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
Authors: Gravely Shannon , Driezen Pete , Kyriakos Christina N , Thompson Mary E , Balmford James , Demjén Tibor , Fernández Esteve , Mons Ute , Tountas Yannis , Janik-Koncewicz Kinga , Zatoński Witold , Trofor Antigona C , Vardavas Constantine I , Fong Geoffrey T ,   the EUREST-PLUS Consortium, Vardavas Constantine I , Glahn Andrea , Kyriakos Christina N , Nguyen Dominick , Nikitara Katerina , Radu-Loghin Cornel , Starchenko Polina , Tsatsakis Aristidis , Girvalaki Charis , Igoumenaki Chryssi , Papadakis Sophia , Papathanasaki Aikaterini , Tzatzarakis Manolis , Vardavas Alexander I , Bécuwe Nicolas , Deaconu Lavinia , Goudet Sophie , Hanley Christopher , Rivière Oscar , Demjén Tibor , Kiss Judit , Kovacs Anna Piroska , Fernández Esteve , Castellano Yolanda , Fu Marcela , Nogueira Sarah O , Tigova Olena , McNeill Ann , East Katherine , Hitchman Sara C , Mons Ute , Kahnert Sarah , Tountas Yannis , Behrakis Panagiotis , Filippidis Filippos T , Gratziou Christina , Katsaounou Paraskevi , Peleki Theodosia , Petroulia Ioanna , Tzavara Chara , Trofor Antigona Carmen , Eremia Marius , Lotrean Lucia , Mihaltan Florin , Rohde Gernot , Asano Tamaki , Cichon Claudia , Far Amy , Genton Céline , Jessner Melanie , Hedman Linnea , Janson Christer , Lindberg Ann , Maguire Beth , Ravara Sofia , Vaccaro Valérie , Ward Brian , Willemsen Marc , de Vries Hein , Hummel Karin , Nagelhout Gera E , Zatoński Witold A , Herbeć Aleksandra , Janik-Koncewicz Kinga , Przewoźniak Krzysztof , Zatoński Mateusz , Fong Geoffrey T , Agar Thomas K , Driezen Pete , Gravely Shannon , Quah Anne C K , Thompson Mary E 
Published: February 2020

AbstractBackgroundThis study presents perceptions of the harmfulness of electronic cigarettes (e-cigarettes) relative to combustible cigarettes among smokers from six European Union (EU) countries, prior to the implementation of the EU Tobacco Products Directive (TPD), and 2 years post-TPD.MethodsData were drawn from the EUREST-PLUS ITC Europe Surveys, a cohort study of adult smokers (≥18 years) from Germany, Greece, Hungary, Poland, Romania and Spain. Data were collected in 2016 (pre-TPD: N = 6011) and 2018 (post-TPD: N = 6027). Weighted generalized estimating equations were used to estimate perceptions of the harmfulness of e-cigarettes compared to combustible cigarettes (less harmful, equally harmful, more harmful or ‘don’t know’).ResultsIn 2016, among respondents who were aware of e-cigarettes (72.2%), 28.6% reported that they perceived e-cigarettes to be less harmful than cigarettes (range 22.0% in Spain to 34.1% in Hungary). In 2018, 72.2% of respondents were aware of e-cigarettes, of whom 28.4% reported perceiving that e-cigarettes are less harmful. The majority of respondents perceived e-cigarettes to be equally or more harmful than cigarettes in both 2016 (58.5%) and 2018 (61.8%, P &gt; 0.05). Overall, there were no significant changes in the perceptions that e-cigarettes are less, equally or more harmful than cigarettes, but ‘don’t know’ responses significantly decreased from 12.9% to 9.8% (P = 0.036). The only significant change within countries was a decrease in ‘don’t know’ responses in Spain (19.3–9.4%, P = .001).ConclusionsThe majority of respondents in these six EU countries perceived e-cigarettes to be equally or more harmful than combustible cigarettes.