Changing Perceptions of Harm of E-Cigarettes Among U.S. Adults, 2012–2015 (original) (raw)
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JAMA Network Open, 2019
IMPORTANCE 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. OBJECTIVE To examine how US adults perceived the harm of e-cigarettes relative to cigarettes and how their perception has changed from 2012 to 2017.
Harm Reduction Journal
Background Electronic cigarettes (e-cigarettes) have been characterised as significantly less harmful than cigarettes by many health agencies and regulators globally. In this study, we examined to what extent perceived relative harms of e-cigarettes compared to cigarettes have changed in the USA. Methods We analysed the data from the longitudinal and nationally representative, Population Assessment of Tobacco and Health Study to assess the relative perceived harm of e-cigarettes amongst US adults between 2013 and 2016. Results The proportion of US adults who correctly perceived e-cigarettes as less harmful than cigarettes decreased each year from 41.1% (CI 40.1–42.1%) in 2013–2014, 31.5% (CI 30.8–32.2%) in 2014–2015 and 25.3% (CI 24.6–26.0%) in 2015–2016. Concurrently, the proportion of US adults who perceived e-cigarettes as equally, or more, harmful than cigarettes increased from 53.7% (CI 52.3–55.1%), 64.9% (CI 63.6–66.2%) to 72.7% (CI 71.5–73.9%) respectively. The proportion of ...
E-Cigarette Health Harm Awareness and Discouragement: Implications for Health Communication
Nicotine & Tobacco Research, 2019
Introduction Evidence for the health harms of e-cigarettes is growing, yet little is known about which harms may be most impactful in health messaging. Our study sought to identify which harms tobacco product users were aware of and which most discouraged them from wanting to vape. Methods Participants were a convenience sample of 1,872 U.S. adult e-cigarette-only users, cigarette-only smokers, and dual users recruited in August 2018. In an online survey, participants evaluated 40 e-cigarette harms from seven categories: chemical exposures, device explosions, addiction, cardiovascular harm, respiratory harm, e-liquid toxicity, and other harms. Outcomes were awareness of the harms (“check all that apply”) and the extent to which the harms discouraged vaping (5-point scale; (1) “not at all” to (5) “very much”). Results Awareness of most e-cigarette harms was modest, being highest for harms in the device explosions category of harms (44%) and lowest for the e-liquid toxicity category (...
E-Cigarette Awareness and Perceived Harmfulness
American Journal of Preventive Medicine, 2014
Background: Electronic cigarettes, or e-cigarettes, are increasingly advertised as replacements for regular cigarettes or cessation aids for smokers.
Smokers' and e-cigarette users' perceptions of modified risk warnings for e-cigarettes
Preventive medicine reports, 2016
The 2009 Family Smoking Prevention and Tobacco Control Act opened the possibility for tobacco companies to apply to market their products as having "modified" or reduced risks. However, research on how to communicate comparative tobacco risks and how such messages are interpreted is limited. This study aimed to qualitatively examine perceptions of potential modified risk statements presented as warning labels for e-cigarettes. We conducted six focus groups between 2014 and 2015 with 27 adult e-cigarette users and cigarette-only smokers who provided comments on two versions of a modified risk warning for e-cigarettes: 1) "WARNING: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes" (as proposed by two companies for their smokeless tobacco products) and 2) "WARNING: This product may be harmful to health, but is substantially less harmful than cigarettes" (an alternative developed by our team). Althoug...
2017
Introduction: We conducted a nationally representative study to identify characteristics of current (e-cigarette users, conventional cigarette smokers, and dual users), former and never smokers linked to perceptions of harm and benefit associated with e-cigarette use. Methods: A crosssectional questionnaire survey of 1,987 adults (≥18 years) males was conducted via face-to-face interviews. Survey questions included sociodemographic and smoking-related variables, and questions relating to perceptions of harm and benefit associated with e-cigarette use. Logistic regression was used to identify sociodemographic characteristic linked to the perception of harm and benefit associated with e-cigarettes between types of EC users and smokers, with never smokers as the reference group. Results: Overall, older respondents aged ≥65 years (OR=1.736, CI 0.821-2.260), civil servants (OR=1.721, CI 1.085-2.729), non-governmental organisations (OR=1.570, CI 1.066-2.311) and the selfemployed (OR=1.469...
Development and Testing of Relative Risk-Based Health Messages for Electronic Cigarette Products
Background: Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to i) develop and test a selection of relative risk messages for e-cigarette products; ii) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and iii) explore differences between smokers, non-smokers and dual users. Method: Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. Results: On all three constructs combined, the two TPD messages rated the highest,...
Testing messages about comparative risk of electronic cigarettes and combusted cigarettes
Tobacco Control, 2018
IntroductionHealth agencies are grappling with communicating risks of electronic cigarettes (e-cigarettes) compared with combusted cigarettes. This study examined smokers’ responses to two types of comparative risk messages with one type incorporating more negative antismoking elements in the design.MethodsIn an online experiment, 1400 US adult (18+ years) current smokers and recent quitters were randomised to view one of three comparative risk messages about e-cigarettes (CR messages), one of three comparative risk messages that included more negative antismoking elements in the design (CR− messages) or a control message. Selection of outcomes was guided by the antismoking message impact framework. Multivariate analyses of covariance and logistic regression models analysed effects of messages on message evaluations, e-cigarette-related and cigarette-related beliefs and behavioural intentions.ResultsBoth CR and CR− messages decreased smokers’ intentions to smoke cigarettes, increase...
Placing Health Warnings on E-Cigarettes: A Standardized Protocol
International Journal of Environmental Research and Public Health, 2018
Health warnings for e-cigarettes are a promising and novel tobacco control intervention for reducing e-cigarette use. We developed a new protocol for evaluating e-cigarette warnings by placing them on users’ own devices to reflect real-world exposure. Study 1 participants were a national convenience sample of 606 U.S. adult e-cigarette users surveyed online in March 2017. Most Study 1 participants were willing to have their e-cigarette devices (87%) and refills (83%) labeled. Study 2 participants were a convenience sample of 22 adult e-cigarette users recruited in California, United States in April 2017. We applied the U.S. Food and Drug Administration’s proposed e-cigarette warning to users’ own devices and refills. Most Study 2 participants (81%) reported using e-cigarette devices with our warning labels at least 90% of the time during the study. Nearly all (95%) said they would participate in the study again, and 100% would recommend the study to a friend. Conversations about e-c...