NUMBER 28

Awareness of Electronic Cigarettes 

and Perceptions of Harmfulness 

The American Association for Cancer Research and 

the American Society for Clinical Oncology recently 

released a joint statement cautioning the public on 

the use of electronic nicotine delivery systems (which 

include electronic cigarettes, also called e-cigarettes), 

their potential harms, and the unsubstantiated benefits 

of their use. They join a growing list of influential 

organizations, including the World Health Organization, 

American Heart Association, American Lung Association, 

and others, that have expressed concern about the 

expanding e-cigarette marketplace, the proliferation of 

new products, the rising number of youth and adults who 

have tried or use e-cigarettes, and the lack of federal 

oversight of these products. 

Currently, e-cigarettes are not regulated under the 

Family Smoking Prevention and Tobacco Control Act of 

2009; therefore, many of the regulations that apply to 

regular cigarettes (such as banning television advertising) 

do not apply to e-cigarettes. E-cigarette companies 

are not required to disclose the ingredients contained 

in the e-liquid or the aerosol produced from using 

their product, nor are they required to include health 

warning labels as regular cigarettes do. Although some 

smokers report using e-cigarettes as a cessation aid, the 

effectiveness of these products in helping people to quit 

and whether they serve to delay or hinder cessation 

efforts is not yet clear.

In this HINTS Brief, we explore e-cigarette awareness, 

use, and perceived harmfulness and suggest strategies for 

provider-patient discussions and health communication 

interventions.

HINTS has explored the public’s perception and use 

of tobacco products since it was first administered 

in 2003. In 2012, HINTS began collecting data on the 

public’s awareness of e-cigarettes and perceptions of 

harmfulness. Since then, awareness of e-cigarettes has 

grown. Using HINTS data, the proportion of U.S. adults 

reporting they had never heard of e-cigarettes dropped 

from 22.3% in 2012 to 13.6% in 2013.

Quick Facts

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E-cigarettes are battery-operated devices designed 

to deliver nicotine in an aerosolized form (commonly 

called vapor) to users by heating a solution that typically 

contains propylene glycol and/or glycerol, nicotine, and 

flavoring agents.

The percentage of adults who have used an e-cigarette 

rose from 3.3% in 2010 to 8.5% in 2013. Current 

cigarette smokers who have ever used an e-cigarette 

increased from 9.8% in 2010 to 36.5% in 2013.

More than 263,000 middle and high school students who 

had never smoked a regular cigarette had tried electronic 

cigarettes in 2013. This number reflects a threefold 

increase, from about 79,000 in 2011.

*Percentages do not add to 100% due to missing data.

Compared to smoking regular cigarettes, would 

you say that electronic cigarettes are:*

2012 2013

8.3%

22.3%

1.2% 0.9%

29.9%

34.9% 9.8%

13.6%

2.8% 1.6%

30.0%

35.4%

Much less harmful | 8.3% in 2012 vs. 9.8% in 2013

Less harmful | 29.9% in 2012 vs. 30.0% in 2013

Just as harmful | 34.9% in 2012 vs. 35.4% in 2013

More harmful | 1.2% in 2012 vs. 2.8% in 2013

Much more harmful | 0.9% in 2012 vs. 1.6% in 2013

I have never heard of e-cigarettes | 22.3% in 2012 vs. 13.6% in 2013

In this HINTS Brief, we explore the public’s awareness of e-cigarettes and perceptions of harmfulness.
Awareness and Perceived Harmfulness of E-cigarettes and Associations with 

Smoking Cessation

Using HINTS 4 Cycle 2 data (collected October 2012 to January 2013), Tan and Bigman examined awareness and perceived harmfulness 

of e-cigarettes as compared with regular cigarettes and also examined associations between e-cigarette awareness and intentions or 

attempts to quit smoking. Findings on awareness were compared with results from other national surveys conducted between 2009-2012.

Awareness of e-cigarettes

Awareness of e-cigarettes among U.S. adults has risen dramatically from 2009, when 16% of adults reported having heard of e-cigarettes, 

to the more than three-quarters (77%) of HINTS respondents in 2012 who indicated that they had heard of e-cigarettes.

Perceptions of e-cigarette harmfulness

By comparing HINTS findings to a previous survey, study authors found that, among current smokers aware of e-cigarettes, there was 

a decline (85% in 2010 to 65% in 2012) in the proportion who believed that e-cigarettes are less harmful than regular cigarettes. The 

study found that older respondents were less likely to believe that e-cigarettes are less harmful than regular cigarettes, as compared with 

respondents aged 18–34 years. Those who had college or higher education were more than twice as likely as those with high school or 

lower education to believe e-cigarettes were less harmful. Compared to non-smokers, current smokers were two and a half times more 

likely to say that e-cigarettes were less harmful.

Association with past-year quit attempts and intentions to quit

Analyzing HINTS results, this study did not find an association between awareness of e-cigarettes and current smokers’ quit attempts in 

the past year or their intention to quit in the next 6 months. Among those current smokers who were aware of e-cigarettes, perceived 

harmfulness of e-cigarettes was also not associated with previous quit attempts or intentions to quit.

The National Cancer Institute (NCI) created the Health Information National Trends Survey (HINTS) to monitor 

changes in the rapidly evolving field of health communication. The survey data can be used to understand how 

adults use different communication channels to obtain health information for themselves and their loved ones. It 

can also help to create more effective health communication strategies across populations. 

NCI fielded the first HINTS survey in 2002–2003, surveying 6,369 Americans. Subsequent surveys followed in 2005 (5,586 Americans 

surveyed), 2008 (7,674 Americans surveyed), 2011–2012 (3,959 Americans surveyed), 2012–2013 (3,630 Americans surveyed), and 2013 

(3,185 Americans surveyed).

HINTS Briefs provide a snapshot of noteworthy, data-driven research findings. They introduce population-level estimates for specific 

questions in the survey and summarize significant research findings resulting from analyses of how certain demographic characteristics 

influence specific outcomes. Many Briefs summarize research findings from recent peer-reviewed journal articles using HINTS data.

How Can This Inform Your Work?

Awareness of e-cigarettes is widespread among adults and 

growing steadily among adolescents. Health communication 

professionals and health care providers should be prepared to 

provide accurate information or counseling to the public as use 

of e-cigarettes continues to rise.

• As awareness and use of e-cigarettes increases, education is 

needed to help the public understand the current evidence 

and what it tells us about the potential benefits and harms of 

using e-cigarettes. 

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Increasingly, youth have tried or use e-cigarettes. Using 

tobacco products, whether regular cigarettes, smokeless 

tobacco, or electronic nicotine delivery systems such as 

e-cigarettes, is harmful for adolescents.

Health communication professionals should develop effective 

evidence-based messaging and campaigns concerning 

e-cigarettes. 

Health care providers who counsel adult patients on 

smoking cessation should direct patients to cessation 

counseling and FDA-approved medications. Refer smokers 

to 1-800-QUIT-NOW and smokefree.gov for additional 

cessation counseling and resources.

About HINTS

hints.cancer.gov

For More Information on Cancer

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Call the NCI Cancer Information Service at 1-800-4-CANCER

Visit http://cancer.gov

Order NCI publications at https://pubs.cancer.gov/ncipl/home.aspx

Visit Facebook.com/cancer.gov and http://www.youtube.com/ncigov

References Used in This HINTS Brief

Brandon TH, Goniewicz ML, Hanna NH, Hatsukami DK, Herbst RS, Hobin JA, Ostroff JS, 

Shields PG, Toll BA, Tyne CA, Viswanat, K, and Warren GW. Electronic nicotine delivery 

systems: A policy statement from the American Association for Cancer Research and the 

American Society of Clinical Oncology. Clinical Cancer Research 2015; 21(3):1–12.

Bunnell RE, Agaku IT, Arrazola RA, Apelberg BJ, Caraballo RS, Corey CG, Coleman BN, 

Dube SR, and King BA. Intentions to smoke cigarettes among never-smoking U.S. middle 

and high school electronic cigarette users: National Youth Tobacco Survey, 2011–2013. 

Nicotine Tobacco Research 2015; 17(2):228–35.

Grana R, Benowitz N, and Glantz SA. E-cigarettes: A scientific review. Circulation 2014; 

129:1972–1986.

King BA, Patel R, Hguyen KH, and Dube SR. Trends in awareness and use of electronic 

cigarettes among U.S. adults, 2010–2013. Nicotine and Tobacco Research; 17(2): 219–227.

Tan ASL, and Bigman CA. E-cigarette awareness and perceived harmfulness. American 

Journal of Preventive Medicine 2014; 47(2):141–149. February 2015