Addiction | 2019
Perceived Relative Harm of Using E-Cigarettes Predicts Future Product Switching among U.S. Adult Cigarette and E-Cigarette Dual Users.
Abstract
BACKGROUND AND AIMS\nPeople s perceptions of the harmfulness of e-cigarettes, compared with cigarettes, may influence their product use decisions. We tested if perceiving e-cigarettes as less harmful than cigarettes predicted whether cigarette and e-cigarette dual users switched their product use status one year later, becoming exclusive e-cigarette users, exclusive cigarette smokers, or non-users of both product types.\n\n\nDESIGN\nLongitudinal analyses of Waves 2 (2014-15) and 3 (2015-16) of the prospective, national Population Assessment of Tobacco and Health (PATH) Study.\n\n\nSETTING\nUnited States.\n\n\nPARTICIPANTS\nAdults who reported using both cigarettes and e-cigarettes within the past 30-days at Wave 2, reported their perceptions of e-cigarette harm at Wave 2, and reported whether they used cigarettes and e-cigarettes within the past 30-days at Wave 3 (n=2211).\n\n\nMEASUREMENTS\nThe key predictor was Wave 2 perceptions of e-cigarette harm compared with cigarettes ( Less harmful, About the same, More harmful, or Don t know ). The key outcome was Wave 3 past 30-day use of e-cigarettes and cigarettes, classified into four categories: exclusive e-cigarette use (i.e., use of e-cigarettes but not cigarettes), exclusive cigarette smoking (i.e., use of cigarettes but not e-cigarettes), dual use of both product types, and non-use of both product types.\n\n\nFINDINGS\nAt Wave 2, 59.4% of dual users perceived e-cigarettes as less harmful than cigarettes (95%CI: 56.9,61.9). Compared with those with other perceptions of e-cigarette harm, dual users who perceived e-cigarettes as less harmful than cigarettes were more likely to become exclusive e-cigarette users one year later (7.5% vs. 2.7%; AOR=2.9, 95%CI: 1.7-4.8), more likely to remain dual users (39.6% vs. 29.9%; AOR=1.5, 95%CI: 1.2-1.8), less likely to become exclusive cigarette smokers (44.8% vs. 59.4%; AOR=0.6, 95%CI: 0.5-0.7), and similarly likely to become non-users of both product types (8.2% vs. 8.0%; AOR=1.1, 95%CI: 0.7-1.7).\n\n\nCONCLUSIONS\nU.S. adult dual users of e-cigarettes and cigarettes who perceive e-cigarettes as less harmful than cigarettes appear to be more likely to switch to exclusive e-cigarette use, more likely to remain dual users, and less likely to switch to exclusive cigarette use one year later than dual users with other perceptions of e-cigarette harm.