American Legacy Foundation staff, led by Dr. Jennifer Pearson, reported two surveys gauging awareness, use and perceptions of e-cigarettes.  The research was published in the American Journal of Public Health (abstract here).


One survey, the online KnowledgePanel, included 2,649 never, current and former smokers.  The other, the Legacy Longitudinal Smoker Cohort (LLSC), surveyed 3,658 current and former smokers.  Major findings appear in the table.


In both surveys, nearly 6 out of 10 smokers were aware of e-cigarettes – a higher percentage than among former smokers (42%) or never smokers (33%) in the KnowledgePanel survey.  However, only 6-11% of current smokers had used the devices; trial among former smokers was even lower.  Only 4% of smokers had used e-cigarettes in the past 30 days.


E-Cigarette Awareness, Use and Perception of Harm
KnowledgePanel LLSC
Never Smokers Former Smokers Current Smokers Former Smokers Current Smokers
Awareness 33% 42% 57% 58% 58%
Ever Use 0.8% 2% 11% 3% 6%
Less Harmful Than Cigarettes 71% 85%
Same/More Harmful 29% 15%


Among current smokers who were aware of e-cigarettes, 71-85% correctly believed they are less harmful than cigarettes.  The remainder, unfortunately, believed that e-cigarettes are just as or more harmful.


The American Legacy Foundation “is dedicated to building a world where young people reject tobacco and anyone can quit.”  In their introduction, the authors write that e-cigarettes “could act as a starter product for combustible cigarettes, especially among youths or young adults…”, but they offer no data on e-cigarette use among youth; even among adult never smokers, ever use is a minuscule 0.5%.


Dr. Pearson and colleagues suggest that e-cigarettes “may lure former smokers to return to nicotine dependence, delay cessation among current smokers, serve as a dual-use product, or enable individuals to avoid smoking restrictions.”  None of these concerns are supported by data.  There is no evidence that e-cigarettes “lure” former smokers into nicotine dependence.  Even if this did occur, it would not be a legitimate reason to deny current smokers access to them.  There is no proof that e-cigarettes delay cessation among current smokers.  In fact, Dr. Pearson writes that “The [KnowledgePanel] survey data suggested that some smokers who were interested in quitting were using [e-cigarettes] as cessation devices…” She asserts that this was “possibly discouraging the use of proven smoking cessation treatments…”  As I discussed several weeks ago (here), pharmaceutical nicotine products are “proven” to fail for 93% of smokers; this is enough to discourage their use.


Dr. Pearson and colleagues opine that, “Given the widespread availability, awareness, and use of [e-cigarettes] by millions of consumers, [they] should not be marketed until adequately tested and regulated by the FDA.”  In the coming months, the FDA is likely to issue regulations for e-cigarettes as tobacco products.


Already, millions of smokers are aware of e-cigarettes; a smaller number have used them; and many have learned that vaping is vastly safer than – and can successfully replace – smoking.

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