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HomeHarm ReductionSmokers’ misconceptions regarding e-cigarettes deter harm reduction behaviours

Smokers’ misconceptions regarding e-cigarettes deter harm reduction behaviours

The concept that some nicotine-delivering products – such as vapes over cigarette smoking are less harmful than others, is broadly acknowledged by the literature, regulatory agencies, and health bodies worldwide. However, it has not been well-communicated to smokers or the general population, according to a study in BMC Public Health.

Despite electronic nicotine delivery systems (ENDS), which deliver nicotine without combustion, being estimated to have a lower risk profile than cigarettes, the latter are the leading cause of preventable morbidity and mortality in America, with 34.1m US adults smoking in 2019.

A scientific consensus is that the toxicity of cigarettes largely comes from the products of combustion, and current and former smokers who have used ENDS often say the one of their most important reasons for using ENDS is because they perceive these as posing lower health risks compared to cigarettes.

In fact, several studies suggest that the numbers of smokers who perceive ENDS as at least as harmful as cigarettes continue to increase, reflecting the exacerbation of this misunderstanding among the general public.

On the other hand, misperceiving the relative risk of ENDS was one of the reasons given for not being willing to try ENDS and for choosing not to switch completely to ENDS

Collectively, these results suggest that the misperception of ENDS may deter smokers from harm reduction behaviours, such as adopting and switching to ENDS, and may lead to increased harm by driving exclusive ENDS users back to cigarette smoking.

For ENDS use to have its intended harm reduction benefit on smokers who would not otherwise quit, they must start using ENDS (which we refer to as “adoption”), stop smoking and switch instead to ENDS use (“switching”), and maintain the switched status and avoid reverting to smoking (“reversion”).

Although dual use may still be beneficial if accompanied by a substantial reduction in cigarette consumption, switching completely has the biggest potential benefit. The first year after switching was considered as a particularly important period of risk for reversion, as this is the highest risk period for relapse in smoking cessation (and ENDS use).

Using the Population Assessment of Tobacco and Health (PATH) data, the current research aims to examine the association of adult smokers’ relative risk perception of ENDS on future smoking/vaping behaviours.

The analyses examine the prospective relationship between risk perceptions and three aspects or stages of switching to ENDS: (1) initial adoption of ENDS; (2) switching away from smoking to ENDS; and (3) reverting to smoking (vs. maintaining switching).

Study details

US adult smokers’ perceived relative risk on ENDS and its effects on their transitions between cigarettes and ENDS

Sooyong Kim, Saul Shiffman & Mark A. Sembower.

Published in BMC Public Health on 19 September 2022


Perceived risk reduction motivates smokers to switch to electronic nicotine delivery systems (ENDS). This research examines US smokers’ relative risk perceptions and their prospective association with various behavioural stages of switching to ENDS.

Data from the nationally representative, longitudinal Population Assessment of Tobacco and Health (PATH) Adult survey, Waves 1 (2014) through 5 (2019), were analysed. We assessed the association between the perceived risk of ENDS relative to cigarettes (“less harmful” vs. “equally harmful” or “more harmful”) and 1) adoption of ENDS (among never-ENDS-using smokers), 2) complete switching to ENDS (i.e., stopping smoking, among ever-ENDS-using smokers), and 3) avoiding reversion to smoking (among smokers who had switched to ENDS), at the next wave.

The proportion of US smokers perceiving ENDS as less harmful than cigarettes continually decreased, reaching 17.4% in Wave 5 (2019). Current smokers with such belief were more likely to adopt ENDS (aOR
1.31; 95% CI 1.15–1.50) and switch completely to ENDS (aOR 2.24; 95% CI 1.89–2.65) in the subsequent wave. Among smokers who had switched within the past year, such beliefs predicted avoidance of resumption of smoking in the next wave (aOR 0.55; 95% CI 0.33–0.93).

Smokers’ beliefs about the relative risk of ENDS compared to cigarettes had a strong and consistent association with transitions between smoking and ENDS use. Addressing the growing misperception about ENDS has the potential to contribute to public health by encouraging smokers’ switching to ENDS.


BMC Public Health article – US adult smokers’ perceived relative risk on ENDS and its effects on their transitions between cigarettes and ENDS (Open access)


See more from MedicalBrief archives:


E-cigarettes not a substantial gateway to smoking for young people – UK study


In world first, NHS may prescribe e-cigarettes for smoking cessation


The health pros and cons of e-cigarettes – Evidence ambivalence


Vape debate – Are e-cigarettes wiping out teen smoking?





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