European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys.

Introduction:
This text presents the findings of a study examining European adult smokers' perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes in six European Union (EU) countries, before and after the implementation of the EU Tobacco Products Directive (TPD). The study aims to understand changing patterns of product use and the impact of regulations on harm perceptions.

Key points:

1. The study was conducted as part of the EUREST-PLUS- HCO-06-2015 project and involved a prospective cohort study of adult smokers from six EU countries.
2. Data were collected in two waves: pre-TPD (2016) and post-TPD (2018).
3. The study found that the majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes, both prior to and after the TPD implementation.
4. The perception that e-cigarettes are less harmful than combustible cigarettes was highest in Hungary (34.1% in 2016 and 35.1% in 2018) and Greece (33.5% in 2016 and 33.2% in 2018).
5. Respondents who self-reported current e-cigarette use were four times more likely than never-e-cigarette users to perceive e-cigarettes to be less harmful than cigarettes.
6. The implementation of the TPD did not have a significant impact on relative harm perceptions over time.
7. Public health communication should be framed to reduce confusion between relative and absolute harms, as smokers in the EU commonly overestimate the relative risk of e-cigarettes compared to combustible cigarettes.

Main message:
The study emphasizes that there is a need for clear and accurate public health communication regarding the relative harm of e-cigarettes compared to combustible cigarettes. The majority of European adult smokers perceive e-cigarettes as equally or more harmful than combustible cigarettes, even after the implementation of the TPD. This misperception may hinder the potential of e-cigarettes in reducing the health-related harms of tobacco smoking. Therefore, it is crucial to provide balanced information to smokers who are interested in using e-cigarettes as a harm reduction alternative to combustible cigarettes.

Gravely S, Driezen P, Kyriakos CN, et al. European adult smokers’ perceptions of the harmfulness of e-cigarettes relative to combustible cigarettes: cohort findings from the 2016 and 2018 EUREST-PLUS ITC Europe Surveys. European journal of public health. 2020;30:iii38-iii45. doi:10.1093/eurpub/ckz215