Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents

Abstract

Introduction: The popularity of e-cigarettes has increased significantly in recent years. E-cigarettes are perceived as less harmful than cigarettes, and both dual-use of cigarette and e-cigarette use is common among adolescents. This study assessed cigarette and e-cigarette risk perception and associations with dual-product use among Canadian adolescents. Methods: We used data from the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Perceived risks of cigarette and e-cigarette use were classified into 4 categories: “high-risk perception,” “high-e-cigarette-risk and low-cigarette-risk perception,” “low-e-cigarette-risk and high-cigarette-risk perception,” and “low-risk perception.” Adjusted odds ratios (aOR) were estimated from multinomial logistic regression. Results: Of the population, 92% perceived high risk from cigarettes, and 65% from e-cigarettes. Compared to students with low-risk perception, those with high-risk perception of both products had lower odds of dual-use (aOR: 0.21; 95% confidence interval [CI]: 0.15, 0.28), cigarette-only use (aOR: 0.33; 95% CI: 0.25, 0.45), and e-cigarette-only use (aOR: 0.64; 95% CI: 0.51, 0.79) relative to nonusers. Adolescents with high-e-cigarette and low-cigarette-risk perception had higher odds of e-cigarette-only use, relative to nonusers. Those with high-risk perception were more likely to be e-cigarette-only users relative to cigarette-only users. Conclusion: Results highlight that high perceived risk is associated with lower odds of use. However, those with a high-risk perception of both products had higher odds of e-cigarette use relative to cigarette-only users; as did those with high-e-cigarette and low-cigarette-risk perception, relative to nonusers. Future research should assess ways of communicating the risks of adolescent tobacco use.

Association between perceived health risks of e-cigarettes and actual e-cigarette use, based on cigarette smoking status and sexual and gender minority status among U.S. adults

“…Our findings further revealed that lower perceived harmfulness of e-cigarettes was associated with e-cigarette use daily or some days. These findings are consistent with previous studies (Amrock et al 2016 ; Huang et al 2019 ; Manzione et al 2020 ) that found that a reason for continuous use of e-cigarettes was related mainly to less perceived harmfulness of e-cigarettes. We also found that current cigarette smokers were more likely to engage in e-cigarettes use than were non-cigarette smokers.…”

“…There is a lack of consensus in the literature about the associations between the perceived health risks of e-cigarettes and their actual use among U.S. adults (Cooper et al 2016 ; Czoli et al 2017 ; Manzione et al 2020 ; Piñeiro et al 2016 ; Popova et al 2017 ; Wackowski and Delnevo 2016 ). Individuals who perceived e-cigarettes as less harmful than actual cigarettes are more likely to use e-cigarettes (Amrock et al 2016 ; Huang et al 2019 ; Manzione et al 2020 ).…”

“…There is a lack of consensus in the literature about the associations between the perceived health risks of e-cigarettes and their actual use among U.S. adults (Cooper et al 2016 ; Czoli et al 2017 ; Manzione et al 2020 ; Piñeiro et al 2016 ; Popova et al 2017 ; Wackowski and Delnevo 2016 ). Individuals who perceived e-cigarettes as less harmful than actual cigarettes are more likely to use e-cigarettes (Amrock et al 2016 ; Huang et al 2019 ; Manzione et al 2020 ). E-cigarette users, perhaps being influenced by external forces such as multinational tobacco companies and marketers, including some celebrities, often perceive e-cigarettes as less harmful and as substitutes for quitting or reducing tobacco intake via cigarette smoking and other tobacco products (Cobb et al 2015 ; Grana et al 2014 ; Luo et al 2014 ; Noel et al 2011 ; Paek et al 2014 ; U.S. National Cancer Institute 2017 ).…”

The role of IQOS risk perceptions on cigarette smoking behaviours: results from a prospective pilot study

“…Smokers who perceived IQOS closer in risk to their cigarettes used more SPD, whereas those who perceived IQOS to be less risky than their cigarettes used fewer. This finding appears inconsistent with the literature on tobacco use risk perceptions, where high risk is associated with lower odds of use 26. As novel products enter the market, smokers may have little information to base their perceptions beyond marketing27 and may base risk perceptions on similarities between the novel product and their cigarettes 28.…”

Youth perceptions of e-cigarette-related risk of lung issues and association with e-cigarette use.

“…Research shows that adolescent and young adult (AYA) perceptions of tobacco- and e-cigarette-related health risks are associated with future use of these products (Cooper et al, 2018; Kong et al, 2015; Manzione et al, 2020; Morrell et al, 2010; Song et al, 2009; Strong et al, 2019). These studies are in line with several theories of health behavior.…”