Harm perceptions of electronic cigarettes and nicotine: A nationally representative cross-sectional survey of young people in Great Britain

Background: E-cigarettes often contain nicotine without the most harmful constituents of tobacco smoke. Aims: This study aims to assess prevalence and correlates of accurately perceiving e-cigarettes as less harmful than cigarettes and that none or a small amount of the harm from smoking comes from nicotine. Methods: Cross-sectional survey of 2,103 11-18-year-olds in Great Britain in 2016. Prevalence of e-cigarette and nicotine harm perceptions were calculated. Logistic regressions assessed associations between accurate e-cigarette and nicotine harm perceptions and smoking, e-cigarette use, gender, age, region, social grade, family smoking, family e-cigarette use, smoking friends, public approval of smoking, and public approval of e-cigarettes. Associations between accurate e-cigarette and nicotine harm perceptions were also assessed. Results: Most (63.4%) accurate e-cigarette harm perceptions were higher among those aged 16 + (OR = 1.89 [95%CI = 1.45-2.471), 14-15 (OR = 1.29 [1.00-1.65]), who tried/used an e-cigarette sometimes (OR = 1.51 [1.03-2.21]), with family e-cigarette use (OR = 2.11 [1.46-3.04]), who perceived public disapproval of smoking (OR = 2.11 [1.18-3.77]) and approval of e-cigarettes (OR = 2.44 [1.73-3.45]), and with accurate nicotine harm perceptions (OR = 2.05 [1.28-3.28]). Accurate nicotine harm perceptions were higher among those aged 16 + (OR = 2.60 [1.62-4.16]), from North England (OR = 1.87 [1.02-3.43]) and Wales/Scotland (OR = 2.61 [1.35-5.03]) vs. London, with family smoking (OR = 1.59 [1.05-2.42]), and with accurate e-cigarette harm perceptions (OR = 2.12 [1.32-3.41]). Conclusions: Many young people have inaccurate harm perceptions of e-cigarettes and nicotine. Accurate e-cigarette and nicotine harm perceptions were associated with one another. E-cigarette use was associated with accurate e-cigarette but not nicotine harm perceptions; smoking was not associated with either.