European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys

Shannon Gravely*, Pete Driezen, Christina N. Kyriakos, Mary E. Thompson, James Balmford, Tibor Demjén, Esteve Fernández, Ute Mons, Yannis Tountas, Kinga Janik-Koncewicz, Witold Zatonski, Antigona C. Trofor, Constantine I. Vardavas, Geoffrey T. Fong, Andrea Glahn, Dominick Nguyen, Katerina Nikitara, Cornel Radu-Loghin, Polina Starchenko, Aristidis TsatsakisCharis Girvalaki, Chryssi Igoumenaki, Sophia Papadakis, Aikaterini Papathanasaki, Manolis Tzatzarakis, Alexander I. Vardavas, Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière, Judit Kiss, Anna Piroska Kovacs, Yolanda Castellano, Marcela Fu, Sarah O. Nogueira, Olena Tigova, Ann McNeill, Katherine East, Sara C. Hitchman, Sarah Kahnert, Panagiotis Behrakis, Filippos T. Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Marc Willemsen, Hein De Vries, Karin Hummel, Gera E. Nagelhout, Et al.

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background: This study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD. Methods: Data were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (=18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N ¼ 6011) and 2018 (post-TPD: N ¼ 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’). Results: In 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P > 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P ¼ 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P ¼ .001). Conclusions: The majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.
Original languageEnglish
Pages (from-to)III38-III45
Number of pages8
JournalEuropean Journal of Public Health
Volume30
DOIs
Publication statusPublished - 1 Jul 2020

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