Widespread Misperception of Relative Risks of ENDS versus Cigarette Smoking among Key Populations for Tobacco Harm Reduction in a 2022 Representative U.S. Sample

Sooyong Kim; Arielle Selya; Saul Shiffman; Lynne Dawkins; Joe Gitchell

doi:10.2478/cttr-2026-0005

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Widespread Misperception of Relative Risks of ENDS versus Cigarette Smoking among Key Populations for Tobacco Harm Reduction in a 2022 Representative U.S. Sample

Contributions to Tobacco & Nicotine Research

Volume 35 (2026): Issue 2 (April 2026)

By: Sooyong Kim, Arielle Selya, Saul Shiffman, Lynne Dawkins and Joe Gitchell

Open Access

|May 2026

Abstract

Objective

Tobacco harm reduction (THR) using represents a pragmatic and realistic strategy, to which electronic nicotine delivery systems (ENDS) misperceptions act as a barrier. This paper explores ENDS misperceptions, especially among certain groups disproportionately affected by smoking.

Methods

Using the Population Assessment of Tobacco and Health (PATH) Wave 7 (2022), key populations for THR were identified as 3,481 adults who exclusively smoke (AWES) and who are not planning to quit within 30 days (NPQ), 56% of whom were male. Non-White racial/ethnic groups, male, ages ≥ 55, high school/GED or less education, household income < $25,000, non-heterosexual, and AWES with fair or poor mental health were characterized as subpopulations disproportionately affected by smoking. Misperception was defined as perceiving ENDS to be at least as harmful as cigarettes.

Results

Ninety-four percent of AWES-NPQ had ENDS misperceptions. While misperceptions were > 91% in all sub-groups, the odds of reporting misperceptions were higher among: Black respondents (vs. White, OR = 1.79 [95% CI = 1.13–2.83]), those aged ≥ 55 (vs. < 55, 1.47 [1.02–2.12]), and AWES with high school or less education (vs. at least some college, 2.10 [1.47–3.01]. Conversely, male AWES had reduced odds of having ENDS misperceptions (vs. female, 0.55 [0.38–0.80]).

Conclusions

ENDS misperceptions were highly prevalent among AWES-NPQ, and some subgroups disproportionately affected by smoking were even more likely to hold misperceptions. Efforts to reduce smoking disparities could be enhanced by communicating ENDS' reduced-risk potential, which could encourage AWES to adopt ENDS and completely switch away from smoking.

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Articles in this issue

DOI: https://doi.org/10.2478/cttr-2026-0005 | Journal eISSN: 2719-9509

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Language: English

Page range: 68 - 76

Submitted on: Oct 14, 2025

Accepted on: Feb 17, 2026

Published on: May 3, 2026

Published by: Institut für Tabakforschung GmbH

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Electronic nicotine delivery systems,

Related subjects:

Life sciences, other,

Physics,

Physics, other

© 2026 Sooyong Kim, Arielle Selya, Saul Shiffman, Lynne Dawkins, Joe Gitchell, published by Institut für Tabakforschung GmbH
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.

Volume 35 (2026): Issue 2 (April 2026)