Top

BMC Medicine

Published in:

Open Access 01-12-2020 | Research article

Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis

Authors: Olga Perski, Emma Beard, Jamie Brown

Published in: BMC Medicine | Issue 1/2020

Abstract

Background

There is a decreasing trend in the proportion of individuals who perceive e-cigarettes to be less harmful than conventional cigarettes across the UK, Europe and the US. It is important to assess whether this may influence the use of e-cigarettes. We aimed to estimate, using a time series approach, whether changes in harm perceptions among current tobacco smokers have been associated with changes in the prevalence of e-cigarette use in England, with and without stratification by age, sex and social grade.

Methods

Respondents were from the Smoking Toolkit Study, which involves monthly cross-sectional household surveys of individuals aged 16+ years in England. Data were aggregated monthly on ~ 300 current tobacco smokers between 2014 and 2019. The outcome variable was the prevalence of e-cigarette use. The explanatory variable was the proportion of smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes. Covariates were cigarette (vs. non-cigarette combustible) current smoking prevalence, past-year quit attempt prevalence and national smoking mass media expenditure. Unadjusted and adjusted autoregressive integrated moving average with exogeneous variables (ARIMAX) models were fitted.

Results

For every 1% decrease in the mean prevalence of current tobacco smokers who endorsed the belief that e-cigarettes are less harmful than combustible cigarettes, the mean prevalence of e-cigarette use decreased by 0.48% (β_adj = 0.48, 95% CI = 0.25–0.71, p < .001). Marginal age and sex differences were observed, whereby significant associations were observed in older (but not in young) adults and in men (but not in women). No differences by social grade were detected.

Conclusions

Between 2014 and 2019 in England, at the population level, monthly changes in the prevalence of accurate harm perceptions among current tobacco smokers were strongly associated with changes in e-cigarette use.

Available only for authorised users

World Health Organisation. WHO report on the global tobacco epidemic; 2019. p. 1–109. Available from: https://www.who.int/tobacco/global_report/en/.

Hajek P, Etter J-F, Benowitz N, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction. 2014;109:1801–10.CrossRef

McNeill A, Brose LS, Calder R, Bauld L, Robson D. Vaping in England: an evidence update February 2019. A report commissioned by Public Health England; 2019.

National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Chicago: National Academies Press. 2018.

Nutt DJ, Phillips LD, Balfour D, Valerie VH, Dockrell M, Foulds J, et al. Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014;20:218–25.CrossRef

Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. Br Med J. 2016;354:i4645.CrossRef

Zhu S, Zhuang Y, Wong S, Cummins SE, Tedeschi GJ. E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys. Br Med J. 2017;358:j3262.

Adkison SE, Connor RJO, Bansal-Travers M, Hyland A, Borland R, Yong H-H, et al. Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med. 2013;44(3):207–15 Available from: https://doi.org/10.1016/j.amepre.2012.10.018.CrossRef

Ambrose BK, Rostron BL, Johnson SE, Portnoy DB, Apelberg BJ, Kaufman AR, et al. Perceptions of the relative harm of cigarettes and e-cigarettes among U.S. youth. Am J Prev Med. 2014;47(2S1):S53–60 Available from: https://doi.org/10.1016/j.amepre.2014.04.016.CrossRef

10.

Amrock SM, Zakhar J, Zhou S, Weitzman M. Perception of e-cigarette harm and its correlation with use among U.S. adolescents. Nicotine Tob Res. 2015;17(3):330–6.

11.

Pokhrel P, Fagan P, Kehl L, Herzog TA. Receptivity to e-cigarette marketing, harm perceptions, and e-cigarette use. Am J Health Behav. 2015;39(1):121–31.CrossRef

12.

Richardson A, Pearson J, Xiao H, Stalgaitis C, Vallone D. Prevalence, harm perceptions, and reasons for using noncombustible tobacco products among current and former smokers. Am J Public Health. 2014;104(8):1437–44.CrossRef

13.

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;157:106–11 Available from: https://doi.org/10.1016/j.drugalcdep.2015.10.014.CrossRef

14.

Wilson S, Partos T, McNeill A, Brose LS. Harm perceptions of e-cigarettes and other nicotine products in a UK sample. Addiction. 2019:114(5):879–88.

15.

Eichler M, Blettner M, Singer S. The use of E-cigarettes: a population-based cross-sectional survey of 4002 individuals in 2016. Dtsch Arztebl Int. 2016;113:847–54.PubMedPubMedCentral

16.

Yong H, 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(2):258–63.

17.

Huang J, Feng B, Weaver SR, Pechacek TF, Slovic P, Eriksen MP. Changing perceptions of harm of e-cigarette vs cigarette use among adults in 2 US National Surveys from 2012 to 2017. JAMA Netw Open. 2019;2(3):e191047.CrossRef

18.

Brown J, West R, Beard E, Michie S, Shahab L, McNeill A. Prevalence and characteristics of e-cigarette users in Great Britain: findings from a general population survey of smokers. Addict Behav. 2014;39:1120–5 Available from: https://doi.org/10.1016/j.addbeh.2014.03.009.CrossRef

19.

Pericot-Valverde I, Gaalema DE, Priest JS, Higgins ST. E-cigarette awareness, perceived harmfulness, and ever use among U.S. adults. Prev Med (Baltim), Available from. 2017;104:92–9 https://doi.org/10.1016/j.ypmed.2017.07.014.

20.

Majeed BA, Weaver SR, Gregory KR, Whitney CF, Slovic P, Pechacek TF, et al. Changing perceptions of harm of e-cigarettes among U.S. adults, 2012–2015. Am J Prev Med. 2017;52(3):331–8 Available from: https://doi.org/10.1016/j.amepre.2016.08.039.CrossRef

21.

Huerta TR, Walker DM, Mullen D, Johnson TJ, Ford EW. Trends in e-cigarette awareness and perceived harmfulness in the U.S. Am J Prev Med. 2017;52(3):339–46 Available from: https://doi.org/10.1016/j.amepre.2016.10.017.CrossRef

22.

European Commission. Special Eurobarometer 458 - attitudes of Europeans towards tobacco and electronic cigarettes. 2017. Available from: http://ec.europa.eu/commfrontoffice/publicopinion/index.cfm/Survey/getSurveyDetail/instruments/SPECIAL/surveyKy/2146.

23.

Czoli CD, Fong GT, Mays D, Hammond D. How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes. Tob Control. 2017;26:e49–58.CrossRef

24.

Bauld L, Angus K, De Andrade M. E-cigarette uptake and marketing: a report commissioned by Public Health England; 2014.

25.

Tan ASL, Bigman CA. E-cigarette awareness and perceived harmfulness: prevalence and associations with smoking-cessation outcomes. Am J Prev Med [Internet]. 2014;47(2):141–9 Available from: https://doi.org/10.1016/j.amepre.2014.02.011.CrossRef

26.

Eastwood B, Dockrell MJ, Arnott D, Britton J, Cheeseman H, Jarvis M, et al. Electronic cigarette use in young people in Great Britain 2013-2014. Public Health. 2015;129:1150–6 Available from: https://doi.org/10.1016/j.puhe.2015.07.009.CrossRef

27.

Filippidis FT, Laverty AA, Gerovasili V, Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tob Control. 2017;26:98–104.CrossRef

28.

Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, et al. Overview of electronic nicotine delivery systems: a systematic review. Am J Prev Med. 2017;52(2):e33–66 Available from: https://doi.org/10.1016/j.amepre.2016.10.036.CrossRef

29.

Bernat JK, Ferrer RA, Margolis KA, Blake KD. US adult tobacco users’ absolute harm perceptions of traditional and alternative tobacco products, information-seeking behaviors, and (mis) beliefs about chemicals in tobacco products. Addict Behav. 2017;71:38–45 Available from: https://doi.org/10.1016/j.addbeh.2017.02.027.CrossRef

30.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche C, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7 Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10385327.CrossRef

31.

Fidler JA, Shahab L, West O, Jarvis MJ, McEwen A, Stapleton JA, et al. “The smoking toolkit study”: a national study of smoking and smoking cessation in England. BMC Public Health. 2011;11(1):479 Available from: http://www.biomedcentral.com/1471-2458/11/479.CrossRef

32.

Jackson SE, Beard E, Kujawski B, Sunyer E, Michie S, Shahab L, et al. Comparison of trends in self-reported cigarette consumption and sales in England, 2011 to 2018. JAMA Netw Open. 2019;2(8):e1910161.CrossRef

33.

Jackson SE, Beard E, Michie S, Shahab L, Raupach T, West R, et al. Are smokers who are regularly exposed to e-cigarette use by others more or less motivated to stop or to make a quit attempt? A cross-sectional and longitudinal survey. BMC Med. 2018;16(206):1–9.

34.

Levy DT, Yuan Z, Luo Y, Abrams DB. The relationship of E-cigarette use to cigarette quit attempts and cessation: insights from a large, nationally representative U.S. survey. Nicotine Tob Res. 2018;20(8):931–9.CrossRef

35.

IPSOS MediaCT. Social Grade: A Classification Tool. 2009.

36.

Kotz D, West R. Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tob Control. 2009;18:43–6.CrossRef

37.

Sharot T. Weighting survey results. J Mark Res Soc. 1986;28(3):269–84.

38.

Beard E, Marsden J, Brown J, Tombor I, Stapleton J, Michie S. Understanding and using time series analyses in addiction research. Addiction. 2019;114(10):1866–84.

39.

Box GEP, Jenkins GM, Reinsel GC. Time series analysis: forecasting and control. Wiley; 2011.

40.

Lee D, Schmidt P. On the power of the KPSS test of stationarity against fractionally-integrated alternatives. J Econom. 1996;73:285–302.CrossRef

41.

Osborn DR, Chu APL, Smith JP, Birchenhall CR. Seasonality and the order of integration for consumption*. Oxf Bull Econ Stat. 1988;50(4):361–77.CrossRef

42.

Cryer JD, Chan K-S. Time series analysis: with applications in R. 2nd ed. New York: Springer-Verlag; 2008.CrossRef

43.

Yaffee R. An introduction to forecasting time series with Stata. New York: Taylor & Francis; 2012.

44.

Kuipers MAG, Beard E, West R, Brown J. Associations between tobacco control mass media campaign expenditure and smoking prevalence and quitting in England: a time series analysis. Tob Control. 2018;27(4):455–62.CrossRef

45.

McNeill A, Brose LS, Calder R, Bauld L, Robson D. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England; 2018.

46.

Lapsley DK, Hill PL. Subjective invulnerability, optimism bias and adjustment in emerging adulthood. J Youth Adolesc. 2010;39(8):847–57.CrossRef

Title: Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis
Authors: Olga Perski
Emma Beard
Jamie Brown
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-020-01565-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association between changes in harm perceptions and e-cigarette use among current tobacco smokers in England: a time series analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Sugar intake and all-cause mortality—differences between sugar-sweetened beverages, artificially sweetened beverages, and pure fruit juices

Aspirin and other non-steroidal anti-inflammatory drugs and depression, anxiety, and stress-related disorders following a cancer diagnosis: a nationwide register-based cohort study

Can real-world data really replace randomised clinical trials?

Guidance for identification and treatment of individuals with attention deficit/hyperactivity disorder and autism spectrum disorder based upon expert consensus

The association between frailty and severe disease among COVID-19 patients aged over 60 years in China: a prospective cohort study

Maternal iodine status, intrauterine growth, birth outcomes and congenital anomalies in a UK birth cohort