Perceived relative harm of e cigarettes and attitudes towards their availability, advertising and use: A longitudinal survey
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1 Perceived relative harm of e cigarettes and attitudes towards their availability, advertising and use: A longitudinal survey Leonie S Brose a,b,c, Sara C Hitchman b,c, Jamie Brown b,d, Ann McNeill b,c a Cancer Research UK b UK Centre for Tobacco and Alcohol Studies c Institute of Psychiatry, Psychology and Neuroscience, King s College London d University College London
2 Funding All authors are part of the UK Centre for Tobacco and Alcohol Studies, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the Medical Research Council, British Heart Foundation, Cancer Research UK, Economic and Social Research Council and the National Institute for Health Research under the auspices of the UK Clinical Research Collaboration is gratefully acknowledged (MR/K023195/1). This analysis was part funded by Cancer Research UK (C25586/A19540).
3 E cigarette use in Great Britain 2.6 million users, almost all are smokers or ex smokers
4 Background E cigarettes: Harm, benefits and appropriate policies discussed extensively Smoking kills at least 1 in 2 continuing smokers 1, 2 E cigarettes less harmful Public perceptions? Perceptions may influence behaviour Support for different potential policies? 1 Doll et al, Banks et al, 2015
5 Objectives Using a longitudinal survey of smokers and ex smokers from Great Britain, 1.To assess perceived harm of e cigarettes relative to cigarettes a) Changes over time? b) Association with subsequent use? 2.To assess attitudes towards availability, advertising and use in smoke free places a) Changes over time? b) Association with e cigarette use and smoking status? Work in progress
6 Internet cohort Baseline Dec 2012 n=5000 past year smokers n=4553 aware of e cigarettes 1 year follow up: n=2011 (44.2%) Panel based online survey National general population (GB) Quotas for sex, age, region Harm perception: All 3 waves Attitudes to policy: Follow ups only 2 year follow up: n=1407 (30.9%)
7 Do you think electronic cigarettes are more harmful than regular cigarettes, less harmful, or are they equally harmful to health? N=1204 aware of e cigs at all waves
8 Predictors of use in non users Among baseline non users, 23% were using e cigarettes 1 year later Baseline characteristics E cigarettes at least as harmful / don t know N (% of 1588) % using e cig 1 year later Adj. OR Lower 95% CI Upper 590 (37.2) E cigarettes less harmful 998 (62.8) Male (referent) 930 (58.6) Female 658 (41.4) Ex smoker (referent) 209 (13.2) Current smoker 1379 (86.8) Also adjusted for age, gender, annual income and education
9 Availability: Do you think that electronic cigarettes should be N=962
10 Advertising: Do you think that electronic cigarette companies should be allowed to advertise e cigarettes?
11 Use in smoke free places: Do you think people should be allowed to use e cigarettes where smoking is not allowed?
12 Availability (2014) E cig use OR 95% CI Never tried (ref) Tried, not using < daily use Daily use Crude odds ratios for should be more available Don t know excluded E cig use OR 95% CI Current smoker
13 Advertising (2014) E cig use OR 95% CI Never tried (ref) Tried, not using < daily use Daily use Crude odds ratios for should be allowed Don t know excluded E cig use OR 95% CI Current smoker
14 Use in smoke free places (2014) E cig use OR 95% CI Never tried (ref) Tried, not using < daily use Daily use Crude odds ratios for should be allowed Don t know excluded E cig use OR 95% CI Current smoker
15 (Differential) attrition Some limitations & strengths Generally, comparable to other surveys 1 Snapshots, changes between waves not recorded Currently crude analysis Generalised estimating equations incl. demographics, e cigarette and smoking status and health harm due to nicotine Agreement with and extension of previous findings 2, 3 First longitudinal study with detailed information on perception, policy support and behaviour 1 Partos et al, ASH, Kular et al, 2014
16 Summary & Conclusions Increase in perceived harm over time Due to focus on risks of e cigarettes without comparing with cigarettes? Perceiving e cigarettes as less harmful predicted subsequent use in never users Misperceptions may impede switching Information on relative harm needed Small increases in support of restrictions on e cigarette advertising and use in smoke free places E cigarette users less likely to support restrictions Smokers more likely to support restricted availability, exsmokers restricted advertising and use in smoke free
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