Widespread Misperception of Relative Risks of ENDS versus Cigarette Smoking among Key Populations for Tobacco Harm Reduction in a 2022 Representative U.S. Sample

Summary Objective Tobacco harm reduction (THR) using represents a pragmatic and realistic strategy, to which electronic nicotine delivery systems (ENDS) misperceptions act as a barrier. This paper explores ENDS misperceptions, especially among certain groups disproportionately affected by smoking. Methods Using the Population Assessment of Tobacco and Health (PATH) Wave 7 (2022), key populations for THR were identified as 3,481 adults who exclusively smoke (AWES) and who are not planning to quit within 30 days (NPQ), 56% of whom were male. Non-White racial/ethnic groups, male, ages ≥ 55, high school/GED or less education, household income < $25,000, non-heterosexual, and AWES with fair or poor mental health were characterized as subpopulations disproportionately affected by smoking. Misperception was defined as perceiving ENDS to be at least as harmful as cigarettes. Results Ninety-four percent of AWES-NPQ had ENDS misperceptions. While misperceptions were > 91% in all sub-groups, the odds of reporting misperceptions were higher among: Black respondents ( vs . White, OR = 1.79 [95% CI = 1.13–2.83]), those aged ≥ 55 ( vs . < 55, 1.47 [1.02–2.12]), and AWES with high school or less education ( vs . at least some college, 2.10 [1.47–3.01]. Conversely, male AWES had reduced odds of having ENDS misperceptions ( vs . female, 0.55 [0.38–0.80]). Conclusions ENDS misperceptions were highly prevalent among AWES-NPQ, and some subgroups disproportionately affected by smoking were even more likely to hold misperceptions. Efforts to reduce smoking disparities could be enhanced by communicating ENDS' reduced-risk potential, which could encourage AWES to adopt ENDS and completely switch away from smoking.