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J Adolesc Health. 2016 May;58(5):558-66. doi: 10.1016/j.jadohealth.2016.01.012.

Adolescents' Perceptions of Health Risks, Social Risks, and Benefits Differ Across Tobacco Products.

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Division of Adolescent Medicine, School of Medicine, Stanford University, Palo Alto, California.
Department of Psychiatry, University of California San Francisco, San Francisco, California.
Division of Adolescent Medicine, School of Medicine, Stanford University, Palo Alto, California. Electronic address:



This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco.


A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure.


Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender.


Given the significant differences in adolescents' perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes.


Decision making; Risk perceptions; Tobacco use

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