Harm perceptions of e‐cigarettes and other nicotine products in a UK sample

• Published in: Addiction (Abingdon, England) Vol. 114; no. 5; pp. 879 - 888
• Main Authors: Wilson, Samara, Partos, Timea, McNeill, Ann, Brose, Leonie S.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-05-2019; John Wiley and Sons Inc
• Subjects: Adolescent; Adult; Attitude to Health; Cancer; Cigarettes; Culture; Demographics; Demography; Electronic cigarettes; Electronic Nicotine Delivery Systems; Female; harm perception; Harm Reduction; Health Knowledge, Attitudes, Practice; Health risks; Health Surveys; Humans; Longitudinal Studies; Male; Middle Aged; Nicotine; nicotine replacement products; Nicotine replacement therapy; Perceptions; Polls & surveys; Quality control; Research Report; Research Reports; Smoking; Smoking - adverse effects; Smoking Cessation; Tobacco; Tobacco Use Cessation Devices - adverse effects; United Kingdom; vaping; Vaping - adverse effects; Young Adult; United Kingdom; United Kingdom > UK; Electronic cigarettes; nicotine replacement products; smoking; harm perception; electronic nicotine delivery systems; vaping; harm reduction
• ISSN: 0965-2140; 1360-0443; 1360-0443
• DOI: 10.1111/add.14502

Background and aims
E‐cigarettes (EC) and nicotine replacement therapy (NRT) are less harmful than smoking, but misperceptions of relative harm are common. Aims were to (1) assess nicotine knowledge and perceptions of: harm of EC and NRT relative to smoking, addictiveness of EC relative to smoking, and change in harm to user if smoking replaced with EC; (2) define associations of these perceptions with respondent characteristics including nicotine knowledge; and (3) explore perceived main harms of EC and whether these differ by vaping status.
Design
Analyses were: (1) frequencies; (2) logistic regressions of perceptions of relative harm, addictiveness and change in harm onto demographics, smoking and vaping status and nicotine knowledge (attributing cancer or health risks of smoking to nicotine); and (3) frequencies and χ2 statistics.
Setting and participants
Participants were smokers and recent ex‐smokers from one wave (September 2017) of a longitudinal online survey in the United Kingdom (n = 1720).
Measurements
Demographics included gender, age, smoking status, vaping status and income. Survey questions collected data on nicotine knowledge and harm perceptions of different products; the relative harm perceptions of NRT, EC and tobacco cigarettes; and perceived main harms of EC.
Findings
Relative to smoking, 57.3% perceived EC and 63.4% NRT to be less harmful; 25.4% perceived EC to be less addictive; and 32.2% thought replacing smoking with EC reduced health harms a great deal. Participants were less likely to endorse these beliefs if they had never vaped, and participants who had inaccurate nicotine knowledge were less likely to endorse all these beliefs apart from the addictiveness of EC. The main concerns about EC were a lack of research (48.3%), regulation or quality control (37.8%) and harmfulness of chemicals (41.6%).
Conclusions
Large proportions of UK smokers and ex‐smokers overestimate the relative harmfulness of e‐cigarettes and nicotine replacement therapy compared with smoking; misattributing smoking harms to nicotine is associated with increased misperceptions.