Widespread Misperception of Relative Risks of ENDS versus Cigarette Smoking among Key Populations for Tobacco Harm Reduction in a 2022 Representative U.S. Sample
References
- U.S. Department of Health and Human Services, Office of the Surgeon General: Eliminating Tobacco-Related Disease and Death: Addressing Disparities – A Report of the Surgeon General, Rockville, MD, USA, 2024. Available at:
https://www.hhs.gov/sites/default/files/2024-sgr-tobacco-related-health-disparities-fullreport.pdf (accessed April, 2026) - U.S. National Cancer Institute: Cancer Trends Progress Report, 2024; NIH, DHHS, Bethesda, MD, USA, April 2025. Available at:
https://progressreport.cancer.gov/prevention/tobacco/adult_smoking (accessed April 2026) - U.S. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General; Centers for Disease Control and Prevention Atlanta, GA, USA, 2010.
- U.S. Food and Drug Administration: Tobacco Product Standard for Nicotine Yield of Cigarettes and Certain Other Combusted Tobacco Products (2025); Federal Register: 90 FR 5032; Publication Date: 01/16/2025; Docket: FDA-2024-N-5471.
- Leventhal, A.M., H. Dai, and S.T. Higgins: Smoking Cessation Prevalence and Inequalities in the United States: 2014–2019; J. Natl. Cancer Inst. (2021) 114 381–390. DOI: 10.1093/jnci/djab208
- Arancini, L., R. Borland, M. Le Grande, M. Mohebbi, S. Dodd, O.M. Dean, M. Berk, A. McNeill, G.T. Fong, and K.M. Cummings: Age as a Predictor of Quit Attempts and Quit Success in Smoking Cessation: Findings from the International Tobacco Control Four-Country Survey (2002–14); Addiction 116 (2021) 2509–2520. DOI: 10.1111/add.15454
- Jordan, H., M. Hidajat, N. Payne, J. Adams, M. White, and Y. Ben-Shlomo: What are Older Smokers' Attitudes to Quitting and How are They Managed in Primary Care? An Analysis of the Cross-Sectional English Smoking Toolkit Study; BMJ Open 7 (2017) e018150. DOI: 10.1136/bmjopen-2017-018150
- Dahal, R., A. Bhattarai, and K. Adhikari: Variation in Characteristics of People With Mental Disorders Across Smoking Status in the Canadian General Population; Tob. Prev. Cessat. 6 (2020) 61. DOI: 10.18332/tpc/127523
- Popova, L., B. Majeed, D. Owusu, C.A. Spears, and D.L. Ashley: Who are the Smokers Who Never Plan to Quit and What Do They Think About the Risks of Using Tobacco Products?; Addict. Behav. 87 (2018) 62–68. DOI: 10.1016/j.addbeh.2018.06.024
- Glasheen, C., S.L. Hedden, V.L. Forman-Hoffman, and L.J. Colpe: Cigarette Smoking Behaviors Among Adults With Serious Mental Illness in a Nationally Representative Sample; Ann. Epidemiol. 24 (2014) 776–80. DOI: 10.1016/j.annepidem.2014.07.009
- Cornelius, M.E., C.G. Loretan, A. Jamal, B.C. Davis Lynn, M. Mayer, I.C. Alcantara, and L. Neff: Tobacco Product Use Among Adults – United States, 2021; MMWR Morb. Mortal Wkly. Rep. 72 (2023) 475–483. DOI: 10.15585/mmwr.mm7218a1
- Bade, B.C. and C.S. Dela Cruz: Lung Cancer 2020: Epidemiology, Etiology, and Prevention; Clin. Chest Med. 41 (2020) 1–24. DOI: 10.1016/j.ccm.2019.10.001
- Liu, Y., S.A. Carlson, K.B. Watson, F. Xu, and K.J. Greenlund: Trends in the Prevalence of Chronic Obstructive Pulmonary Disease Among Adults Aged ≥18 Years – United States, 2011–2021; MMWR Morb. Mortal Wkly. Rep. 72 (2023) 1250–1256. DOI: 10.15585/mmwr.mm7246a1
- Mendez, D. and K.E. Warner: A Magic Bullet? The Potential Impact of E-Cigarettes on the Toll of Cigarette Smoking; Nicotine Tob. Res. 23 (2021) 654–661. DOI: 10.1093/ntr/ntaa160
- Vuong, J.T., I. Ruedisueli, C.S. Beaudin, and H.R. Middlekauff: Electronic Cigarettes: An Overlooked Tool to Alleviate Disparities in Tobacco Use Disorder Among People With Mental Health and Substance Use Disorders; J. Gen. Intern. Med. 38 (2023) 1970–1974. DOI: 10.1007/s11606-023-08137-z
- Kim, S., N.I. Goldenson, A. Selya, and S. Shiffman: Switching Away From Smoking and Reduction in Cigarette Consumption Among U.S. Adult Purchasers of the JUUL System Across 24 Months Including Diverse Subpopulations Disproportionately Affected by Cigarette Smoking; Nicotine Tob. Res. 26 (2024) 1183–1191. DOI: 10.1093/ntr/ntae072
- Kalkhoran, S., Y. Chang, and N.A. Rigotti: Electronic Cigarette Use and Cigarette Abstinence Over 2 Years Among U.S. Smokers in the Population Assessment of Tobacco and Health Study; Nicotine Tob. Res. 22 (2020) 728–733. DOI: 10.1093/ntr/ntz114
- Harlow, A.F., A. Stokes, and D.R. Brooks: Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study; Nicotine Tob. Res. 21 (2019) 1385–1393. DOI: 10.1093/ntr/nty141
- Vuss, B., L. Kock, R. West, E. Beard, D. Kale, and J. Brown: Trends in Vaping in England; Updated July 8, 2025. Available at:
https://smokinginengland.info/graphs/e-cigarettes-latest-trends (accessed July 14, 2025) - Toll, B.A., T.T. Smith, and B.A. King: Nicotine E-Cigarettes: Considerations for Healthcare Providers; Nat. Medicine 30 (2024) 1513–14. DOI: 10.1038/s41591-024-02926-7
- Murthy, V.: Surgeon General: Vaping May Be an ‘Attractive’ Smoking Cessation Tool for Adults; edited by J. Faust, MedPage Today (2024). Available at:
https://www.medpagetoday.com/special-reports/heavy-hitters/111165 (accessed April 2026) - Hartmann-Boyce, J., A.R. Butler, A. Theodoulou, I.J. Onakpoya, P. Hajek, C. Bullen, N.A. Rigotti, and N. Lindson: Biomarkers of Potential Harm in People Switching from Smoking Tobacco to Exclusive E-Cigarette Use, Dual Use or Abstinence: Secondary Analysis of Cochrane Systematic Review of Trials of E-Cigarettes for Smoking Cessation; Addiction 118 (2023) 539–545. DOI: 10.1111/add.16063
- U.S. Food and Drug Administration: The Relative Risks of Tobacco Products. Available at:
https://www.fda.gov/tobacco-products/health-effects-tobacco-use/relativerisks-tobacco-products (accessed June 5, 2024) - Kim, S., S. Shiffman, and M.A. Sembower: U.S. Adult Smokers' Perceived Relative Risk on ENDS and its Effects on their Transitions Between Cigarettes and ENDS; BMC Public Health 22 (2022) 1771. DOI: 10.1186/s12889-022-14168-8
- Persoskie. A., E.K. O'Brien, and K. Poonai: Perceived Relative Harm of Using E-Cigarettes Predicts Future Product Switching Among U.S. Adult Cigarette and E-Cigarette Dual Users; Addiction 114 (2019) 2197–2205. DOI: 10.1111/add.14730
- Elton-Marshall, T., P. Driezen, G.T. Fong, K.M. Cummings, A. Persoskie, O. Wackowski, K. Choi, A. Kaufman, D. Strong, S. Gravely, K. Taylor, J. Kwan, M. Bansal-Travers, M. Travers, and A. Hyland: Adult Perceptions of the Relative Harm of Tobacco Products and Subsequent Tobacco Product Use: Longitudinal Findings from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study; Addict. Behav. 106 (2020) 106337. DOI: 10.1016/j.addbeh.2020.106337
- Evans, A.T., K.C. Henderson, A. Geier, S.R. Weaver, C.A. Spears, D.L. Ashley, M. Fritz, L. John, and T.F. Pechacek: What Motivates Smokers to Switch to ENDS? A Qualitative Study of Perceptions and Use; Int. J. Environ. Res. Public Health 17 (2020) 8865. DOI: 10.3390/ijerph17238865
- East, K., E. Taylor, A. McNeill, I. Bakolis, A.E. Taylor, O.M. Maynard, M.R. Munafò, and J. Khouja: Perceived Harm of Vaping Relative to Smoking and Associations With Subsequent Smoking and Vaping Behaviors Among Young Adults: Evidence From a UK Cohort Study; Nicotine Tob. Res. 27 (2025) 1479–85. DOI: 10.1093/ntr/ntaf018
- Rubenstein, D., R.L. Denlinger-Apte, J. Cornacchione Ross, D.M. Carroll, and F.J. McClernon: Older Age is Associated With Greater Misperception of the Relative Health Risk of E-Cigarettes and Cigarettes Among U.S. Adults Who Smoke; Tob. Control 33 (2023) e266–e269. DOI: 10.1136/tc-2023-057943
- Harlow, A.F., W. Xie, A.R. Goghari, D.J. Lundberg, R.V. Raquib, J.B. Berlowitz, and A.C. Stokes: Sociodemographic Differences in E-Cigarette Uptake and Perceptions of Harm; Am. J. Prev. Med. 65 (2023) 356–365. DOI: https://doi.org/10.1016/j.amepre.2023.03.009
- Snell, L.M., A.J. Barnes, and T. Eissenberg: Variation in Relative Risk Perceptions and Tobacco Use by Race and Socioeconomic Status Among Older Adults Who Smoke: Evidence From the Population Assessment of Tobacco and Health Study; Nicotine Tob. Res. 27 (2024) 1168–1176. DOI: 10.1093/ntr/ntae242
- O'Brien, E.K., A.B. Nguyen, A. Persoskie, and A.C. Hoffman: U.S. Adults' Addiction and Harm Beliefs About Nicotine and Low Nicotine Cigarettes; Prev. Med. 96 (2017) 94–100. DOI: 10.1016/j.ypmed.2016.12.048
- Smith, C.A., L. Shahab, A. McNeill, S.E. Jackson, J. Brown, and L. Brose: Harm Perceptions of E-Cigarettes Among Smokers With and Without Mental Health Conditions in England: A Cross-Sectional Population Survey; Nicotine Tob. Res. 23 (2020) 511–517. DOI: 10.1093/ntr/ntaa020
- Shiffman, S., S. Kim, N.I. Goldenson, and M.A. Sembower: Readiness to Stop Smoking and Subsequent Switching Away to Electronic Nicotine Delivery Systems Among Adults Who Smoke Cigarettes; Am. J. Drug Alcohol Abuse 51 (2025) 328–338. DOI: 10.1080/00952990.2024.2439363
- United States Public Health Service Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion (U.S.) Office on Smoking and Health: Smoking Cessation: A Report of the Surgeon General; U.S. Department of Health and Human Services, Washington, DC, USA, 2020.
- Steinberg, M.B., S. Greenhaus, A.C. Schmelzer, M.T. Bover, J. Foulds, D.R. Hoover, and J.L. Carson: Triple-Combination Pharmacotherapy for Medically Ill Smokers: A Randomized Trial; Ann. Intern. Med. 150 (2009) 447–54. DOI: 10.7326/0003-4819-150-7-200904070-00004
- Bock, B., K. Heron, E. Jennings, K. Morrow, V. Cobb, J. Magee, J. Fava, C. Deutsch, and R. Foster: A Text Message Delivered Smoking Cessation Intervention: The Initial Trial of TXT-2-Quit: Randomized Controlled Trial; JMIR mHealth uHealth, 1 (2013) e17. DOI: 10.2196/mhealth.2522
- Kasza, K.A., K.C. Edwards, H.L. Kimmel, A. Anesetti-Rothermel, K.M. Cummings, R.S. Niaura, A. Sharma, E.M. Ellis, R. Jackson, C. Blanco, M.L. Silveira, D.K. Hatsukami, and A. Hyland: Association of E-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit; JAMA Netw. Open 4 (2021) e2140880. DOI: 10.1001/jamanetworkopen.2021.40880
- Vu, G.T., D. Stjepanoviæ, T. Sun, J. Leung, J. Chung, J. Connor, P.K. Thai, C.E. Gartner, B.X. Tran, W.D. Hall, and G. Chan: Predicting the Long-Term Effects of Electronic Cigarette Use on Population Health: A Systematic Review of Modelling Studies; Tob. Control 33 (2024) 790–797. DOI: 10.1136/tc-2022-057748
- United States Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, Food and Drug Administration, Center for Tobacco Products: Data from: Population Assessment of Tobacco and Health (PATH) Study [United States] Public-Use Files User Guide, 2024, Inter-University Consortium for Political and Social Research, Ann Arbor, MI, USA. Available at:
https://www.icpsr.umich.edu/files/NAHDAP/documentation/ug36498-all.pdf (accessed April 2026) - DiClemente, C.C., J.O. Prochaska, S.K. Fairhurst, W.F. Velicer, M.M. Velasquez, and J.S. Rossi: The Process of Smoking Cessation: An Analysis of Precontemplation, Contemplation, and Preparation Stages of Change; J. Consult. Clin. Psychol. 59 (1991) 295–304. DOI: 10.1037//0022-006x.59.2.295
- Klosterhalfen, S., D. Kotz, S. Kastaun: Smokers' Perception of the Comparative Health Risks of Cigarettes, E-Cigarettes and Heated Tobacco Products: A Survey Among the German Population; J. Public Health 46 (2024) e400–e409. DOI: 10.1093/pubmed/fdae068
- Jackson, S.E., H. Tattan-Birch, K. East, S. Cox, L. Shahab, and J. Brown: Trends in Harm Perceptions of E-Cigarettes vs Cigarettes Among Adults Who Smoke in England, 2014–2023; JAMA Netw. Open 7 (2024) e240582. DOI: 10.1001/jamanetworkopen.2024.0582
- Wang, J., C.C. Xie, X.X. Jia, K. Xu, Z.Y. Gong, Y.Q. Sun, J.R. Gao, Y. Ding, Z.Y. Huang, and D. Chen: E-Cigarette Awareness and Use, Among Adult Residents in Shanghai, China; Tob. Induc. Dis. 21 (2023) 104. DOI: 10.18332/tid/169559
- Guiney, H., A. Oakly, and G.J. Martin: E-Cigarette Use and Perceptions Among Current and Ex-Smokers in New Zealand; Health Promotion Agency, Wellington, New Zealand; 2019. Available at:
https://apo.org.au/node/219566 (accessed April 2026) - Case, K.R., A.J. Lazard, M.S. Mackert, and C.L. Perry: Source Credibility and E-Cigarette Attitudes: Implications for Tobacco Communication; Health Commun. 33 (2018) 1059–1067. DOI: 10.1080/10410236.2017.1331190
- Delnevo, C.D., M. Jeong, A. Teotia, M.M. Bover Manderski, B. Singh, M. Hrywna, O.A. Wackowski, and M.B. Steinberg: Communication Between U.S. Physicians and Patients Regarding Electronic Cigarette Use; JAMA Netw. Open 5 (2022) e226692. DOI: 10.1001/jamanetworkopen.2022.6692
- Yu, Y.S., A. Altares, A. Leib, L.L. Bellows, C. Berry, D.J. Graham, and M.P. Mueller: Sociodemographic Disparities in Health Literacy Among American Adults: A National Survey Study; Prev. Med. Rep. 57 (2025) 103179. DOI: 10.1016/j.pmedr.2025.103179
- U.S. Centers for Disease Control and Prevention: Tobacco Product Use Among Adults – United States, 2022. 2022 National Health Interview Survey (NHIS) Highlights; September 10, 2024. Available at:
https://www.cdc.gov/tobacco/media/pdfs/2024/09/cdcoshncis-data-report-508.pdf (accessed April 2026)
DOI: https://doi.org/10.2478/cttr-2026-0005 | Journal eISSN: 2719-9509
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
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© 2026 Sooyong Kim, Arielle Selya, Saul Shiffman, Lynne Dawkins, Joe Gitchell, published by Institut für Tabakforschung GmbH
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