- A major US study found 94% of smokers who do not vape believe vaping is at least as harmful as smoking cigarettes
- Misperceptions were even higher among older smokers, Black smokers and people with lower levels of education
- Researchers warned these beliefs may discourage smokers from switching away from combustible cigarettes
- The study said correcting misinformation about vaping’s relative risks could help reduce smoking-related disease and inequalities
A new US study has found that almost all smokers who do not vape wrongly believe vaping is just as harmful – or even more harmful – than smoking cigarettes.
Researchers analysing nationally representative US data found that 94 per cent of adults who smoke, do not use vapes and are not planning to quit within the next 30 days believed vaping products were “at least as harmful as cigarettes”.
The study, published in Contributions to Tobacco and Nicotine Research, examined responses from 3,481 adults using data from the Population Assessment of Tobacco and Health (PATH) Study Wave 7, collected in 2022 and 2023.
Researchers defined a “misperception” as believing electronic nicotine delivery systems (ENDS), commonly known as vapes, were “about the same” or “more harmful” than smoking cigarettes.
Misperceptions highest among some smoking groups
While inaccurate beliefs about vaping risks were widespread across all groups studied, researchers found some smokers were even more likely to hold these views.
Black respondents had 79 per cent higher odds of wrongly perceiving vaping risks compared with White respondents, while smokers aged 55 and over also had significantly higher odds of misperception. People with a high school education or less were more than twice as likely to hold inaccurate beliefs compared with those with at least some college education.
Even among groups with lower levels of misperception, the figures remained extremely high. The paper noted that misperceptions exceeded 91 per cent across every subgroup examined.
The authors described the findings as “an all-time high in the past decade”.
Researchers warn beliefs may discourage switching
The study focused specifically on smokers who were not planning to quit in the near future – a group researchers said may benefit most from harm reduction approaches.
The paper stated that “adopting and completely switching from cigarettes to ENDS provides an opportunity to reduce combustible tobacco-related harms and disparities”.
Researchers said inaccurate beliefs about vaping may act as a barrier preventing smokers from moving away from cigarettes.
The study noted that previous research has shown smokers who believe vaping is as harmful as smoking are “less likely to engage in harm reduction behaviors, such as adopting ENDS, completely switching to them, and not returning to smoking”.
It also highlighted that misperceptions about vaping risks have risen sharply over time. According to the paper, between 2014 and 2019 the proportion of US smokers holding these beliefs increased from 46 per cent to 83 per cent.
The researchers said the findings were particularly important because the study focused on smokers who are often hardest to reach through traditional quit-smoking programmes.
The paper noted that around 85 per cent of US adults who smoke are “not planning to quit in the next 30 days”, suggesting many smokers may not engage with conventional cessation approaches.
The authors warned that widespread misunderstanding about vaping risks now represents “a substantial public health concern”. They added that these beliefs may be especially damaging among groups already disproportionately affected by smoking-related disease, because “such misperceptions may limit” the potential for smokers to move away from combustible cigarettes.
Calls for better public education
The researchers argued there is now a substantial gap between scientific evidence and public understanding of vaping risks. The paper said: “Current efforts to reduce smoking-related harm and disparities could be significantly advanced by aligning public perceptions of ENDS with the current evidence.”
It also suggested educational campaigns may help reduce smoking-related disease, particularly if they involve trusted public health organisations and healthcare providers.
However, the authors acknowledged that correcting these beliefs may not be straightforward, noting that healthcare professionals themselves often hold inaccurate perceptions about vaping risks.
The study also pointed out that similar patterns of vaping misperceptions have been reported internationally, including in the UK, Germany, China and New Zealand.
The study was funded by Juul Labs, although the authors stated the company “did not have any role in data management, analysis, interpretation of data, manuscript preparation, or decision to submit the manuscript for publication”.
