Abstract
We sought to understand smokers’ perceived likelihood of health problems from using cigarettes and four non-cigarette tobacco products (NCTPs: e-cigarettes, snus, dissolvable tobacco, and smokeless tobacco). A US national sample of 6,607 adult smokers completed an online survey in March 2013. Participants viewed e-cigarette use as less likely to cause lung cancer, oral cancer, or heart disease compared to smoking regular cigarettes (all p < .001). This finding was robust for all demographic groups. Participants viewed using NCTPs other than e-cigarettes as more likely to cause oral cancer than smoking cigarettes but less likely to cause lung cancer. The dramatic increase in e-cigarette use may be due in part to the belief that they are less risky to use than cigarettes, unlike the other NCTPs. Future research should examine trajectories in perceived likelihood of harm from e-cigarette use and whether they affect regular and electronic cigarette use.
Similar content being viewed by others
References
Agaku, I. T., King, B. A., Husten, C. G., Bunnell, R., Ambrose, B. K., …, Day, H. R. (2014). Tobacco product use among adults—United States, 2012–2013. Morbidity and Mortality Weekly Report (MMWR), 63, 542–547.
Alexander, T. (2013). Communicating about harmful and potentially harmful constituents in tobacco and tobacco smoke: potential opportunities and challenges. Paper presented at the Joint Meeting of the Risk Communication Advisory Committee (RCAC) & the Tobacco Products Scientific Advisory Committee (TPSAC), Silver Spring, MD.
American Cancer Society. (2013). Cancer facts & figures 2013. Atlanta, GA.
Barbeau, A. M., Burda, J., & Siegel, M. (2013). Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: A qualitative approach. Addiction Science & Clinical Practice, 8, 5. doi:10.1186/1940-0640-8-5
Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychology, 26, 136–145. doi:10.1037/0278-6133.26.2.136
Brewer, N. T., Weinstein, N. D., Cuite, C. L., & Herrington, J. E. (2004). Risk perceptions and their relation to risk behavior. Annals of Behavioral Medicine, 27, 125–130. doi:10.1207/s15324796abm2702_7
Brown, C. J., & Cheng, J. M. (2014). Electronic cigarettes: product characterisation and design considerations. Tobacco Control, 23, ii4–ii10. doi: 10.1136/tobaccocontrol-2013-051476
Centers for Disease Control and Prevention. (2014). Current cigarette smoking among adults—United States, 2005–2012. Morbidity and Mortality Weekly Report, 63, 29–34.
Choi, K., Fabian, L., Mottey, N., Corbett, A., & Forster, J. (2012). Young adults’ favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: Findings from a focus group study. American Journal of Public Health, 102, 2088–2093. doi:10.2105/AJPH.2011.300525
Cobb, N. K., Brookover, J., & Cobb, C. O. (2013). Forensic analysis of online marketing for electronic nicotine delivery systems. Tobacco Control (advance online publication). doi: 10.1136/tobaccocontrol-2013-051185
Costello, M. J., Logel, C., Fong, G. T., Zanna, M. P., & McDonald, P. W. (2012). Perceived risk and quitting behaviors: Results from the ITC 4-country survey. American Journal of Health Behavior, 36, 681–692. doi:10.5993/AJHB.36.5.10
Courtenay, W. H. (2011). Dying to be men: Psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys. New York: Routledge.
Cummings, K. M., Hyland, A., Bansal, M. A., & Giovino, G. A. (2004). What do Marlboro Lights smokers know about low-tar cigarettes? Nicotine & Tobacco Research, 6, S323–S332.
Duke, J. C., Lee, Y. O., Kim, A. E., Watson, K. A., Arnold, K. Y., Nonnemaker, J. M., et al. (2014). Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics, 134, e29–e36. doi:10.1542/peds.2014-0269
Emery, S. (2013). It’s not just message exposure anymore: A new paradigm for health media research. Paper presented at the Presented at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Farsalinos, K. E., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of flavour variability on electronic cigarette use experience: An internet survey. International Journal of Environmental Research and Public Health, 10, 7272–7282. doi:10.3390/ijerph10127272
Food and Drug Administration. (2014). Deeming tobacco products to be subject to the federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Federal Register, 79, 23141–23207.
GfK Knowledge Networks. (2014). KnowledgePanel overview. Retrieved January 13, 2014, from http://www.knowledgenetworks.com/knpanel/KNPanel-Design-Summary.html
Grana, R. A., & Ling, P. M. (2014). “Smoking revolution”: A content analysis of electronic cigarette retail websites. American Journal of Preventive Medicine, 46, 395–403. doi:10.1016/j.amepre.2013.12.010
Hecht, S. S. (2003). Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nature Reviews Cancer, 3, 733–744. doi:10.1038/nrc1190
Kim, A. E., Arnold, K. Y., & Makarenko, O. (2014). E-cigarette advertising expenditures in the U.S., 2011–2012. American Journal of Preventive Medicine, 46, 409–412. doi:10.1016/j.amepre.2013.11.003
Kosmider, L., Sobczak, A., Fik, M., Knysak, J., Zaciera, M., Kurek, J., & Goniewicz, M. L. (2014). Carbonyl compounds in electronic cigarette vapors: Effects of nicotine solvent and battery output voltage. Nicotine & Tobacco Research (advance online publication). doi:10.1093/ntr/ntu078
Latimer, L. A., Batanova, M., & Loukas, A. (2013). Prevalence and harm perceptions of various tobacco products among college students. Nicotine & Tobacco Research (advance online publication). doi:10.1093/ntr/ntt174
Lee, Y. O., Hebert, C. J., Nonnemaker, J. M., & Kim, A. E. (2014). Multiple tobacco product use among adults in the United States: Cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus. Preventive Medicine, 62C, 14–19.
Levy, D. T., Mumford, E. A., Cummings, K. M., Gilpin, E. A., Giovino, G., …, Warner, K. E. (2004). The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: Estimates of a panel of experts. Cancer Epidemiology, Biomarkers and Prevention, 13, 2035–2042.
McCaul, K. D., Hockemeyer, J. R., Johnson, R. J., Zetocha, K., Quinlan, K., & Glasgow, R. E. (2006). Motivation to quit using cigarettes: A review. Addictive Behaviors, 31, 42–56. doi:10.1016/j.addbeh.2005.04.004
McQueen, A., Tower, S., & Sumner, W. (2011). Interviews with “vapers”: Implications for future research with electronic cigarettes. Nicotine & Tobacco Research, 13, 860–867. doi:10.1093/ntr/ntr088
Moser, R. P., McCaul, K., Peters, E., Nelson, W., & Marcus, S. E. (2007). Associations of perceived risk and worry with cancer health-protective actions: Data from the Health Information National Trends Survey (HINTS). Journal of Health Psychology, 12, 53–65. doi:10.1177/1359105307071735
Oncken, C., McKee, S., Krishnan-Sarin, S., O’Malley, S., & Mazure, C. M. (2005). Knowledge and perceived risk of smoking-related conditions: A survey of cigarette smokers. Preventive Medicine, 40, 779–784. doi:10.1016/j.ypmed.2004.09.024
Orr, M. S. (2014). Electronic cigarettes in the USA: A summary of available toxicology data and suggestions for the future. Tobacco Control, 23, ii18–ii22.
Paek, H. J., Kim, S., Hove, T., & Huh, J. Y. (2013). Reduced harm or another gateway to smoking? Source, message, and information characteristics of e-cigarette videos on YouTube. J Health Commun (advance online publication). doi:10.1080/10810730.2013.821560
Pepper, J. K., & Brewer, N. T. (2014). Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions, and beliefs: A systematic review. Tobacco Control, 23, 375–384. doi:10.1136/tobaccocontrol-2013-051122
Pepper, J. K., Emery, S. L., Ribisl, K. M., & Brewer, N. T. (2014). How do U.S. adults find out about electronic cigarettes? Implications for public health messages. Nicotine & Tobacco Research, 16, 1140–1144. doi:10.1093/ntr/ntu060
Regan, A. K., Promoff, G., Dube, S. R., & Arrazola, R. (2013). Electronic nicotine delivery systems: Adult use and awareness of the ‘e-cigarette’ in the USA. Tobacco Control, 22, 19–23. doi:10.1136/tobaccocontrol-2011-050044
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.
Rosenstock, I. M. (1974). The Health Belief Model and preventive health behavior. Health Education and Behavior, 2, 354–386. doi:10.1177/109019817400200405
Royal College of Physicians. (2007). Harm reduction in nicotine addiction: Helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians, London, UK.
Substance Abuse and Mental Health Services Administration. (2012). Results from the 2012 National Survey on Drug Use and Health: Detailed tables. Retrieved from: http://www.samhsa.gov/data/population-data-nsduh
U.S. Department of Health and Human Services. (2014). The health consequences of smoking–50 years of progress: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General.
Vansickel, A. R., & Eissenberg, T. (2013). Electronic cigarettes: Effective nicotine delivery after acute administration. Nicotine & Tobacco Research, 15, 267–270. doi:10.1093/ntr/ntr316
Varughese, S., Teschke, K., Brauer, M., Chow, Y., van Netten, C., & Kennedy, S. M. (2005). Effects of theatrical smokes and fogs on respiratory health in the entertainment industry. American Journal of Industrial Medicine, 47, 411–418. doi:10.1002/ajim.20151
Zhu, S. H., Gamst, A., Lee, M., Cummins, S., Yin, L., & Zoref, L. (2013). The use and perception of electronic cigarettes and snus among the U.S. population. PLoS One, 8, e79332.
Conflict of interest
Drs. Jessica Pepper, Sherry Emery, Kurt Ribisl, Christine Rini, and Noel Brewer declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pepper, J.K., Emery, S.L., Ribisl, K.M. et al. How risky is it to use e-cigarettes? Smokers’ beliefs about their health risks from using novel and traditional tobacco products. J Behav Med 38, 318–326 (2015). https://doi.org/10.1007/s10865-014-9605-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-014-9605-2