Advertisement

Journal of Behavioral Medicine

, Volume 38, Issue 2, pp 318–326 | Cite as

How risky is it to use e-cigarettes? Smokers’ beliefs about their health risks from using novel and traditional tobacco products

  • Jessica K. Pepper
  • Sherry L. Emery
  • Kurt M. Ribisl
  • Christine M. Rini
  • Noel T. Brewer
Article

Abstract

We sought to understand smokers’ perceived likelihood of health problems from using cigarettes and four non-cigarette tobacco products (NCTPs: e-cigarettes, snus, dissolvable tobacco, and smokeless tobacco). A US national sample of 6,607 adult smokers completed an online survey in March 2013. Participants viewed e-cigarette use as less likely to cause lung cancer, oral cancer, or heart disease compared to smoking regular cigarettes (all p < .001). This finding was robust for all demographic groups. Participants viewed using NCTPs other than e-cigarettes as more likely to cause oral cancer than smoking cigarettes but less likely to cause lung cancer. The dramatic increase in e-cigarette use may be due in part to the belief that they are less risky to use than cigarettes, unlike the other NCTPs. Future research should examine trajectories in perceived likelihood of harm from e-cigarette use and whether they affect regular and electronic cigarette use.

Keywords

Electronic cigarettes Electronic nicotine delivery systems Tobacco products Risk perceptions Health behavior 

Notes

Conflict of interest

Drs. Jessica Pepper, Sherry Emery, Kurt Ribisl, Christine Rini, and Noel Brewer declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.

References

  1. Agaku, I. T., King, B. A., Husten, C. G., Bunnell, R., Ambrose, B. K., …, Day, H. R. (2014). Tobacco product use among adults—United States, 2012–2013. Morbidity and Mortality Weekly Report (MMWR), 63, 542–547.Google Scholar
  2. Alexander, T. (2013). Communicating about harmful and potentially harmful constituents in tobacco and tobacco smoke: potential opportunities and challenges. Paper presented at the Joint Meeting of the Risk Communication Advisory Committee (RCAC) & the Tobacco Products Scientific Advisory Committee (TPSAC), Silver Spring, MD.Google Scholar
  3. American Cancer Society. (2013). Cancer facts & figures 2013. Atlanta, GA.Google Scholar
  4. Barbeau, A. M., Burda, J., & Siegel, M. (2013). Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: A qualitative approach. Addiction Science & Clinical Practice, 8, 5. doi: 10.1186/1940-0640-8-5 CrossRefGoogle Scholar
  5. Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D. (2007). Meta-analysis of the relationship between risk perception and health behavior: The example of vaccination. Health Psychology, 26, 136–145. doi: 10.1037/0278-6133.26.2.136 CrossRefPubMedGoogle Scholar
  6. Brewer, N. T., Weinstein, N. D., Cuite, C. L., & Herrington, J. E. (2004). Risk perceptions and their relation to risk behavior. Annals of Behavioral Medicine, 27, 125–130. doi: 10.1207/s15324796abm2702_7 CrossRefPubMedGoogle Scholar
  7. Brown, C. J., & Cheng, J. M. (2014). Electronic cigarettes: product characterisation and design considerations. Tobacco Control, 23, ii4–ii10. doi:  10.1136/tobaccocontrol-2013-051476
  8. Centers for Disease Control and Prevention. (2014). Current cigarette smoking among adults—United States, 2005–2012. Morbidity and Mortality Weekly Report, 63, 29–34.Google Scholar
  9. Choi, K., Fabian, L., Mottey, N., Corbett, A., & Forster, J. (2012). Young adults’ favorable perceptions of snus, dissolvable tobacco products, and electronic cigarettes: Findings from a focus group study. American Journal of Public Health, 102, 2088–2093. doi: 10.2105/AJPH.2011.300525 CrossRefPubMedCentralPubMedGoogle Scholar
  10. Cobb, N. K., Brookover, J., & Cobb, C. O. (2013). Forensic analysis of online marketing for electronic nicotine delivery systems. Tobacco Control (advance online publication). doi:  10.1136/tobaccocontrol-2013-051185
  11. Costello, M. J., Logel, C., Fong, G. T., Zanna, M. P., & McDonald, P. W. (2012). Perceived risk and quitting behaviors: Results from the ITC 4-country survey. American Journal of Health Behavior, 36, 681–692. doi: 10.5993/AJHB.36.5.10 CrossRefPubMedCentralPubMedGoogle Scholar
  12. Courtenay, W. H. (2011). Dying to be men: Psychosocial, environmental, and biobehavioral directions in promoting the health of men and boys. New York: Routledge.Google Scholar
  13. Cummings, K. M., Hyland, A., Bansal, M. A., & Giovino, G. A. (2004). What do Marlboro Lights smokers know about low-tar cigarettes? Nicotine & Tobacco Research, 6, S323–S332.CrossRefGoogle Scholar
  14. Duke, J. C., Lee, Y. O., Kim, A. E., Watson, K. A., Arnold, K. Y., Nonnemaker, J. M., et al. (2014). Exposure to electronic cigarette television advertisements among youth and young adults. Pediatrics, 134, e29–e36. doi: 10.1542/peds.2014-0269 CrossRefPubMedGoogle Scholar
  15. Emery, S. (2013). It’s not just message exposure anymore: A new paradigm for health media research. Paper presented at the Presented at Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Google Scholar
  16. Farsalinos, K. E., Romagna, G., Tsiapras, D., Kyrzopoulos, S., Spyrou, A., & Voudris, V. (2013). Impact of flavour variability on electronic cigarette use experience: An internet survey. International Journal of Environmental Research and Public Health, 10, 7272–7282. doi: 10.3390/ijerph10127272 CrossRefPubMedCentralPubMedGoogle Scholar
  17. Food and Drug Administration. (2014). Deeming tobacco products to be subject to the federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Federal Register, 79, 23141–23207.Google Scholar
  18. GfK Knowledge Networks. (2014). KnowledgePanel overview. Retrieved January 13, 2014, from http://www.knowledgenetworks.com/knpanel/KNPanel-Design-Summary.html
  19. Grana, R. A., & Ling, P. M. (2014). “Smoking revolution”: A content analysis of electronic cigarette retail websites. American Journal of Preventive Medicine, 46, 395–403. doi: 10.1016/j.amepre.2013.12.010 CrossRefPubMedGoogle Scholar
  20. Hecht, S. S. (2003). Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nature Reviews Cancer, 3, 733–744. doi: 10.1038/nrc1190 CrossRefPubMedGoogle Scholar
  21. Kim, A. E., Arnold, K. Y., & Makarenko, O. (2014). E-cigarette advertising expenditures in the U.S., 2011–2012. American Journal of Preventive Medicine, 46, 409–412. doi: 10.1016/j.amepre.2013.11.003 CrossRefPubMedGoogle Scholar
  22. Kosmider, L., Sobczak, A., Fik, M., Knysak, J., Zaciera, M., Kurek, J., & Goniewicz, M. L. (2014). Carbonyl compounds in electronic cigarette vapors: Effects of nicotine solvent and battery output voltage. Nicotine & Tobacco Research (advance online publication). doi: 10.1093/ntr/ntu078
  23. Latimer, L. A., Batanova, M., & Loukas, A. (2013). Prevalence and harm perceptions of various tobacco products among college students. Nicotine & Tobacco Research (advance online publication). doi: 10.1093/ntr/ntt174
  24. Lee, Y. O., Hebert, C. J., Nonnemaker, J. M., & Kim, A. E. (2014). Multiple tobacco product use among adults in the United States: Cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus. Preventive Medicine, 62C, 14–19.CrossRefGoogle Scholar
  25. Levy, D. T., Mumford, E. A., Cummings, K. M., Gilpin, E. A., Giovino, G., …, Warner, K. E. (2004). The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: Estimates of a panel of experts. Cancer Epidemiology, Biomarkers and Prevention, 13, 2035–2042.Google Scholar
  26. McCaul, K. D., Hockemeyer, J. R., Johnson, R. J., Zetocha, K., Quinlan, K., & Glasgow, R. E. (2006). Motivation to quit using cigarettes: A review. Addictive Behaviors, 31, 42–56. doi: 10.1016/j.addbeh.2005.04.004 CrossRefPubMedGoogle Scholar
  27. McQueen, A., Tower, S., & Sumner, W. (2011). Interviews with “vapers”: Implications for future research with electronic cigarettes. Nicotine & Tobacco Research, 13, 860–867. doi: 10.1093/ntr/ntr088 CrossRefGoogle Scholar
  28. Moser, R. P., McCaul, K., Peters, E., Nelson, W., & Marcus, S. E. (2007). Associations of perceived risk and worry with cancer health-protective actions: Data from the Health Information National Trends Survey (HINTS). Journal of Health Psychology, 12, 53–65. doi: 10.1177/1359105307071735 CrossRefPubMedGoogle Scholar
  29. Oncken, C., McKee, S., Krishnan-Sarin, S., O’Malley, S., & Mazure, C. M. (2005). Knowledge and perceived risk of smoking-related conditions: A survey of cigarette smokers. Preventive Medicine, 40, 779–784. doi: 10.1016/j.ypmed.2004.09.024 CrossRefPubMedGoogle Scholar
  30. Orr, M. S. (2014). Electronic cigarettes in the USA: A summary of available toxicology data and suggestions for the future. Tobacco Control, 23, ii18–ii22.Google Scholar
  31. Paek, H. J., Kim, S., Hove, T., & Huh, J. Y. (2013). Reduced harm or another gateway to smoking? Source, message, and information characteristics of e-cigarette videos on YouTube. J Health Commun (advance online publication). doi: 10.1080/10810730.2013.821560
  32. Pepper, J. K., & Brewer, N. T. (2014). Electronic nicotine delivery system (electronic cigarette) awareness, use, reactions, and beliefs: A systematic review. Tobacco Control, 23, 375–384. doi: 10.1136/tobaccocontrol-2013-051122 CrossRefPubMedGoogle Scholar
  33. Pepper, J. K., Emery, S. L., Ribisl, K. M., & Brewer, N. T. (2014). How do U.S. adults find out about electronic cigarettes? Implications for public health messages. Nicotine & Tobacco Research, 16, 1140–1144. doi: 10.1093/ntr/ntu060 CrossRefGoogle Scholar
  34. Regan, A. K., Promoff, G., Dube, S. R., & Arrazola, R. (2013). Electronic nicotine delivery systems: Adult use and awareness of the ‘e-cigarette’ in the USA. Tobacco Control, 22, 19–23. doi: 10.1136/tobaccocontrol-2011-050044 CrossRefPubMedGoogle Scholar
  35. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.Google Scholar
  36. Rosenstock, I. M. (1974). The Health Belief Model and preventive health behavior. Health Education and Behavior, 2, 354–386. doi: 10.1177/109019817400200405 Google Scholar
  37. Royal College of Physicians. (2007). Harm reduction in nicotine addiction: Helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians, London, UK.Google Scholar
  38. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2012 National Survey on Drug Use and Health: Detailed tables. Retrieved from: http://www.samhsa.gov/data/population-data-nsduh
  39. U.S. Department of Health and Human Services. (2014). The health consequences of smoking50 years of progress: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General.Google Scholar
  40. Vansickel, A. R., & Eissenberg, T. (2013). Electronic cigarettes: Effective nicotine delivery after acute administration. Nicotine & Tobacco Research, 15, 267–270. doi: 10.1093/ntr/ntr316 CrossRefGoogle Scholar
  41. Varughese, S., Teschke, K., Brauer, M., Chow, Y., van Netten, C., & Kennedy, S. M. (2005). Effects of theatrical smokes and fogs on respiratory health in the entertainment industry. American Journal of Industrial Medicine, 47, 411–418. doi: 10.1002/ajim.20151 CrossRefPubMedGoogle Scholar
  42. Zhu, S. H., Gamst, A., Lee, M., Cummins, S., Yin, L., & Zoref, L. (2013). The use and perception of electronic cigarettes and snus among the U.S. population. PLoS One, 8, e79332.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jessica K. Pepper
    • 1
    • 2
  • Sherry L. Emery
    • 3
  • Kurt M. Ribisl
    • 1
    • 2
  • Christine M. Rini
    • 1
    • 2
  • Noel T. Brewer
    • 1
    • 2
  1. 1.Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA
  2. 2.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillUSA
  3. 3.Institute for Health Research and PolicyUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations