Understanding “don’t know” responses about comparative harms of cigarettes and e-cigarettes

Objective: Substantial segments of the US public are misinformed about the relative risks of nicotine products. There have been recent calls to educate the public about these relative risks. This study analyses correlates of “don’t know” responses on the relative risks of e-cigarettes and combustible cigarettes. Design and setting: Self-reported, nationally representative data from the USA’s Health Information National Trends Survey 2022 cycle (HINTS 6) were used ( n = 5835). Methods: Multivariable logistic regression examined associations between sociodemographic characteristics and “don’t know” responses to a question about the relative risks of e-cigarettes compared to cigarettes. Analyses used jackknife estimation sampling weights to provide population representative estimates. Results: Over one-third (38.2%) of adults indicated they “don’t know” the relative harm of e-cigarettes compared to cigarettes, with increasing prevalence with older age. In adjusted models, middle-aged/older adults, race/ethnicities other than White, and adults with lower incomes had higher odds of selecting a “don’t know” response ( p < 0.05, compared to respective reference groups). Adults with some college education/college degree, females, current/former users of cigarettes, and current/former users of e-cigarettes had lower odds of selecting “don’t know” ( p < 0.05). Conclusions: An improved understanding of “don’t know” responses assessing the public’s understanding of the relative risks of nicotine products could serve as a vital tool to identify knowledge gaps among older adults and in other marginalised populations, serving as an indicator for targeted educational programmes and interventions. Data such as this are necessary to inform populations about the risks of smoking and the benefits of cessation and harm-reduction strategies.