Perceptions of the relative harm of cigarettes and E-cigarettes among U.S. youth

Background Despite progress in reducing youth smoking, adolescents remain highly susceptible to tobacco use. Of concern is whether youth perceive electronic cigarettes (e-cigarettes) as a preferable alternative to conventional cigarettes. Purpose To describe cigarette harm perception patterns among youth based on the frequency and intensity of cigarette smoking, and examine the relative harm perceptions of conventional versus e-cigarettes, using data from a large, nationally representative sample of U.S. youth. Methods Data from the 2012 National Youth Tobacco Survey (N=24,658) were analyzed in 2013 to identify patterns of cigarette harm perceptions. Multinomial logistic regression was conducted to identify associations between demographic and tobacco use characteristics and cigarette harm perception patterns. Logistic regression was conducted to examine the relationship between cigarette harm perceptions and the perception of e-cigarettes as less harmful than cigarettes for current, ever, and never cigarette smokers. Results The majority of youth (64.2%) perceived the harmfulness of cigarettes as dose-dependent. Approximately one in three students perceived e-cigarettes as less harmful than conventional cigarettes. Regardless of cigarette smoking status, ever users of e-cigarettes and those with "dose-dependent" cigarette harm perceptions consistently were more likely to perceive e-cigarettes as less harmful than conventional cigarettes. Conclusions Many youth perceive tobacco use on a continuum of harm. Youth who perceive gradations in harm - both by frequency and intensity of cigarette use and by type of product - may be particularly susceptible to e-cigarette use.