18B.11 Public perceptions of e-cigarettes

Last updated: November 2017

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2017. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

Current and former smokers—who comprise the vast majority of e-cigarette users—generally perceive e-cigarettes as less harmful than tobacco cigarettes, and as potentially helpful in their attempts at smoking reduction or cessation.1-6 (Refer Section 18B.7 for findings of research on efficacy for smoking cessation). Survey research in NSW found that the most common reasons for using e-cigarettes among smokers over 30 was “to help me quit” and to “cut down” smoking; for younger adults it was “because they are not as bad for your health as cigarettes”.7 An analysis of Australian and UK data from the 2013 International Tobacco Control Four-Country project found that, consistent with the country’s less stringent regulations, smokers and recent ex-smokers in the UK were more likely to perceive e-cigarettes as less harmful than cigarettes, compared to those in Australia.8   

Among young people, e-cigarettes are similarly perceived as less harmful than conventional cigarettes, but also as less addictive.9, 10 One US study found that compared with never-users, youth who had ever or currently used e-cigarettes believed them to be not at all harmful or addictive, and were more likely to report flavoured products were less harmful than non-flavoured.9 Qualitative research in the UK found that adolescents perceive the products are ‘fun’, and find the diverse range of flavours particularly appealing.11 The wide range of sweet flavours is one of the most commonly cited reasons for experimentation among children, along with curiosity.12-15

Nonetheless, perceptions of harm appear to be increasing. Research in the EU found that between 2012 and 2014, the perception that e-cigarettes are harmful increased from 27.1% to 51.6%, although there were major differences between member states.16 Studies in the US have similarly found that the proportion of people who perceive vaping as less harmful than smoking has decreased over time.17-19 One found that the proportion of people who did not think vaping could help people quit, that thought vaping was addictive, and thought that vape was comparable to secondhand smoke increased between 2015 and 2016.17  

Relevant news and research

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1. Adkison S, O'Connor R, Bansal-Travers M, Hyland A, Borland R, et al. Electronic nicotine delivery systems: International tobacco control four-country survey. American Journal of Preventive Medicine, 2013; 44(3):207–15. Available from: http://www.ajpmonline.org/article/S0749-3797%2812%2900822-7/fulltext

2. Bauhoff S, Montero A, and Scharf D. Perceptions of e-cigarettes: A comparison of adult smokers and non-smokers in a mechanical turk sample. American Journal of Drug and Alcohol Abuse, 2016:1–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27712126

3. Tomashefski A. The perceived effects of electronic cigarettes on health by adult users: A state of the science systematic literature review. Journal of the American Association of Nurse Practitioners, 2016; 28(9):510–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26997487

4. Czoli CD, Fong GT, Mays D, and Hammond D. How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes. Tobacco Control, 2017; 26(e1):e49–e58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27625408

5. Pepper JK, Emery SL, Ribisl KM, Rini CM, and Brewer NT. How risky is it to use e-cigarettes? Smokers' beliefs about their health risks from using novel and traditional tobacco products. Journal of Behavioral Medicine, 2015; 38(2):318–26. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25348584

6. Xu Y, Guo Y, Liu K, Liu Z, and Wang X. E-cigarette awareness, use, and harm perception among adults: A meta-analysis of observational studies. PLoS ONE, 2016; 11(11):e0165938. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27861501

7. Dunlop S, Lyons C, Dessaix A, and Currow D. How are tobacco smokers using e-cigarettes? Patterns of use, reasons for use and places of purchase in New South Wales. Medical Journal of Australia, 2016; 204(9):355. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27169972

8. Yong HH, Borland R, Balmford J, Hitchman SC, Cummings KM, et al. Prevalence and correlates of the belief that electronic cigarettes are a lot less harmful than conventional cigarettes under the different regulatory environments of Australia and the United Kingdom. Nicotine & Tobacco Research, 2017; 19(2):258–63. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27190403

9. Cooper M, Harrell MB, Perez A, Delk J, and Perry CL. Flavorings and perceived harm and addictiveness of e-cigarettes among youth. Tobacco Regulatory Science, 2016; 2(3):278–89. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27722185

10. Cooper M, Loukas A, Harrell MB, and Perry CL. College students' perceptions of risk and addictiveness of e-cigarettes and cigarettes. Journal of American College Health, 2016:1–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27805472

11. Hilton S, Weishaar H, Sweeting H, Trevisan F, and Katikireddi SV. E-cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers' views. BMJ Open, 2016; 6(11):e013271. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27852721

12. Measham F, O’Brien K, and Turnbull G. “Skittles & red bull is my favourite flavour”: E-cigarettes, smoking, vaping and the changing landscape of nicotine consumption amongst British teenagers – implications for the normalisation debate. Drugs: Education, Prevention and Policy, 2016; 23(3):224–37. Available from: http://dx.doi.org/10.1080/09687637.2016.1178708

13. Kong G, Morean ME, Cavallo DA, Camenga DR, and Krishnan-Sarin S. Reasons for electronic cigarette experimentation and discontinuation among adolescents and young adults. Nicotine & Tobacco Research, 2015; 17(7):847–54. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25481917

14. Harrell MB, Weaver SR, Loukas A, Creamer M, Marti CN, et al. Flavored e-cigarette use: Characterizing youth, young adult, and adult users. Preventive Medicine Reports, 2017; 5:33-40. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27896041

15. Pepper JK, Ribisl KM, and Brewer NT. Adolescents' interest in trying flavoured e-cigarettes. Tobacco Control, 2016; 25(Suppl 2):ii62–ii6. Available from: http://tobaccocontrol.bmj.com/content/25/Suppl_2/ii62.abstract

16. Filippidis FT, Laverty AA, Gerovasili V, and Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tobacco Control, 2017; 26(1):98–104. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27220621

17. Mincer J. US e-cigarette use stalls as health concerns grow: Reuters/ipsos poll, in Reuters2016. Available from: http://uk.reuters.com/article/us-usa-ecigarettes-poll-idUKKCN0YF0DE.

18. Huerta TR, Walker DM, Mullen D, Johnson TJ, and Ford EW. Trends in e-cigarette awareness and perceived harmfulness in the u.S. American Journal of Preventive Medicine, 2017; 52(3):339–46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27890516

19. Majeed BA, Weaver SR, Gregory KR, Whitney CF, Slovic P, et al. Changing perceptions of harm of e-cigarettes among US adults, 2012–2015. American Journal of Preventive Medicine, 2017; 52(3):331–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28341303


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