Teens may still be vaping in record numbers, but the e-cigarette industry is having a harder time convincing adults that vaping is safe. Though vaping is usually pitched as the safer alternative to smoking, research published Friday in JAMA Network Open shows that since 2012, fewer and fewer adults are convinced by that story.

The paper shows that the amount of adults (18 and over) who saw vaping as less harmful than smoking has significantly decreased over the past five years, according to two national surveys: the Tobacco Products and Risk Perceptions Surveys (TPRPS) and the Health Information National Trends Surveys (HINTS).

In 2012, the TRPS survey found that 39.4 percent of adults thought vaping was safer than smoking. By 2017, only 33.9 percent believed that vaping was the safer alternative. In the HINTS survey, the decrease was even bigger: In 2012, 50.7 percent of adults thought vaping was safer, decreasing to only 34 percent in 2017.

The authors also report that the amount of adults who see vaping as equally harmful as smoking increased. In 2012, only 11.5 percent of adults in the TPRPS survey thought that vaping was just as harmful as smoking. By 2017, that nearly tripled to 36.4 percent.

Adults are starting to change their minds about vaping. Flickr / lindsay-fox

These changes in perception hit straight to the heart of the debate about vaping and safety. At least for teens, the FDA has condemned vaping as an epidemic. But for adults, guidelines are ambiguous at best. The National Academies of Sciences, Engineering, and Medicine; Health and Medicine division’s 2018 report on the safety of e-cigarettes says that “e-cigarettes cannot be simply categorized as either beneficial or harmful to health” because they have to weigh the adverse outcomes of vaping with the idea that it could help people quit smoking.

Since that report was released, there has been more research that points to vaping’s risks. High levels of nicotine delivery aside, vaping is associated with wheezing, and some of the chemicals in e-liquid pose their own risks, like DNA damage. One of the most common chemicals in some e-liquids, diacetyl, is also associated with a condition called popcorn lung, which scars the air sacs in the lungs.

That said, e-cigarettes do sidestep the effects of burning tobacco, which releases its own array of toxic chemicals. But it’s not exactly a win to call vaping less dangerous than smoking, because smoking itself is incredibly risky.

Some vape juice flavors contain chemicals that have been linked to lung tissue damage. Pexels

Research presented before the American College of Cardiology in early March indicated that cigarette smokers were 165 percent more likely to have a heart attack and 94 percent more likely to have coronary artery disease than non smokers. The vapers were 34 percent more likely to have a heart attack and 25 percent more likely to have coronary artery disease. These numbers are high enough to raise concern on their own, but they do pale in comparison to smoking statistics.

Professor of medicine Stanton A. Glantz, Ph.D., of the University of California San Francisco’s Center for Tobacco Control, Research and Education, writes in a commentary that the public’s declining opinion of the safety of e-cigarettes may be slightly ahead of the science documenting their harmful effects. However, he adds, the public has the right idea, and the evidence that supports the concerns about vaping is only accumulating.

“From this perspective declining public perception that e-cigarettes are less harmful than cigarettes is a good thing that may turn out to be where the scientific consensus lands as the new evidence on the harms of e-cigarettes continues to accumulate,” he writes.

There’s a difference between being safer than cigarettes and actually being safe. In conjunction with the mounting evidence that vaping has its own risks, that’s a difference that adults seem to be starting to appreciate.

Abstract

Importance. Debate is ongoing about whether the scientific evidence of the health risks of electronic cigarettes (e-cigarettes) compared with combustible cigarettes (hereinafter referred to as cigarettes) has been accurately communicated to the public. Large representative surveys are needed to examine how the public perceives the health risk of e-cigarettes and how their perceptions change over time.

Objective. To examine how US adults perceived the harm of e-cigarettes relative to cigarettes and how their perception has changed from 2012 to 2017.

Design, Setting, and Participants. Survey study using data from 2 multiyear cross-sectional nationally representative surveys—the Tobacco Products and Risk Perceptions Surveys (TPRPS) and the Health Information National Trends Surveys (HINTS)—to assess perceived harm of e-cigarettes relative to cigarettes among US adults in 2012, 2014, 2015, 2016, and 2017. Respondents were selected via address-based sampling or random-digit dialing and consisted of adults 18 years or older. Analyses were conducted from February through April 2018.

Main Outcomes and Measures. Self-reported perceived harm of e-cigarettes relative to cigarettes.

Results. The analytical samples of TPRPS consisted of 2800 adults in 2012 (cumulative response rate, 7.3%), 5668 in 2014 (cumulative response rate, 6.6%), 5372 in 2015 (cumulative response rate, 6.8%), 5245 in 2016 (cumulative response rate, 6.4%), and 5357 in 2017 (cumulative response rate, 5.8%). The analytical samples of HINTS consisted of 2609 adults in 2012 (response rate, 39.9%), 3301 in 2014 (response rate, 34.4%), 2224 in 2015 (response rate, 33.0%), and 2683 in 2017 (response rate, 32.4%). The proportion of adults who perceived e-cigarettes as less harmful than cigarettes decreased from 39.4% (95% CI, 36.9%-41.9%) in 2012 to 33.9% (95% CI, 32.7%-35.2%) in 2017 in TPRPS and decreased from 50.7% (95% CI, 48.8%-52.7%) in 2012 to 34.5% (95% CI, 32.7%-36.3%) in 2017 in HINTS. During the same period, the proportion of adults who perceived e-cigarettes to be as harmful as cigarettes increased from 11.5% (95% CI, 10.0%-13.2%) in 2012 to 36.4% (95% CI, 35.1%-37.7%) in 2017 (TPRPS) and from 46.4% (95% CI, 44.5%-48.3%) in 2012 to 55.6% (95% CI, 53.7%-57.5%) in 2017 (HINTS). Those who perceived e-cigarettes to be more harmful than cigarettes increased from 1.3% (95% CI, 0.8%-2.2%) in 2012 to 4.3% (95% CI, 3.8%-4.9%) in 2017 (TPRPS) and from 2.8% (95% CI, 2.2%-3.5%) in 2012 to 9.9% (95% CI, 8.8%-11.1%) in 2017 (HINTS).

Conclusions and Relevance. In this study, the proportion of US adults who perceived e-cigarettes to be as harmful as or more harmful than cigarettes increased substantially from 2012 to 2017. The findings of this study underscore the urgent need to accurately communicate the risks of e-cigarettes to the public, which should clearly differentiate the absolute from the relative harms of e-cigarettes.