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TSRC, Tob. Sci. Res. Conf., 2023, 76, abstr. 38

Assessing the relationship between e-cigarettes risk perception, intention to quit cigarettes, and cigarette consumption: a structural equation model

RAI Services Company, Winston-Salem, NC, USA

Background: It remains unclear whether appraisal of e-cigarettes risk relative to cigarettes could influence current smokers’ intentions to quit cigarettes, which in turn could impact cigarette consumption. This project demonstrates that misperception or miscommunication about the harmfulness of e-cigarettes relative to cigarettes may hinder tobacco harm reduction efforts.

Methods: We postulate that e-cigarette perception of harmfulness influences cigarette consumption directly and indirectly through intentions to quit cigarettes. Data from the five initial waves of PATH adults were used to identify baseline cigarette smokers. A structural equation model simultaneously estimated: (1) e-cigarette risk perception as a function of baseline characteristics, (2) the effect of e-cigarettes’ risk perception on intentions to quit cigarettes, (3) the effect of e-cigarettes’ risk perception on cigarettes consumption with intentions to quit cigarettes as a mediating factor.

Results: The sample included 6,366 adult cigarette smokers. A unit increase in the perception of e-cigarettes harmfulness relative to cigarette was associated with 1.7 (p-value: 0.036) reduced points on the quit intentions scale at wave 4. Subsequently, a unit increase in cigarette quit intentions at wave 4, was associated with 0.18 (p-value: 0.001) reduction in CPD at wave 5, whereas a unit increase in e-cigarette risk perception at wave 4 was associated with 1.1 (p-value: <0.001) increase in CPD at wave 5.

Conclusion: The effect of e-cigarette risk perception on cigarette reduction is partially mediated through intentions to quit cigarettes. Findings suggest that beliefs that e-cigarettes are as harmful or more harmful than cigarette may lead to continued or higher cigarette consumption. A public health goal should address the public misperception of e-cigarettes harmfulness relative to cigarettes.