How are beliefs about e-cigarette vapor constituents associated with perceived harms of e-cigarettes vapor? An analysis of a national survey of U.S. adults

Background: Potentially harmful chemicals are detectable in e-cigarette vapor, contrary to advertising and marketing claims that it contains “only water vapor.” We assessed public beliefs about the presence of vapor constituents and their associations with perceived harms of breathing secondhand vapor (SHV).

Method: Online survey of a nationally representative sample of 1449 U.S. adults from October-December 2013. Respondents were asked whether e-cigarette vapor contains only water vapor, contains tar, or contains formaldehyde (response options were true, false, or don’t know). They were also asked if they perceived breathing SHV to be harmful to one’s health, if they were concerned about the health impact of breathing SHV, and comparative harm of breathing SHV versus breathing secondhand smoke (SHS). Multiple regression analyses were weighted to the U.S. adult population and adjusted for demographic covariates.

Results: Between 58-75% did not know whether e-cigarette emissions contained chemical constituents. Age, income, smoking status, ever tried e-cigarettes, and having observed others vaping were significant predictors of one or more belief items. Responding that vapor contains only water vapor and does not contain tar (versus don’t know) was associated with lower perceived harms to health and concerns about health impact of breathing SHV and with lower comparative harm of breathing SHV versus breathing SHS.

Conclusion: Awareness of vapor constituents was low among U.S. adults. Responding that vapor does not contain chemicals was associated with lower perceived harms. These findings suggest a need to provide accurate information about vapor constituents (e.g., using product ingredient labels or public education).