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More Adults Believe Electronic Nicotine Systems To Be As Harmful as Cigarettes

MedicalResearch.com Interview with:
Amy L. Nyman, MA

Research Associate
Georgia State University, School of Public Health
Atlanta, GA 30303

Coauthors: Nyman, Huang, Weaver, Eriksen

MedicalResearch.com: What is the background for this study?

Response: Though the negative health consequences of smoking combustible cigarettes have been well-established and widely accepted, there has been significant public debate about the health effects of Electronic Nicotine Delivery Systems (ENDS) use, and the extent to which use of ENDS may present less health risk to smokers than smoking combustible cigarettes. Many tobacco control researchers and scientists believe that ENDS use is safer than combustible cigarette smoking, though recent news of an expansive outbreak of vaping-related lung illnesses and deaths has led to continued speculation.

A prior study of perceived comparative harm of combustible cigarettes and ENDS revealed the proportion of US adults perceiving ENDS to be as harmful as, or more harmful than combustible cigarettes increased substantially between 2012 and 2017. Given recently proposed regulations and the escalating focus on the impact of ENDS use on youth in the past few years, our study assessed changes in perceived comparative harm of combustible cigarettes and ENDS among US adults since the prior study, between 2017 and 2018. 

MedicalResearch.com: What are the main findings?

Response: Between 2017 and 2018, there was another significant increase in the proportion of US adults who perceive Electronic Nicotine Delivery Systems to be as harmful as, or more harmful than combustible cigarettes. Among current smokers of combustible cigarettes, there was also a significant increase in the proportion perceiving ENDS to be more harmful or much more harmful than combustible cigarettes.

MedicalResearch.com: What should readers take away from your report?

Response: Despite the position of many tobacco control researchers and scientists that use of Electronic Nicotine Delivery Systems presents less risk of harm than use of combustible cigarettes, increasing proportions of US adults believe otherwise. This holds true for smokers of combustible cigarettes as well, who may decide against trying ENDS in their efforts to quit smoking, despite the well-established harms of combustible cigarette smoking.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Our study is based on survey data collected in November and December of 2018. Beginning in August of 2019, increasing numbers of cases of vaping-related illnesses and deaths were reported throughout the US. Given the significant media attention given to these illnesses and deaths, we suspect perceived harm from ENDS use may continue to increase. Therefore, we recommend continued monitoring of harm perceptions.

This work was supported by NIH, NIDA, and the FDA. The authors have no conflicts of interest to report.


Nyman AL, Huang J, Weaver SR, Eriksen MP. Perceived Comparative Harm of Cigarettes and Electronic Nicotine Delivery Systems. JAMA Netw Open. 2019;2(11):e1915680. doi:https://doi.org/10.1001/jamanetworkopen.2019.15680



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Last Updated on November 21, 2019 by Marie Benz MD FAAD