Perceptions of the Harms of E-Cigarettes, Combustible Cigarettes, and Other Substances among Adults who Smoke in the UK: A Mixed Methods Study

Author(s): Neil McKeganey, Gabriel Barnard, Sophie Notley, Joanne Coyle, Farhana Haseen, Andrea Patton.

Whilst e-cigarettes have been characterised by public health bodies as substantially less harmful than combustible tobacco products, research shows that a proportion of adults, including those who are smoking combustible cigarettes, perceive these devices to be as harmful, or more harmful, than combustible cigarettes, whilst many others are uncertain as to the relative harmfulness of these products. Research has also shown that perceptions of the diverse harms of combustible cigarettes and e-cigarettes can influence the likelihood of individuals using e-cigarettes as a means of quitting smoking. In this paper, we focus upon the harm perceptions of a sample of adults who smoke in the United Kingdom. Whilst a large proportion of the adults surveyed correctly viewed e-cigarettes as less harmful than combustible cigarettes, around four in ten (41%) viewed these devices as equally harmful, more harmful, or were unsure of the relative harm of these devices in comparison to combustible cigarettes. Qualitative interviews with survey participants indicated that the perceptions of relative harm between combustible cigarettes and e-cigarettes were a complex amalgam of beliefs, fears, predictions, reactions, and uncertainties about the longterm impact of e-cigarettes and judgements about the greater frequency and intensity with which e-cigarettes were likely to be used compared to combustible cigarettes. There is an important need to identify the most effective means by which those involved in the use, regulation, manufacture, media reporting and evaluation of these devices can be combined in developing effective communication strategies to ensure that those who are smoking have access to accurate information with which to make informed choices as to whether to use e-cigarettes as a means of quitting smoking.