Association between perceived relative harm of electronic cigarettes versus cigarettes on nicotine or tobacco use...

As public awareness of potential risks of e-cigarette use grows, young adults may forgo using e-cigarettes in favor of cigarettes or alternative nicotine or tobacco products (NTPs). We examined the association between relative harms of e-cigarettes versus cigarettes and NTP use patterns in young adults.

We conducted a prospective analysis of data from n = 2180 young adults (ages 18-24) who reported past 30-day NTP use in the Population Assessment of Tobacco and Health Study. Perceived relative harm of e-cigarettes versus cigarettes was assessed at wave 6 (2021). Individuals were classified as having reduced harm perceptions or no reduced harm perceptions. NTP use was assessed at wave 7 (2022-2023). We used adjusted multinomial logistic regression to estimate relative risk ratios (RRRs), with exclusive e-cigarette use as the reference group.

At wave 6, 69.4% of young adults reported no reduced harm perceptions. In adjusted models, young adults with no reduced harm perceptions (vs. those with reduced harm perceptions) had a higher likelihood of reporting past 30-day NTP abstinence (RRR = 1.60, 95% CI: 1.04-2.40), exclusive cigarette use (RR = 3.81, 95% CI: 1.73-8.39), or exclusive alternative NTP use (RRR = 1.77, 95% CI: 1.00-3.13), each compared to exclusive e-cigarette use.

As perceptions shift toward viewing e-cigarettes as equally harmful as cigarettes, some young adults may abstain from NTP use; however, others may transition toward combustible cigarette use or other NTPs. This pattern suggests that factors which contribute to these types of beliefs may prompt product discontinuation among some but also inadvertently encourage shifts toward harmful NTP use patterns.

This study highlights how shifts in perceptions of e-cigarette harm are associated with patterns of nicotine and tobacco product use among young adults. Higher perceived harm of e-cigarettes was associated with quitting, but also with continued use and substitution across other tobacco products (such as cigars, hookah, and smokeless tobacco). These patterns indicate that increased harm awareness does not eliminate product appeal and may be linked to unintended shifts in use. The findings highlight the need for improved characterization of the health risks of nicotine and tobacco product use to inform strategies aimed at reducing overall tobacco and nicotine use among young adults.