Latent profile analysis reveals diverse perceptions of tobacco product risks among youth

We examined how youth differentiate the harms of four commonly used tobacco products.

Using monthly online repeated cross-sectional surveys among N = 1,858 New England youth (13-17) from April 2021 to August 2022, we conducted a latent profile analysis to identify classes of perceived harm across e-cigarettes, cigarettes, smokeless tobacco, and cigars/cigarillos/little cigars and multinomial logistic regression to model the odds of belonging to each class, including time, sociodemographic factors, tobacco advertising exposure, and tobacco product use.

We identified four classes: low harm across all products (Class 1, 8.5%), all products as equally somewhat harmful (Class 2, 40.0%), all products as very harmful (Class 3, 46.6%), and cigarettes as most harmful (Class 4, 4.9%, comparison class). Older youth had lower odds of perceiving low harm across all products. Past-30-day e-cigarette use was associated with higher odds of perceiving low harm across all products (RRR: 2.54, CI: 1.21-5.35) and lower odds for perceiving all products as very harmful (RRR: 0.20, CI: 0.10-0.40). Ever cigarette use was associated with higher odds of perceiving low harm across all products (RRR: 3.40, CI: 1.61-8.61). Past-30-day cigarette use was associated with higher odds of perceiving low harm across all products (RRR: 4.07, CI: 1.26-13.19) and lower odds of perceiving all products as equally somewhat harmful (RRR: 0.23, CI: 0.07-0.79). Past-30-day cigar use was associated with lower odds of perceiving all products as equally somewhat harmful (RRR: 0.23, CI: 0.07-0.79). There were geographic differences in harm perceptions.

Findings can inform youth education on the relative risks of tobacco products.