The number of US adults who think e-cigarettes are more harmful than traditional tobacco products has effectively doubled year on year from 2018 to 2020, according to new research – and that has affected smoking rates.

The study, led by researchers from the American Cancer Society (ACS), found 28.3% of the roughly 3,300 Americans surveyed in 2020 believed vaping was more harmful than smoking – up from 12.8% in 2019 and 6.8% in 2018 – possibly influenced by scares over Evali and Covid.
Those who perceived e-cigarettes as less harmful than smoking dropped from 17.6% in 2018 to 11.4% in 2020, while the belief that they were equally harmful remained relatively steady at 35.6% in 2020 compared to 37.4% in 2018.
The researchers said the trend was worrying because harm perception could be guiding tobacco product use, as changes in use primarily occurred among people who believed their preferred product was less harmful, and the widespread belief that vaping was as bad as smoking was leading to an overall increase in use of combustible tobacco products.
Comparing survey responses on harm perception to responses about use, they found that among those who believed e-cigarettes to be less harmful, exclusive e-cigarette use increased and exclusive smoking declined linearly between 2018 and 2020. Among those who said the two were equally harmful, dual use increased linearly between 2018 and 2020 while among those that said e-cigarettes were more harmful, exclusive smoking almost doubled from 8.4% in 2019 to 16.3% in 2020 after declining between 2018 (18.5%) and 2019 (8.4%).
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