Perception of e-cigarette harm and its correlation with use among U.S. adolescents

Nicotine Tob Res. 2015 Mar;17(3):330-6. doi: 10.1093/ntr/ntu156. Epub 2014 Aug 14.


Introduction: U.S. adolescents increasingly use e-cigarettes. The perceived harm of e-cigarettes has not been described, nor has the correlation between harm perception and e-cigarette use been assessed. This study examines correlates of e-cigarette harm perception and use of e-cigarettes in a national survey.

Methods: We used cross-sectional nationally representative data from the 2012 National Youth Tobacco Survey (n = 24,658). Cross-tabulations and multivariate ordered probit and logistic regression models were employed to assess relative harm perception and e-cigarette use.

Results: Half of U.S. adolescents had heard of e-cigarettes. Of these, 13.2% (95% confidence interval [CI] = 11.7-14.9) and 4.0% (95% CI = 3.4-4.7) reported ever or currently using e-cigarettes, respectively. Of those aware of e-cigarettes, 34.2% (95% CI = 32.8-35.6) believed e-cigarettes were less harmful than cigarettes. Among those trying e-cigarettes, 71.8% (95% CI = 69.0-74.5) believed e-cigarettes were comparatively less harmful. Females and those ≥ 17 years old were more likely to perceive e-cigarettes as more harmful relative to cigarettes, while on average Whites, users of other tobacco products, and those with family members who used tobacco were more likely to perceive e-cigarettes as comparatively safer. Among cigarette-naive e-cigarette users, use of other tobacco products and perceived harm reduction by e-cigarettes were, respectively, on average associated with 1.6 and 4.1 percentage-point increases in e-cigarette use.

Conclusions: Perception of e-cigarettes as less harmful than conventional cigarettes was associated with increased e-cigarette use, including among cigarette-naive e-cigarette users. These findings should prompt further scientific investigation and merit attention from regulators.

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology*
  • Awareness*
  • Child
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems / psychology*
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Harm Reduction*
  • Humans
  • Male
  • Perception*
  • Smoking / epidemiology
  • Smoking / psychology
  • United States / epidemiology