Department of Behavioural Science and Health, University College London, London, United Kingdom.
SPECTRUM Consortium, Edinburgh, United Kingdom.
JAMA Netw Open. 2024 Feb 5;7(2):e240582. doi: 10.1001/jamanetworkopen.2024.0582.
Electronic cigarettes (e-cigarettes) are less harmful to users than combustible cigarettes. However, public health and media reporting have often overstated the potential risks of e-cigarettes, and inaccurate perceptions of the harms of vaping relative to smoking are pervasive.
To examine time trends in harm perceptions of e-cigarettes compared with combustible cigarettes among adults who smoke.
DESIGN, SETTING, AND PARTICIPANTS: This nationally representative monthly cross-sectional survey study was conducted from November 2014 to June 2023 in England. Participants were adults who currently smoke.
Participants were asked whether they thought e-cigarettes were less harmful, equally harmful, or more harmful than cigarettes, or did not know, with the proportion responding less harmful (vs all other responses) as the primary outcome. Logistic regression was used to test associations between survey wave and participants' perceptions of the harms of e-cigarettes.
Data were collected from 28 393 adults who smoke (mean [SD] age, 43.5 [17.3] years; 13 253 [46.7%] women). In November 2014, 44.4% (95% CI, 42.0%-46.8%) thought e-cigarettes were less harmful than cigarettes, 30.3% (95% CI, 28.2%-32.6%) thought e-cigarettes were equally harmful, 10.8% (95% CI, 9.4%-12.3%) thought they were more harmful, and 14.5% (95% CI, 12.9%-16.4%) did not know. However, by June 2023, the proportion who thought e-cigarettes were less harmful had decreased by 40% (prevalence ratio, 0.60; 95% CI, 0.55-0.66), and the proportion who thought e-cigarettes were more harmful had more than doubled (prevalence ratio, 2.16; 95% CI, 1.84-2.54). Changes over time were nonlinear: late 2019 saw a sharp decline in the proportion who thought e-cigarettes were less harmful and increases in the proportions who thought they were equally or more harmful. These changes were short-lived, returning to pre-2019 levels by the end of 2020. However, perceptions worsened again from 2021 up to the end of the study period: the proportion who thought e-cigarettes were more harmful increased to a new high, and the proportion who thought e-cigarettes were less harmful decreased to levels comparable to those in late 2019. As a result, in June 2023, the perception that e-cigarettes were equally as harmful as cigarettes was the most commonly held view among adults who smoke (33.7%; 95% CI, 31.4%-36.1%), with roughly similar proportions perceiving e-cigarettes to be less (26.7%; 95% CI, 24.6%-28.9%) and more (23.3%; 95% CI, 21.1%-25.7%) harmful.
This survey study of adults who smoke in England found that harm perceptions of e-cigarettes have worsened substantially over the last decade, such that most adults who smoked in 2023 believed e-cigarettes to be at least as harmful as cigarettes. The timing of the 2 most notable changes in harm perceptions coincided with the e-cigarette, or vaping product, use-associated lung injury outbreak in 2019 and the recent increase in youth vaping in England since 2021.
电子烟 (e-cigarettes) 对使用者的危害比可燃香烟小。然而，公共卫生和媒体报道经常夸大电子烟的潜在风险，对电子烟相对于吸烟的危害的不准确认知普遍存在。
在吸烟的成年人中，比较电子烟与可燃香烟的危害感知的时间趋势。
设计、地点和参与者：本全国代表性的月度横断面调查研究于 2014 年 11 月至 2023 年 6 月在英国进行。参与者为目前吸烟的成年人。
参与者被问到他们认为电子烟是否比香烟危害更小、危害相等或更大，或不知道，主要结果是对电子烟危害感知的比例（与其他所有反应相比）。使用逻辑回归检验了调查波次与参与者对电子烟危害的感知之间的关联。
共有 28393 名吸烟成年人（平均 [标准差] 年龄，43.5 [17.3] 岁；13253 名 [46.7%] 女性）参与了数据收集。2014 年 11 月，44.4%（95%置信区间，42.0%-46.8%）的人认为电子烟比香烟危害小，30.3%（95%置信区间，28.2%-32.6%）的人认为电子烟危害相等，10.8%（95%置信区间，9.4%-12.3%）的人认为电子烟危害更大，14.5%（95%置信区间，12.9%-16.4%）的人不知道。然而，到 2023 年 6 月，认为电子烟危害小的比例下降了 40%（流行率比，0.60；95%置信区间，0.55-0.66），认为电子烟危害更大的比例增加了一倍多（流行率比，2.16；95%置信区间，1.84-2.54）。时间变化是非线性的：2019 年末，认为电子烟危害小的比例急剧下降，而认为电子烟危害相等或更大的比例上升。这些变化是短暂的，到 2020 年底又回到了 2019 年前的水平。然而，从 2021 年开始，情况再次恶化，一直持续到研究结束：认为电子烟危害更大的比例上升到一个新的高度，而认为电子烟危害小的比例下降到与 2019 年末相当的水平。因此，在 2023 年 6 月，认为电子烟与香烟危害相等的观点是吸烟成年人中最普遍的观点（33.7%；95%置信区间，31.4%-36.1%），大致相同比例的人认为电子烟危害较小（26.7%；95%置信区间，24.6%-28.9%）和较大（23.3%；95%置信区间，21.1%-25.7%）。
这项针对英格兰吸烟成年人的调查研究发现，过去十年中，对电子烟危害的认知大幅恶化，以至于 2023 年的大多数吸烟成年人认为电子烟的危害至少与香烟一样大。对电子烟危害认知的两次最显著变化的时间恰逢 2019 年电子烟或蒸气产品相关肺损伤爆发以及自 2021 年以来英国青少年电子烟使用率的最近增加。
