E-cigarettes are gaining mainstream attention as a competitor to traditional cigarettes. Researchers from the University of Pennsylvania and the University of Illinois at Urbana-Champaign wanted to examine changes in e-cigarette awareness, how harmful people believe them to be, and if those attitudes have any connection to smoking cessation attempts. They found that while awareness of e-cigarettes has increased significantly, smokers are less inclined to consider them safer than cigarettes. Also, investigators discovered that awareness did not show evidence of promoting smoking cessation. Their findings are published in the August issue of the American Journal of Preventive Medicine.
It is predicted that e-cigarette sales will soon reach 1.7 billion dollars, which represents roughly 1% of current regular cigarette sales in the U.S. This is due in part to the surge in marketing and increasing availability of e-cigarette products in the last few years. E-cigarettes are perceived as an invention that competes with tobacco cigarettes. While some people and advertisements even go so far as to refer to them as cessation aids, they are not currently approved by the FDA for that purpose.
In this new study, researchers set out to examine the prevalence of e-cigarette awareness and perceived harmfulness. Using data collected from the Health Information National Trends Survey (HINTS), they discovered that national awareness of e-cigarettes has risen from 16.4% in 2009 to 77.1% in 2013. Young people, more educated respondents, and current and former smokers were more likely to be aware of e-cigarettes, while Hispanics and older survey participants were less likely to be aware of e-cigarettes.
"Compared with earlier national surveys among U.S. adults, this study found a notable increase in public awareness of e-cigarettes since 2009," explains co-investigator Andy Tan, MBBS, MPH, MBA, PhD, Center of Excellence in Cancer Communication Research, Annenberg School for Communication, University of Pennsylvania. "In the beginning of 2013, more than three in four respondents were aware of this novel product. The rise in awareness of e-cigarettes could reflect sharp increases in advertising expenditures by manufacturers, availability in retail stores across the country, and presence in popular media."
The study also looked at the perceived harmfulness of e-cigarettes among current smokers. In 2010, 84.7% of smokers surveyed believed e-cigarettes were less harmful than traditional cigarettes, but according to this new study in 2013, that number dropped to just 65%.
"This apparent decline in smokers' beliefs about reduced harm of e-cigarettes compared with regular cigarettes is perplexing against the background of advertising and media messages touting e-cigarettes as safer alternatives and cessation aids," adds co-investigator Cabral Bigman, PhD, College of Liberal Arts & Sciences, University of Illinois at Urbana-Champaign. "One possible explanation is that the increased media attention over the lack of FDA approval and regulation of this emerging tobacco product, injuries arising from e-cigarette-induced fires, and health concerns from toxic chemicals in e-cigarettes in recent years may have conveyed conflicting information about the relative safety of e-cigarette use."
Another important aspect of the new study was to examine if there are possible links between e-cigarette awareness or beliefs they are less harmful and current smokers' quit attempts. After data analysis, investigators found no association between increased awareness or perceptions of lower harms and smokers' attempts to quit. There was also no evidence at the population level that widespread knowledge about e-cigarettes or beliefs they are less harmful is associated with current smokers being more likely to think about quitting.
"The current analyses showed that there were no significant associations between e-cigarette awareness or perceived harmfulness and smokers' intentions to quit or past-year quit attempts," comments Dr. Tan. "One potential interpretation is that adult smokers have not yet accepted e-cigarettes as a means to quit smoking."
While levels of awareness have increased rapidly, use percentage is still very low with only 6% of U.S. adults reporting ever using e-cigarettes. This small number means that e-cigarettes may not yet be a threat to tobacco control programs, but at the same time, means any claim that e-cigarettes are helping to reduce the harm done by regular cigarettes is probably premature.
"There is an ongoing debate within the public health community about whether e-cigarettes are a viable alternative for harm reduction and whether smokers are merely supplementing or truly replacing their smoking with e-cigarettes and achieving smoking cessation," concludes Dr. Tan. "It is uncertain whether increased population e-cigarette awareness and perceptions about reduced harm might play a role in encouraging smoking-cessation behaviors. However, public health professionals should systematically scrutinize the nature of marketing activities and media coverage of e-cigarettes, their impact on population awareness and perceptions of e-cigarettes, and how these factors may influence e-cigarette use and smoking prevalence in the U.S. population."