Perceptions of the Harms of E-Cigarettes, Combustible Cigarettes, and Other Substances Among Adults Who Smoke in the UK: A Mixed Methods Study

Abstract

Abstract Whilst e-cigarettes have been characterised by public health bodies as substantially less harmful than combustible tobacco products, research shows that a proportion of adults who smoke perceive these devices to be as harmful, or more harmful, than combustible cigarettes. In addition, research also indicates that adults who are smoking are less likely to use these devices to quit smoking when they overestimate the harms of e-cigarettes. In this paper, we focus upon the harm perceptions of a sample of adults who smoke in the United Kingdom. Whilst most of the adults surveyed viewed e-cigarettes as less harmful than combustible cigarettes, around four in ten (41%) viewed these devices as equally harmful as combustible cigarettes, more harmful, or did not know how harmful e-cigarettes were relative to combustible cigarettes. Qualitative interviews with survey participants indicated that the perceptions of relative harm between combustible cigarettes and e-cigarettes were a complex amalgam of beliefs, fears, predictions, reactions, and uncertainties about the long-term impact of e-cigarettes arising from the relative recency with which these devices have been available for widespread use. There is an important need to identify the most effective means through which accurate information around e-cigarettes can be communicated and in doing so to draw upon the diverse range of expertise of those involved in the use, regulation, manufacture, and media reporting of these devices in fashioning those communications.