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