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Addict Behav. 2019 Apr;91:180-187. doi: 10.1016/j.addbeh.2018.11.023. Epub 2018 Nov 17.

U.S. adult perceptions of the harmfulness of tobacco products: descriptive findings from the 2013-14 baseline wave 1 of the path study.

Author information

Department of Psychology, University of Waterloo, Waterloo, ON, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada.
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada; Ontario Tobacco Research Unit, Toronto, Ontario, Canada. Electronic address:
Department of Psychology, University of Waterloo, Waterloo, ON, Canada.
US Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
Center for Tobacco Products, United States Food and Drug Administration, Silver Spring, MD, USA.
Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA.
Westat, Rockville, MD, USA.
Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada.



This study is the first nationally representative survey of U.S. adults (18+) to examine perceptions of the relative harms of eight non-cigarette tobacco products.


Data are from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study Adult Questionnaire, a nationally representative study of 32,320 adults in the United States conducted from September 2013 to December 2014.


40.7% of adults believed that electronic cigarettes were less harmful than cigarettes, and 17.8% of adults believed that hookah was less harmful than cigarettes. Those less knowledgeable about the health risks of smoking were more likely to believe that the non-cigarette products were less harmful than cigarettes. Current non-cigarette tobacco product users were more likely to perceive that product to be less harmful than cigarettes (except filtered cigars). There was a significant positive correlation between beliefs that cigarettes were harmful and the likelihood of using hookah; perceptions of the harmfulness of cigarettes was not associated with the likelihood of using any other product.


Perceptions of harmfulness varied widely across non-cigarette tobacco products. E-cigarettes and hookah in particular are seen as less harmful compared to cigarettes.


Electronic cigarette; Hookah; Perception of harm; Tobacco products

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