The growth in e-cigarette use may be driven by the perception that they are a safer, healthier alternative to conventional cigarettes. However, their long-term health implications are not well known and use is discouraged by most cancer societies. It is currently unclear how cancer survivors perceive the risks associated with e-cigarette and how this may influence use in this population.
A cross-sectional analysis was conducted using the Health Information National Trends Survey (HINTS) (Years 2017–2019). Our primary study outcome was the perception of harm associated with e-cigarettes compared to traditional cigarettes among adults with and without a self-reported history of cancer. We used logistic regression analyses assessing the association of a cancer history with the perception that e-cigarettes are as much or more harmful than cigarettes.
A total of 11,846 respondents (weighted population estimate 243,728,483) were included. Of these, 26.6% reported a history of cancer. The proportion of cancer survivors who perceived e-cigarettes to be as much or more harmful than conventional cigarettes was similar to non-cancer respondents (70.6% vs 68.3%, P = 0.35). There was no difference in perception of harm among cancer and non-cancer respondents, adjusted for sociodemographic factors (OR 0.82, 95% CI 0.6–1.1). Past (OR 9.06, 95% Cl 5.06–16.20) and never e-cigarette use (OR 23.40, 95% Cl 13.56–40.38) as well as having a history of cardiopulmonary disease (OR 1.28, 95% Cl 1.05–1.56) was associated with higher odds of perceiving e-cigarettes to be as much or more harmful.
Cancer survivors commonly perceive e-cigarettes to be as much or more harmful than traditional cigarettes though these findings are similar to perceptions among adults without a history of cancer. There is a strong association with avoidance of e-cigarette products among those who perceive them to be harmful.
- • Use of electronic cigarettes is rapidly increasing including among cancer survivors.
- • The growth in e-cigarette use may be driven by the perception that they are a safer alternative to conventional cigarettes.
- • E-cigarette use is discouraged by most cancer societies.
- • It is important to understand the perceived risks associated with e-cigarettes among the cancer population.
- • We found no differences in the perception of e-cigarette harm observed between those with and without a history of cancer.
- • There is a strong association with avoidance of e-cigarette products among those who perceive them to be harmful.
Electronic cigarettes (e-cigarettes) are gaining in popularity as an alternative to conventional cigarettes even though their health implications are unclear . Although the U.S. Food and Drug Administration (FDA) endorses that there are health risks associated with its use, the incidence of e-cigarette use has been increasing in nearly all populations including adolescents, adults, smokers and non-smokers, as well as cancer survivors . Among cancer survivors specifically, e-cigarette use has risen from 8.5% in 2014 to 10.7% in 2017, while up to 26% of newly diagnosed cancer survivors continue to use e-cigarettes. Given the increasing use of e-cigarettes, there is pressing need to understand reasons for adoption in this vulnerable population. Perception of a product’s harm has been shown to influence consumer behavior . Therefore, we postulate that increasing use among cancer survivors may be driven by underappreciation of the harms and health implications of e-cigarette use.
Cancer survivors have different perceptions of risk compared to non-cancer participants and this plays a critical role in decisions to use tobacco and potentially e-cigarettes . The increase in e-cigarette use among cancer survivors may reflect a perception that e-cigarettes are low risk even though e-cigarette use has been linked to the potential of several smoking related malignancies . Specifically, the rise in their use may reflect, in part, a perceived harm reduction approach to smoking cessation . This strategy aims to curb combustible cigarette smoking by encouraging smokers to switch to potentially lower-risk tobacco products such as e-cigarettes. However, this approach appears to have limited success and may potentially promote dual use . Several cancer organizations including the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Association for Cancer Research (AACR), and the American Society of Clinical Oncologists (ASCO) all have issued guidelines or statements that recognize the potential for e-cigarettes to alter existing smoking behaviors, as well as the lack of definitive data regarding associated benefits and harms. However, to date none of these organizations endorse e-cigarette use and the impact of their use continues to be an important question for cancer providers . Understanding the perceived harm of e-cigarette use among cancer survivors may inform the observed shifts in e-cigarette patterns of use along with public health planning.
There is a paucity of contemporary nationally representative studies evaluating perceptions of e-cigarette harms among cancer survivors. The primary objective of this study was to assess perceived harmfulness of e-cigarettes relative to conventional cigarettes among cancer survivors compared to non-cancer respondents using a nationally representative survey of U.S. adults. We determined factors associated with the perception that e-cigarettes are as much or more harmful than conventional cigarettes. As a secondary study objective, we sought to assess whether this perceived relative harm has changed over time. As late adolescents and young adults have the highest prevalence of using e-cigarettes, we included a sub-analysis of this group. Additionally, smoking linked cardiopulmonary disease may impact perceived e-cigarette harm and was therefore included in our analysis.