Association of Vaping-related Events with Relative Harm Perceptions of E-cigarettes

Wu A, Son S, Lee M, Pruitt SL, Ahn C, Balis D, Minna JD, Thomas C, Gerber DE.
Association of Vaping-related Events with Relative Harm Perceptions of E-cigarettes
Nicotine Tob Res. 2026 Mar 11:ntag024. doi: 10.1093/ntr/ntag024. Epub ahead of print. PMID: 41808432.

Introduction: Although electronic cigarettes (e-cigarettes) have demonstrated efficacy for quitting combustible cigarette smoking, they also convey inherent risks. How the public views e-cigarettes and their potential harm may influence how e-cigarettes are used. We therefore evaluated perceptions of e-cigarettes over a recent 10-year period.

Methods: Longitudinal data from a multiyear cross-sectional nationally representative survey, Health Information National Trends Survey, were analyzed to assess changes in perceptions of e-cigarettes' harm relative to cigarettes and factors affecting perceptions among US adults from 2012 to 2022. We used interrupted time series regression analysis to determine possible associations with key public health events.

Results: A total of 20 771 survey respondents were included in the analysis. From 2012 to 2022, the proportion perceiving e-cigarettes as more harmful than combustible cigarettes increased from 2.8% (95% CI, 1.8%-3.9%) to 30.4% (95% CI, 28.2%-32.7%). Likewise, perceptions of e-cigarettes as less harmful decreased from 50.7% (95% CI, 47.6%-53.9%) to 16.7% (95% CI, 14.9%-18.6%). Perceptions changed significantly following the national rollout of anti-vaping campaigns (p < .001) and the e-cigarette or vaping product use-associated lung injury outbreak (p < .001).

Conclusions: Public perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. These changes appear closely linked to major public health events and campaigns. Understanding how such events influence perceptions is essential for guiding risk communication, public health policy, and future tobacco control strategies.

Implications: How the public views electronic cigarettes (e-cigarettes) and their potential harm may influence how e-cigarettes are used. Although e-cigarettes convey risks, they have also demonstrated efficacy for quitting combustible cigarette smoking. We found that perceptions of e-cigarettes have shifted markedly over the past decade, with increasing proportions of US adults viewing e-cigarettes as more harmful than combustible cigarettes. How such perceptions influence smoking behavior represents an important consideration for risk communication, public health policy, and tobacco control strategies. Clear, evidenced-based messaging may reduce uptake of e-cigarette use, support harm-reduction efforts for current smokers, and promote trust in public health institutions.