18B.11 Public perceptions of e-cigarettes

Last updated:  April 2020

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from:  http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

 

Current and former smokers—who comprise the majority of e-cigarette users—generally perceive e-cigarettes as less harmful than tobacco cigarettes, and as potentially helpful in their attempts at smoking reduction or cessation.1-13  (Refer Section 18B.7 for findings of research on efficacy for smoking cessation). Survey research in NSW found that the most common reasons for using e-cigarettes among smokers over 30 was “to help me quit” and to “cut down” smoking; for younger adults it was “because they are not as bad for your health as cigarettes”.14  Completely switching to e-cigarettes appears to be more common among dual users who perceive e-cigarettes as less harmful than cigarettes.15 An analysis of Australian and UK data from the 2013 International Tobacco Control (ITC) Four-Country project found that, consistent with the country’s less stringent regulations, compared to those in Australia smokers and recent ex-smokers in the UK were more likely to perceive e-cigarettes as less harmful than cigarettes.16 Another ITC study found that among current and ex-smokers in Canada, the US, England and Australia in 2016, 37.4% allowed smoking in the home, while 60.4% of current vapers allowed vaping.17 Continued use of e-cigarettes among smokers appears to depend on whether the products live up to expectations regarding perceptions of short-term health improvements and ability to mimic smoking behaviours.18 ITC research found that for smokers, the top reasons for regular vaping were that it was deemed helpful for cutting down or quitting smoking, and less harmful to others. Smokers discontinued vaping if it was not satisfying, or if was perceived as not helpful for quitting or reducing cravings. For ex-smokers, current vaping was motivated by ‘enjoyment’, ‘affordability’, and ‘less harm to others’, while not needing e-cigarettes to stay quit, not being satisfying, and safety concerns motivated stopping vaping.13 

Among the general public, research in 2013–14 in the US found that fewer than half (40.7%) of adults believed that e-cigarettes were less harmful than cigarettes, although they were most likely to be seen as less harmful compared with other products (such as hookah and cigars).19 Many also report having rules prohibiting e-cigarette use inside homes and vehicles.20 Another study in the US found that more positive affect towards e-cigarettes was associated with lower perceived risks, which in turn was associated with higher odds of being a current e-cigarette user.21 In a sample of young Australian adults, the majority believed e-cigarettes have some level of harm (72%), and just over half believed them to be addictive (57%); however many did not know whether e-cigarettes are harmful (20%) or addictive (34%). Forty-two per cent believed e-cigarettes are effective cessation aids. Smokers and users tended to be more positive about the products.22

Among adolescents, e-cigarettes are generally perceived as less harmful than conventional cigarettes,23 and also as less addictive.24, 25  Such perceptions of lesser harm appear to predict later use of e-cigarettes.26 One US study found that compared with never-users, youth who had ever or currently used e-cigarettes believed them to be not at all harmful or addictive, and were more likely to report flavoured products were less harmful than non-flavoured.24 Several studies in the US have found that adolescents who have lower parental education and who are from lower income families report lower perceived health risks of e-cigarettes.27, 28 Qualitative research in the UK found that adolescents perceive the products are ‘fun’, and find the diverse range of flavours particularly appealing.29 The wide range of sweet flavours is one of the most commonly cited reasons for experimentation among children, along with curiosity.30-33 Young adults similarly cite curiosity34 and flavours35 as common reasons for initiating e-cigarette use. A review found that young people tend to highlight the trendiness of e-cigarettes as a perceived benefit, and perceive fewer health benefits than adults.18 In the US, there is strong public support for regulations that would potentially reduce use by children, including banning flavours.36, 37

Despite the general beliefs about potential for reduced health risk noted above, perceptions of harm appear to be increasing. Research in the EU found that between 2012 and 2014, the perception that e-cigarettes are harmful increased from 27.1% to 51.6%, although there were major differences between member states.38 Studies in the UK39 and the US40-44 have similarly found that the proportion of people who perceive vaping as less harmful than smoking has decreased over time. One found that the proportion of people who did not think vaping could help people quit, that thought vaping was addictive, and that thought vape was comparable to secondhand smoke increased between 2015 and 2016.40 In the US, the proportion of adults who perceived e-cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017.43

Surveys of health professionals have also found uncertainty regarding the safety and efficacy of e-cigarettes. A review of the beliefs and practices of healthcare professionals found that although most believe that e-cigarettes are less harmful than cigarettes, they also express concern about the health risks of e-cigarettes, and uptake and ‘gateway effects’ among young people. While most do not proactively recommend e-cigarette use, they are more likely to support use among patients with smoking related co-morbidities, heavy smokers with previous unsuccessful quit attempts, or patients who express interest in trying them.45 A study of Australian pharmacy staff found many reported a lack of confidence in the safety of e-cigarettes that contained nicotine, although most regarded e-cigarettes as less harmful than tobacco cigarettes.46 A survey of Australian cardiothoracic surgeons found that although e-cigarettes were perceived as unlikely to be safe (although less harmful than cigarettes), they may have a role as a perioperative smoking cessation aid.47 Results from the ITC Four Country Smoking and Vaping Survey showed that few health professionals in Australia, Canada, England, and the US are discussing with or recommending vaping products to patients.48 People generally report greater trust in medical professionals and public health organisations for providing accurate information on e-cigarettes than those with commercial interests; health professionals therefore may be able to effectively counter misleading e-cigarette promotion and improve public knowledge.49

 

 

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References  

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