title: How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes.
abstract: Substantial harm could result from concurrent cigarette and e-cigarette use (i.e., dual use) were it to undermine smoking cessation. Perceptions of chemical exposure and resulting harms may influence dual use. We conducted a probability-based phone survey of 1164 U.S. adult cigarette smokers in 2014-2015 and analyzed results in 2016. In a between-subjects experiment, smokers heard a hypothetical scenario in which cigarettes and e-cigarettes had the same amount of harmful chemicals or cigarettes had more chemicals than e-cigarettes (10× more, 100× more, or chemicals were present only in cigarettes). Smokers indicated how the scenario would change their interest in dual use and perceived health harms. Few smokers (7%) who heard that the products have the same amount of chemicals were interested in initiating or increasing dual use. However, more smokers were interested when told that cigarettes have 10× more chemicals than e-cigarettes (31%), 100× more chemicals than e-cigarettes (32%), or chemicals were present only in cigarettes (43%) (all p<.001). Individuals told that cigarettes have more chemicals were more likely than those in the "same amount" scenario to perceive that cigarettes would be more harmful than e-cigarettes (79% vs. 41%, OR=5.41, 95% CI=4.08-7.17). These harm perceptions partially explained the relationship between chemical scenario and dual use interest. Smokers associated higher chemical amounts in cigarettes versus e-cigarettes with greater health harms from cigarettes and thus expressed increased interest in dual use. The findings suggest that disclosing amounts of chemicals in cigarette smoke and e-cigarette aerosol could unintentionally encourage dual use.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Rosenau Hall, CB#7440, Chapel Hill, NC 27599, USA; RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, USA. Electronic address: jpepper@rti.org.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Pepper
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Rosenau Hall, CB#7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, CB#7295, Chapel Hill, NC 27599, USA.
authors.forename: M Justin
authors.initials: MJ
authors.lastname: Byron
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Rosenau Hall, CB#7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, CB#7295, Chapel Hill, NC 27599, USA.
authors.forename: Kurt M
authors.initials: KM
authors.lastname: Ribisl
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Rosenau Hall, CB#7440, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, CB#7295, Chapel Hill, NC 27599, USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000328:Adult; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D010465:Perception; D012907:Smoking / Q000009:adverse effects* / Q000523:psychology; D062789:Tobacco Products / Q000009:adverse effects*; D014481:United States
keywords: Electronic cigarettes; Smoking; Tobacco products