Research & Commentary: Despite Scientific Evidence, More Americans Believe E-Cigarettes Are as Harmful as Tobacco Cigarettes

Published April 2, 2019

A study in JAMA reveals the percentage of U.S. adults “who perceived e-cigarettes to be as harmful as or more harmful than [combustible] cigarettes increased substantially from 2012 to 2017.”

The authors analyzed data from the Tobacco Product and Risk Perception Survey (TPRPS), which was conducted by the Tobacco Center of Regulatory Science at the School of Public Health at Georgia State University at Atlanta. They also used data from the Health Informational National Trends Survey by the National Cancer Institute in Rockville, Maryland (HINTS).

The study’s authors found from 2012 to 2017, the “proportion of adults who perceived e-cigarettes as less harmful” than combustible cigarettes decreased from 39.4 to 33.9 percent in the TPRPS and from 50.7 to 34.5 percent in the HINTS. In the same period, the number of adults who say e-cigarettes are as harmful as cigarettes jumped from 11.5 percent to 36.4 percent in the TPRPS survey and from 46.4 to 55.6 percent in the HINTS survey

These findings “underscore the urgency to convey accurate risk information about e-cigarettes to the public, especially adult smokers who are unable or unwilling to quit smoking,” the authors note. They also added that misperceptions about the relative harm of electronic cigarettes and vaping devices may “deter current smokers from initiating or continuing of e-cigarettes.”

This research is consistent with a 2018 study that found “a majority of adults erroneously link nicotine to cancer.” Researchers at PinneyAssociates, a pharmaceutical research firm, analyzed data from the 2017 HINTS and found 53 percent of respondents “said they believe that nicotine causes most of the cancer related to smoking.”

Unfortunately, actions by state lawmakers have fueled misperceptions on the efficacy of e-cigarettes and vaping devices. In 2019, several states introduced bills to regulate, tax, and even prohibit electronic cigarettes. States have brought forth Tobacco 21 and Vaping 21 proposals, which would severely restrict access to cigarettes and THR devices. Other legislation would regulate e-cigarettes as tobacco products.

Across the country, lawmakers have also introduced draconian taxes on vaping devices, despite the negative impact of similar taxes in recent years. In 2016, Pennsylvania enacted a 60 percent wholesale floor tax on e-cigarettes. Within a year, an estimated 120 vape shops closed in the commonwealth.

There is also legislation in California, Hawaii, and New York banning flavors other than tobacco and menthol in tobacco products and vaping devices. These bans were created even after a study of nearly 70,000 vapers found flavors played an important role in e-cigarette initiation and continued use.

Approximately three million Americans have used e-cigarettes and vaping devices to quit smoking, and a 2019 study found the use of these products to be “twice as effective as nicotine replacement [therapy] in helping smokers quit.” Notable public health groups, including Public Health England, the Royal College of Physicians, American Cancer Society, and National Academies of Sciences, Engineering, and Medicine have found e-cigarettes are less harmful than combustible cigarettes.

Rather than imposing arbitrary taxes, onerous regulations, and legislation banning flavors, lawmakers should promote the use of e-cigarettes and vaping devices as effective tobacco cessation tools that have helped millions of American adults quit smoking.

The following documents provide more information on e-cigarettes and tobacco harm reduction.

Vaping, E-Cigarettes, and Public Policy Toward Alternatives to Smoking
For decades, lawmakers and regulators have used taxes, bans, and burdensome regulations as part of their attempt to reduce the negative health effects of smoking. Recently, some have sought to extend those policies to electronic cigarettes. This booklet from The Heartland Institute urges policymakers to re-think that tax-and-regulate strategy. Policymakers should be mindful of the extensive research that supports tobacco harm reduction and understand bans, excessive regulations, and high taxes on e-cigarettes often encourage smokers to continue using more-harmful traditional cigarette products.

Podcast Series: Voices of Vapers
In this weekly podcast series, State Government Relations Manager Lindsey Stroud talks with researchers, advocates, and policymakers about tobacco harm reduction and electronic cigarettes. The series provides important information about the thousands of entrepreneurs who have started small businesses thanks to THRs and the millions of adults that have used electronic cigarettes and vaping devices to quit smoking tobacco cigarettes.

Research & Commentary: Randomized Trial Finds E-Cigarettes Are More Effective Smoking Cessation Tool Than Nicotine Replacement Therapy–commentary-randomized-trial-finds-e-cigarettes-are-more-effective-smoking-cessation-tool-than-nicotine-replacement-therapy
Lindsey Stroud, a State Government Relations Manager at The Heartland Institute examines a study in The New England Journal of Medicine that finds e-cigarettes and vaping devices to be twice as effective as nicotine replacement therapy (NRT) in helping smokers quit cigarettes. Nearly 700 participants were studied over a 52-week period, with researchers finding that 18 percent of e-cigarette users reported abstinence, compared to 9 percent of those using NRT. Stroud writes that “these latest findings provide more valuable information on the public health role that e-cigarettes and vaping devices provide for the 38 million cigarette smokers in the United States,” an implores policymakers to regulate these devices in a way that promotes their usage.

Research & Commentary: Vaping Taxes and Bans Hurt Smokers Trying to Quit–commentary-vaping-taxes-and-bans-hurt-smokers-trying-to-quit
In this Research & Commentary, Heartland Institute Senior Policy Analyst Matthew Glans and State Government Relations Manager Lindsey Stroud examine vaping bans and taxes and consider how such measures block or limit what is for many smokers an effective method for halting the use of tobacco cigarettes.

Research & Commentary: Largest Vaping Survey Finds Flavors Play Important Role in Tobacco Harm Reduction–commentary-largest-vaping-survey-finds-flavors-play-important-role-in-tobacco-harm-reduction
In this Research & Commentary, Heartland State Government Relations Manager Lindsey Stroud examines a survey of nearly 70,000 adult vapers in the United States. The survey was completed in response to the U.S. Food and Drug Administration’s recent Advanced Notice of Proposed Rulemaking seeking comment on the role of flavors in tobacco products. The authors found nearly 95 percent of survey respondents were at one time smokers and the majority reported using flavors at the point of e-cigarette initiation. Stroud compares this to other surveys. She concludes, “eliminating flavors will force [vapers] to vape only tobacco-flavored e-cigarettes, which would likely cause them to return to combustible cigarettes.” Stroud also found research has found e-cigarettes are a key tobacco harm reduction product and could help alleviate state budgets by mitigating health care costs.

Research & Commentary: ‘Vaping 21’ Laws Favor Cigarettes Over Tobacco Harm Reduction–commentary-vaping-21-laws-favor-cigarettes-over-tobacco-harm-reduction.

In this Research & Commentary, Lindsey Stroud, a state government relations manager at The Heartland Institute, examines several proposals to increase the age to purchase vaping products from 18 to 21 without restricting access to combustible tobacco cigarettes—even though tobacco products are significantly more harmful.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this and other topics, visit the Budget & Tax News website, The Heartland Institute’s website, our Consumer Freedom Lounge, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus; host an event in your state; or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact Lindsey Stroud, a state government relations manager at Heartland, at [email protected] or 757/354-8170.