Comparison of Direct and Indirect Measures of E-cigarette Risk Perceptions

OBJECTIVES: Risk perception measures of tobacco products relative to cigarettes are commonly used and important to tobacco research given that they may be associated with and predict tobacco use. However, results may differ based on measures used. This study compares direct and indirect approaches to measuring e-cigarette/cigarette risk perceptions. METHODS: measure (which measured perceived levels of harm from e-cigarettes and cigarettes independently in two parallel questions). RESULTS: We found that 60% of smokers rated e-cigarettes "less harmful" than cigarettes when using a direct comparative risk measure versus 73% when using an indirect measure. Agreement between measure types was fair (Cohen's Kappa=0.45) and was lower for males, Blacks, older and less educated smokers. CONCLUSIONS: E-cigarettes were more likely to be rated by smokers as less harmful than cigarettes when using indirect versus direct measures. Additional methodology research into this area is warranted given the importance of risk perceptions to tobacco control interventions, communications, policy-making and regulation.