Research so far has shown that legal e-cigarettes are less harmful than tobacco cigarettes and they can help people stop smoking. However, public perceptions of both their relative harms and effectiveness for smoking cessation have become less positive over time.
This study explored the reasons behind these perceptions among adults in Northern England, with the aim of identifying the beliefs and concerns shaping views about e-cigarettes. A mixed-methods survey combined quantitative data with analysis of participants' open-ended responses.
Around half of participants believed that e-cigarettes are less harmful than cigarettes (50%), while one-third were unsure (33%) and 17% disagreed.
Among those who viewed e-cigarettes as less harmful, the most commonly cited reasons were that they do not produce smoke and are believed to contain fewer toxic substances than cigarettes.
Among those who viewed e-cigarettes as equally or more harmful than cigarettes, the most common concerns related to a perceived lack of trustworthy research, uncertainty about long-term health effects, and concerns about product safety.
Lack of knowledge was a common theme. Around half of participants who were uncertain about the relative harms of e-cigarettes said they did not feel they knew enough about them to make a judgement.
Around half of participants believed that e-cigarettes are effective aids for stopping smoking (50%), while 37% were unsure and 13% disagreed.
Participants who viewed e-cigarettes as effective for stop smoking aids most commonly mentioned their ability to replace aspects of smoking. This included nicotine and replicating smoking-related behaviours. Some also referred to positive experiences or advice from health professionals, family members and friends.
Participants who viewed e-cigarettes as ineffective were most likely to express concerns that they maintain nicotine addiction or simply replace one addiction with another.
Lack of knowledge and limited personal experience of smoking or e-cigarette use were also common reasons for uncertainty about whether e-cigarettes are effective smoking cessation aids.
E-cigarettes can be a tool to support people who smoke to stop; however, e-cigarettes are not risk-free, and we don't yet know their long-term effects, therefore, children and people who have never smoked should not use them.
This study provides insight into the beliefs and concerns underlying public perceptions of e-cigarettes, rather than simply measuring whether those perceptions are positive or negative. The findings suggest that concerns about the strength of the evidence base, long-term safety, and potential addiction play an important role in shaping perceptions of e-cigarettes.
The results also indicate that uncertainty is common. For both harm and effectiveness perceptions, lack of knowledge was one of the most frequently reported reasons for being undecided, suggesting that many people do not feel they have sufficient information to form a clear view.
The findings highlight specific areas that may be important to address in public health communications, including questions about the evidence on e-cigarettes' harms, their regulation and safety, and their role in smoking cessation.
Further research is needed to understand how perceptions of e-cigarettes continue to evolve and how different types of information or messaging influence public understanding and decision-making about their use.
Read in full on the Science Direct websiteHumairah Arshad, Sarah E. Jackson, Loren Kock, Charlotte Ide-Walters, Harry Tattan-Birch.
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