Sociodemographic Differences in E-Cigarette Uptake and Perceptions of Harm

Introduction: This study aimed to evaluate socioeconomic and racial/ethnic differences in e-cigarette uptake and harm perceptions about e-cigarettes among adults who smoke cigarettes in the U.S.

Methods: Five waves of the U.S. Population Assessment of Tobacco and Health Study (2013-2019) were used to assess transitions from exclusive cigarette smoking to (1) exclusive e-cigarette use, (2) dual use, and (3) nonuse of either product (N=7,172). Analyses (conducted in 2022) estimated differences in transitions and e-cigarette harm perceptions by race/ethnicity, income, and education.

Results: Hispanic (OR=0.32; 95% CI=0.18, 0.54) and Black (OR=0.38; 95% CI=0.22, 0.65) adults were less likely than White adults to transition from exclusive cigarette to exclusive e-cigarette use after 1 year. Adults with a bachelor's degree (versus those with less than high school) (OR=2.57; 95% CI=1.49, 4.45) and adults making ≥$100,000/year (versus those making <$10,000) (OR=3.61; 95% CI=2.10, 6.22) were more likely to transition from exclusive cigarette to exclusive e-cigarette use. Hispanic and Black adults and those with lower income and education were more likely to perceive e-cigarettes as equally or more harmful than cigarettes, which in turn was associated with lower odds of transitioning from exclusive cigarette smoking to exclusive e-cigarette use (OR=0.62; 95% CI=0.47, 0.81).

Conclusions: Adults who were Hispanic, were Black, and/or had lower SES were less likely to use e-cigarettes to quit cigarettes. Findings provide preliminary evidence that differences in harm perceptions may contribute to disparities in e-cigarette transitions.