'Most smokers wrongly believe vaping is at least as harmful as smoking'

 More than half of smokers in England wrongly believe that vaping is more harmful or as harmful as smoking, according to a new study led by UCL researchers.

The study, published in the journal JAMA Network Open, looked at survey responses from 28,393 smokers in England between 2014 and 2023.

The research team found that public perceptions of e-cigarettes had worsened considerably over the past decade, with an overall increase in the perceived harm of e-cigarettes since 2021, coinciding with a sharp rise in vaping among young people.

In June 2023, 57% of respondents said they thought vaping was equally as harmful as smoking or more harmful, while only 27% thought e-cigarettes were less harmful.

Lead author Dr. Sarah Jackson (UCL Institute of Epidemiology & Health Care) said, "These findings have important implications for public health. The risks of vaping are much lower than the risks of smoking and this isn't being clearly communicated to people.

"This misperception is a health risk in and of itself, as it may discourage smokers from substantially reducing their harm by switching to e-cigarettes. It may also encourage some young people who use e-cigarettes to take up smoking for the first time, if they believe the harms are comparable.

"Better communication about the health risks is needed so that adults who smoke can make informed choices about the nicotine products they use."

The researchers used data from the Smoking Toolkit Study, in which a different sample of approximately 1,700 adults in England (who are representative of the population) are interviewed each month.

In 2014, the study showed, public perceptions of e-cigarettes were more favorable, with 44% of smokers regarding them as less harmful than cigarettes, and only 11% saying e-cigarettes were more harmful (this doubled to 23% by 2023).

The perception of e-cigarettes' harm worsened sharply in late 2019 and early 2020, coinciding with an outbreak of acute lung injuries in the United States that was wrongly linked to nicotine e-cigarettes (the EVALI outbreak) but later attributed to illicit cannabis vaping products containing vitamin E acetate.

Though perceptions had recovered by late 2020, they declined again from 2021 through to 2023 amid growing concern about youth vaping, as large numbers of young people starting to use disposable e-cigarettes.

By 2023, only 19% of smokers who did not vape said they thought vaping was less harmful than smoking.

The rise in the proportion who said e-cigarettes were more harmful than cigarettes was most pronounced among those aged under 35, despite use of e-cigarettes being much more common in this age group.

Senior author Professor Jamie Brown (UCL Institute of Epidemiology & Health Care) said, "E-cigarettes are novel and so have attracted much attention in the media, with news articles often overstating their risks to health compared with smoking. There is relatively little reporting about deaths caused by smoking, even though 75,000 people die as a result of it in England each year.

"The Government plans to offer one million smokers a free vaping starter kit alongside behavioral support to help them quit. This initiative may be undermined if many smokers are unwilling to try e-cigarettes because they wrongly believe them to be just as harmful as cigarettes or more so."

In its online guidance, the NHS says, "Cigarettes release thousands of different chemicals when they burn. Many are poisonous and up to 70 cause cancer. They also cause other serious illnesses, including lung disease, heart disease and stroke. Most of the harmful chemicals in tobacco smoke, including tar and carbon monoxide, are not contained in vape aerosol."

More information: Sarah E. Jackson et al, Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014-2023, JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2024.0582

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