Harm perceptions across vaping product features: An on-line cross-sectional survey of adults who smoke and/or vape in the United Kingdom.
Harm reduction
perceptions
risk
smoking
survey
vaping
Journal
Addiction (Abingdon, England)
ISSN: 1360-0443
Titre abrégé: Addiction
Pays: England
ID NLM: 9304118
Informations de publication
Date de publication:
05 Jun 2024
05 Jun 2024
Historique:
received:
19
12
2023
accepted:
01
05
2024
medline:
6
6
2024
pubmed:
6
6
2024
entrez:
5
6
2024
Statut:
aheadofprint
Résumé
Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping. This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494). As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex. Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex). Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Vaping products are diverse with a wide variety of features, and popular products change rapidly. This study examined the features and types of vaping products that people who smoke and/or vape perceive contribute to the health harms of vaping.
DESIGN, SETTING AND PARTICIPANTS
METHODS
This was a cross-sectional survey co-designed with adults who smoked/vaped and pre-registered. An on-line survey (November 2022) was used of a convenience sample of adults in the United Kingdom who smoked and/or vaped (n = 494).
MEASUREMENTS
METHODS
As primary outcomes, respondents were asked to select any of 15 vaping product features they perceived might have any effect on the health harms of vaping (for each: selected, not selected). Independent variables were smoking/vaping status (smoke and vape; vape, formerly smoked; vape, never regularly smoked; smoke, do not currently vape); relative vaping harm perceptions [less harmful than smoking (accurate), equally/more harmful than smoking or do not know/refused (other)]. Binary logistic regressions were used to compare outcomes by current vaping/smoking status and relative harm perceptions, adjusting for age and sex.
FINDINGS
RESULTS
Most people (54.7%) selected between one and three features. The most frequently selected were nicotine concentration (62.2%) and amount of e-liquid consumed (59.1%), followed by nicotine type (e.g. salt or freebase; 33.0%), source/purchase location (25.3%), flavours (24.7%), temperature to heat e-liquid (21.1%), heat produced by device (20.9%), e-liquid brand (20.9%), amount of emissions (18.6%), device type (e.g. disposable, pod, tank; 17.2%), material of tank (17.0%), power/wattage (13.0%), device brand (8.1%), device size (4.1%) and device weight (2.4%). Higher nicotine concentrations, more e-liquid and salt (versus freebase) nicotine were perceived to confer greater harms. Disposables were perceived as slightly more harmful than reusable devices. There were few differences by current vaping/smoking status and between those with accurate (versus other) harm perceptions of vaping relative to smoking (P > 0.05 for most contrasts, adjusting for age and sex).
CONCLUSIONS
CONCLUSIONS
Certain features and types of vaping products [higher nicotine concentrations, more e-liquid consumed and salt (versus freebase) nicotine] were perceived to confer greater health harms among a sample of UK adults who smoked and/or vaped. Findings are consistent with pervasive misperceptions that nicotine is a major cause of harm, although e-liquid volume is likely to contribute to harms.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : National Institute for Health Research Health Protection Research Unit
Organisme : Society for the Study of Addiction
ID : Fellowship
Organisme : CIHR
ID : Michael Smith Foreign Study Supplement and Canada
Pays : Canada
Organisme : University of Queensland
ID : Higher Degree by Research Scholarships
Organisme : Economic and Social Research Council
ID : LISS DTP
Organisme : Cancer Research UK
Pays : United Kingdom
Organisme : UK Research and Innovation
ID : MR/S037519/1
Organisme : National Institutes of Health Research
ID : NIHR South London ARC
Organisme : UK Society for the Study of Addiction (SSA)
Organisme : NIH HHS
ID : 1P01CA200512
Pays : United States
Organisme : NIHR Health Protection Research Unit in Environmental Exposures and Health
Organisme : NIHR South London ARC
Organisme : Cancer Research UK (CRUK)
Organisme : ESRC LISS DTP
Organisme : SPECTRUM Consortium
Organisme : UK Research and Innovation Councils
Organisme : The University of Queensland Higher Degree by Research Scholarships
Organisme : Canadian Institutes of Health Research (CIHR) Michael Smith Foreign Study Supplement
Organisme : Canada Graduate Scholarships-Master's programme grant
Informations de copyright
© 2024 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.
Références
Lindson N, Theodoulou A, Ordóñez‐Mena JM, Fanshawe TR, Sutton AJ, Livingstone‐Banks J, et al. Pharmacological and electronic cigarette interventions for smoking cessation in adults: component network meta‐analyses. Cochrane Database Syst Rev. 2023;(9):CD015226.
McNeill A, Simonavičius E, Brose L, Taylor E, East K, Zuikova E, et al. Nicotine Vaping in England: an Evidence Update Including Health Risks and Perceptions. London, UK: King's College London; 2022.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems. In: Eaton DL, Kwan LY, Stratton K, editorsPublic Health Consequences of E‐cigarettes Washington, DC: The National Academies of Sciences, Engineering and Medicine; 2018.
Akiyama Y, Sherwood N. Systematic review of biomarker findings from clinical studies of electronic cigarettes and heated tobacco products. Toxicol Rep. 2021;8:282–294.
Hartmann‐Boyce J, Butler AR, Theodoulou T, Onakpoya IJ, Hajek P, Bullen C, et al. 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. 2022;118:539–545.
Lin W, Muscat JE. Knowledge and beliefs regarding harm from specific tobacco products: findings from the H.I.N.T. Survey. Am J Health Promot. 2021. https://doi.org/10.1177/08901171211026116
East K, Reid JL, Burkhalter R, Wackowski OS, Thrasher JF, Tattan‐Birch H, et al. Exposure to negative news stories about vaping, and harm perceptions of vaping, among youth in England, Canada, and the United States before and after the outbreak of E‐cigarette or Vaping‐Associated Lung Injury (‘EVALI’). Nicotine Tob Res. 2022;24:1386–1395.
Yong H‐H, Gravely S, Borland R, Gartner C, Cummings KM, East K, et al. Do smokers’ perceptions of the harmfulness of nicotine replacement therapy and nicotine vaping products as compared to cigarettes influence their use as an aid for smoking cessation? Findings from the ITC Four Country Smoking and Vaping Surveys. Nicotine Tob Res. 2022;24:1413–1421.
Perman‐Howe PR, Horton M, Robson D, McDermott MS, McNeill M, Brose LS. Harm perceptions of nicotine‐containing products and associated sources of information in UK adults with and without mental ill health: a cross‐sectional survey. Addiction. 2021;117:715–729.
Action on Smoking and Health. Use of e‐cigarettes (vapes) among adults in Great Britain. 2023. Available at: https://ash.org.uk/uploads/Use-of-e-cigarettes-among-adults-in-Great-Britain-2023.pdf. Accessed August 2023.
East K, Brose LS, McNeill A, Cheeseman H, Arnott D, Hitchman SC. Harm perceptions of electronic cigarettes and nicotine: a nationally representative cross‐sectional survey of young people in Great Britain. Drug Alcohol Depend. 2018;192:257–263.
King B, Borland R, Le Grande M, Diaz D, O’Connor R, East K, et al. Associations between smokers’ knowledge of causes of smoking harm and related beliefs and behaviors: findings from the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey. PLoS ONE. 2023;18:e0292856.
Committee on Toxicity of Chemicals in Food. Statement on the potential toxicological risks from electronic nicotine (and non‐nicotine) delivery systems (E(N)NDS – e‐cigarettes). 2020. Available at: https://cot.food.gov.uk/sites/default/files/2020-09/COT%20E%28N%29NDS%20statement%202020-04.pdf
Dawkins L, Cox S, Goniewicz M, McRobbie H, Kimber C, Doig M, et al. ‘Real‐world’ compensatory behaviour with low nicotine concentration e‐liquid: subjective effects and nicotine, acrolein and formaldehyde exposure. Addiction. 2018;113:1874–1882.
Kośmider L, Kimber CF, Kurek J, Corcoran O, Dawkins LE. Compensatory puffing with lower nicotine concentration e‐liquids increases carbonyl exposure in e‐cigarette aerosols. Nicotine Tob Res. 2017;20:998–1003.
Action on Smoking and Health. Headline results ASH Smokefree GB adults and youth survey results. 2023. Available at: https://ash.org.uk/uploads/Headline-results-ASH-Smokefree-GB-adults-and-youth-survey-results-2023.pdf?v=1684400380
Tattan‐Birch H, Jackson SE, Kock L, Dockrell M, Brown J. Rapid growth in disposable e‐cigarette vaping among young adults in Great Britain from 2021 to 2022: a repeat cross‐sectional survey. Addiction. 2023;118:382–386.
Leventhal AM, Tackett AP, Whitted L, Jordt SE, Jabba AV. Ice flavours and non‐menthol synthetic cooling agents in e‐cigarette products: a review. Tob Control. 2022;32:769–777.
Jabba SV, Erythropel HC, Torres DG, Delgado LA, Woodrow JG, Anastas PT, et al. Synthetic cooling agents in US‐marketed E‐cigarette refill liquids and popular disposable E‐cigarettes: chemical analysis and risk assessment. Nicotine Tob Res. 2022;24:1037–1046.
Brose L, Reid JL, Robson D, McNeill A, Hammond D. Associations between vaping and respiratory symptoms in young people in Canada, England and the US. BMC Med. In Press.
Effah F, Taiwo B, Baines D, Bailey A, Marczylo T. Pulmonary effects of e‐liquid flavors: a systematic review. J Toxicol Env Heal B. 2022;25:343–371.
Chang CM, Edwards SG, Arab A, del Valle‐Pinero AY, Yang L, Hatsukami DH. Biomarkers of tobacco exposure: summary of an FDA‐sponsored public workshop. Cancer Epidemiol Biomarkers Prev. 2017;26:291–302.
Benowitz NL, St Helen G, Liakoni E. Clinical pharmacology of electronic nicotine delivery systems (ENDS): implications for benefits and risks in the promotion of the combusted tobacco endgame. J Clin Pharmacol. 2021;61:S18–S36.
East K. What are people's views about the risks of vaping? Findings from conversations with the public. 2022. Available at: https://nrgppi.org/recent-research/what-are-people-s-views-about-the-risks-of-vaping
East KA, Tompkins CN, McNeill A, Hitchman SC. ‘I perceive it to be less harmful, I have no idea if it is or not:’ a qualitative exploration of the harm perceptions of IQOS among adult users. Harm Reduct J. 2021;18(1):42.
Brose LS, Brown J, Hitchman SC, McNeill A. Perceived relative harm of electronic cigarettes over time and impact on subsequent use. A survey with 1‐year and 2‐year follow‐ups. Drug Alcohol Depend. 2015;157:106–111.
Erku DA, Bauld L, Dawkins L, Gartner CE, Steadman KJ, Noar SM, et al. Does the content and source credibility of health and risk messages related to nicotine vaping products have an impact on harm perception and behavioural intentions? A systematic review. Addiction. 2021;116:3290–3303.
Yong HH, Borland R, Balmford J, Hitchman SC, Cummings KM, Driezen P, et al. Prevalence and correlates of the belief that electronic cigarettes are a lot less harmful than conventional cigarettes under the different regulatory environments of Australia and the United Kingdom. Nicotine Tob Res. 2017;19:258–263.
Neale J, Bouteloup A, M Getty M, Hogan C, Lennon P, McCusker M, et al. Why we should conduct research in collaboration with people who use alcohol and other drugs. Addiction. 2017;112:2084–2085.
East K, D’Mello K, Vu G, Sun T, Perman‐Howe PR, Taylor E et al. Perceptions of risks across vaping products: an online survey of adult smokers and vapers. Open Science Framework 2022. https://doi.org/10.17605/OSF.IO/KA2ZC
Prolific. London, UK. 2014. Available at: https://www.prolific.com
Jakobsen JC, Gluud V, Wetterslev J, Winkel R. When and how should multiple imputation be used for handling missing data in randomised clinical trials—a practical guide with flowcharts. BMC Med Res Methodol. 2017;17:162.
Buss V, Kock L, West R, Beard E, Kale D, Brown J. Smoking in England—E‐Cigarettes Latest Trends. 2024. Available at: https://smokinginengland.info/graphs/e-cigarettes-latest-trends
Wilson S, Partos T, McNeill A, Brose LS. Harm perceptions of e‐cigarettes and other nicotine products in a UK sample. Addiction. 2019;114:879–888. PMID: Prolific, London, UK. 2014. https://www.prolific.com
Benowitz NL, St Helen G, Nardone N, Addo N, Zhang JJ, Harvanko AM, et al. Twenty‐four‐hour cardiovascular effects of electronic cigarettes compared with cigarette smoking in dual users. J Am Heart Assoc. 2020;9:e017317.
Benowitz NL, Burbank AD. Cardiovascular toxicity of nicotine: implications for electronic cigarette use. Trends Cardiovasc Med. 2016;26:515.
Mills EJ, Thorlund K, Eapen S, Wu P, Prochaska JJ. Cardiovascular events associated with smoking cessation pharmacotherapies: a network meta‐analysis. Circulation. 2014;129:28.
Hilton S, Weishaar H, Sweeting H, Trevisan F, Katikireddi SV. E‐cigarettes, a safer alternative for teenagers? A UK focus group study of teenagers’ views. BMJ Open. 2016;6:e013271.
Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. London, UK: Silverback Publishing; 2014.
Tattan‐Birch H, Brown J, Shahab L, Jackson SE. Association of the US outbreak of vaping‐associated lung injury with perceived harm of e‐cigarettes compared with cigarettes. JAMA Netw Open. 2020;3:e206981.
Li Y, Burns AE, Tran LN, Abellar KA, Poindexter M, Li X, et al. Impact of e‐liquid composition, coil temperature, and puff topography on the aerosol chemistry of electronic cigarettes. Chem Res Toxicol. 2021;34:1640–1654.
Sleiman M, Logue JM, Montesinos VN, Russell ML, Litter MI, Gundel LA, et al. Emissions from electronic cigarettes: key parameters affecting the release of harmful chemicals. Environ Sci Technol. 2016;50:9644–9651.
Chang JT, Vivar JC, Tam J, Hammad HT, Christensen CH, van Bemmel DM, et al. Biomarkers of potential harm among adult cigarette and smokeless tobacco users in the PATH Study Wave 1 (2013–2014): a cross‐sectional analysis. Cancer Epidemiol Biomark Prev. 2021;30:1320–1327.