Harm Perceptions of Electronic Cigarettes and Nicotine: A Nationally Representative Cross-Sectional Survey of Young People in Great Britain

Background: E-cigarettes often contain nicotine without most
harmful constituents of tobacco smoke. Aims: To assess prevalence and
correlates of accurately perceiving e-cigarettes as less harmful than
cigarettes, and that none or a small amount of the harm from smoking
comes from nicotine. Methods: Cross-sectional survey of 2103 11-18-yearolds
in Great Britain in 2016. Prevalence of e-cigarette and nicotine
harm perceptions were calculated. Logistic regressions assessed
associations between accurate e-cigarette and nicotine harm perceptions
and: smoking, e-cigarette use, gender, age, region, social grade, family
smoking, family e-cigarette use, smoking friends, public approval of
smoking, public approval of e-cigarettes. Associations between accurate
e-cigarette and nicotine harm perceptions were also assessed. Results:
Most (63.4%) had accurate e-cigarette harm perceptions. Few (8.6%) had
accurate nicotine harm perceptions. Accurate e-cigarette harm perceptions
were higher among those: aged 16+ (OR=1.89 [95%CI=1.45-2.47]), 14-15
(OR=1.29 [1.00-1.65]), who tried/used an e-cigarette sometimes (OR=1.51
[1.03-2.21]), with family e-cigarette use (OR=2.11 [1.46-3.04]), who
perceived public disapproval of smoking (OR=2.11 [1.18-3.77]) and
approval of e-cigarettes (OR=2.44 [1.73-3.45]), and with accurate
nicotine harm perceptions (OR=2.05 [1.28-3.28]). Accurate nicotine harm
perceptions were higher among those: aged 16+ (OR=2.60 [1.62-4.16]), from
North England (OR=1.87 [1.02-3.43]) and Wales/Scotland (OR=2.61 [1.35-
5.03]) vs. London, with family smoking (OR=1.59 [1.05-2.42]), and with
accurate e-cigarette harm perceptions (OR=2.12 [1.32-3.41]). Conclusions:
Many young people have inaccurate harm perceptions of e-cigarettes and
nicotine. Accurate e-cigarette and nicotine harm perceptions were
associated with one another. E-cigarette use was associated with accurate
e-cigarette, but not nicotine, harm perceptions; smoking was not
associated with either.