Perceived Harm of Vaping Relative to Smoking and Associations with Subsequent Smoking and Vaping Behaviors among Young Adults: Evidence from a UK Cohort Study

Katherine East; Eve Taylor; Ann McNeill; Ioannis Bakolis; Amy E. Taylor; Olivia M. Maynard; Marcus R. Munafò; Jasmine Khouja

doi:10.1093/ntr/ntaf018

Perceived Harm of Vaping Relative to Smoking and Associations with Subsequent Smoking and Vaping Behaviors among Young Adults: Evidence from a UK Cohort Study

Katherine East, Eve Taylor, Ann McNeill, Ioannis Bakolis, Amy E. Taylor, Olivia M. Maynard, Marcus R. Munafò, Jasmine Khouja

Research output: Contribution to journal › Article › peer-review

4 Citations (SciVal)

Abstract

Introduction: There is a lack of evidence on whether vaping harm perceptions can predict vaping and smoking behaviors among young adults in the United Kingdom. We aimed to assess whether the perceived harm of vaping relative to smoking is associated with subsequent changes in vaping and smoking behaviors in this population. Methods Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study. Longitudinal associations were assessed between the perceived harm of vaping relative to smoking at baseline (approximately 24 years old; Nov'15-Aug'17) and the following smoking/vaping outcomes at follow-up (approximately 30 years old; May-Oct'22): (1) stopping smoking, (2) initiation of ever smoking and/or vaping, and (3) uptake of past 30-day smoking and/or vaping. Multinomial logistic regressions were used, adjusting for sociodemographic factors.

Results: Among young adults who smoked but did not vape at baseline (n = 687), the perception that vaping is less harmful than smoking (vs. equally/more harmful, or don't know) was associated with stopping smoking and now vaping at follow-up (adjusted Relative Risk Ratio (aRRR)=1.69, 95%CI = 1.02 to 2.81, p = .04). Initiation of ever smoking/vaping, or uptake of past 30-day smoking/vaping, were not common during the study period and there was little evidence that these outcomes were associated with relative vaping harm perceptions at baseline.

Conclusions: Among young adults who smoke, perceiving vaping as less harmful than smoking was associated with switching from smoking to vaping six years later. Few young adults who did not smoke or vape initiated these behaviors during the study period.

Implications: This is the first study in England to find that young adults who smoked and who accurately perceived vaping as less harmful than smoking were more likely to switch to vaping 6 years later. This is consistent with prior studies among adults and highlights the need for interventions to improve the pervasive misperceptions about vaping that are currently observed among young adults who smoke.

Original language	English
Pages (from-to)	1479-1485
Number of pages	7
Journal	Nicotine and Tobacco Research
Volume	27
Issue number	8
DOIs	https://doi.org/10.1093/ntr/ntaf018
Publication status	Published - 1 Aug 2025

Funding

The smoking and vaping questionnaires used in this study were specifically funded by Cancer Research UK C54841/A20491. This publication is the work of the authors who serve as guarantors for the contents of this paper. KE is the recipient of Fellowship funding from the Society for the Study of Addiction (SSA). Authors also acknowledge salary support from NIH (KE, AM, 1P01CA200512), NIHR Health Protection Research Unit in Environmental Exposures and Health (ET, AM), NIHR South London ARC (AM, IB), MRC Integrative Epidemiology Unit (MC_UU_00032/07, MM), NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (IB). The UK Medical Research Council (MRC) and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website ( www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf ). The smoking and vaping questionnaires used in this study were specifically funded by Cancer Research UK C54841/A20491. This publication is the work of the authors who serve as guarantors for the contents of this paper. KE is the recipient of Fellowship funding from the Society for the Study of Addiction (SSA). Authors also acknowledge salary support from NIH (KE, AM, 1P01CA200512), NIHR Health Protection Research Unit in Environmental Exposures and Health (ET, AM), NIHR South London ARC (AM, IB), MRC Integrative Epidemiology Unit (MC_UU_00032/07, MM), NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (IB).

Funders	Funder number
Society for the Study of Addiction
Medical Research Council
Cancer Research UK C54841
National Institute for Health and Care Research
South London and Maudsley NHS Foundation Trust
A20491
University of Bristol
King's College London
NIH	1P01CA200512
National Institute for Health Research Applied Research Collaboration South London	MC_UU_00032/07
Wellcome	217065/Z/19/Z

ASJC Scopus subject areas

General Medicine

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@article{39f3dc4793c74179a1a1b587506d20c9,

title = "Perceived Harm of Vaping Relative to Smoking and Associations with Subsequent Smoking and Vaping Behaviors among Young Adults: Evidence from a UK Cohort Study",

abstract = "Introduction: There is a lack of evidence on whether vaping harm perceptions can predict vaping and smoking behaviors among young adults in the United Kingdom. We aimed to assess whether the perceived harm of vaping relative to smoking is associated with subsequent changes in vaping and smoking behaviors in this population. Methods Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study. Longitudinal associations were assessed between the perceived harm of vaping relative to smoking at baseline (approximately 24 years old; Nov'15-Aug'17) and the following smoking/vaping outcomes at follow-up (approximately 30 years old; May-Oct'22): (1) stopping smoking, (2) initiation of ever smoking and/or vaping, and (3) uptake of past 30-day smoking and/or vaping. Multinomial logistic regressions were used, adjusting for sociodemographic factors. Results: Among young adults who smoked but did not vape at baseline (n = 687), the perception that vaping is less harmful than smoking (vs. equally/more harmful, or don't know) was associated with stopping smoking and now vaping at follow-up (adjusted Relative Risk Ratio (aRRR)=1.69, 95\%CI = 1.02 to 2.81, p = .04). Initiation of ever smoking/vaping, or uptake of past 30-day smoking/vaping, were not common during the study period and there was little evidence that these outcomes were associated with relative vaping harm perceptions at baseline. Conclusions: Among young adults who smoke, perceiving vaping as less harmful than smoking was associated with switching from smoking to vaping six years later. Few young adults who did not smoke or vape initiated these behaviors during the study period. Implications: This is the first study in England to find that young adults who smoked and who accurately perceived vaping as less harmful than smoking were more likely to switch to vaping 6 years later. This is consistent with prior studies among adults and highlights the need for interventions to improve the pervasive misperceptions about vaping that are currently observed among young adults who smoke.",

author = "Katherine East and Eve Taylor and Ann McNeill and Ioannis Bakolis and Taylor, \{Amy E.\} and Maynard, \{Olivia M.\} and Munaf{\`o}, \{Marcus R.\} and Jasmine Khouja",

year = "2025",

month = aug,

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doi = "10.1093/ntr/ntaf018",

language = "English",

volume = "27",

pages = "1479--1485",

journal = "Nicotine and Tobacco Research",

issn = "1462-2203",

publisher = "Oxford University Press",

number = "8",

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T1 - Perceived Harm of Vaping Relative to Smoking and Associations with Subsequent Smoking and Vaping Behaviors among Young Adults

T2 - Evidence from a UK Cohort Study

AU - East, Katherine

AU - Taylor, Eve

AU - McNeill, Ann

AU - Bakolis, Ioannis

AU - Taylor, Amy E.

AU - Maynard, Olivia M.

AU - Munafò, Marcus R.

AU - Khouja, Jasmine

PY - 2025/8/1

Y1 - 2025/8/1

N2 - Introduction: There is a lack of evidence on whether vaping harm perceptions can predict vaping and smoking behaviors among young adults in the United Kingdom. We aimed to assess whether the perceived harm of vaping relative to smoking is associated with subsequent changes in vaping and smoking behaviors in this population. Methods Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study. Longitudinal associations were assessed between the perceived harm of vaping relative to smoking at baseline (approximately 24 years old; Nov'15-Aug'17) and the following smoking/vaping outcomes at follow-up (approximately 30 years old; May-Oct'22): (1) stopping smoking, (2) initiation of ever smoking and/or vaping, and (3) uptake of past 30-day smoking and/or vaping. Multinomial logistic regressions were used, adjusting for sociodemographic factors. Results: Among young adults who smoked but did not vape at baseline (n = 687), the perception that vaping is less harmful than smoking (vs. equally/more harmful, or don't know) was associated with stopping smoking and now vaping at follow-up (adjusted Relative Risk Ratio (aRRR)=1.69, 95%CI = 1.02 to 2.81, p = .04). Initiation of ever smoking/vaping, or uptake of past 30-day smoking/vaping, were not common during the study period and there was little evidence that these outcomes were associated with relative vaping harm perceptions at baseline. Conclusions: Among young adults who smoke, perceiving vaping as less harmful than smoking was associated with switching from smoking to vaping six years later. Few young adults who did not smoke or vape initiated these behaviors during the study period. Implications: This is the first study in England to find that young adults who smoked and who accurately perceived vaping as less harmful than smoking were more likely to switch to vaping 6 years later. This is consistent with prior studies among adults and highlights the need for interventions to improve the pervasive misperceptions about vaping that are currently observed among young adults who smoke.

AB - Introduction: There is a lack of evidence on whether vaping harm perceptions can predict vaping and smoking behaviors among young adults in the United Kingdom. We aimed to assess whether the perceived harm of vaping relative to smoking is associated with subsequent changes in vaping and smoking behaviors in this population. Methods Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort study. Longitudinal associations were assessed between the perceived harm of vaping relative to smoking at baseline (approximately 24 years old; Nov'15-Aug'17) and the following smoking/vaping outcomes at follow-up (approximately 30 years old; May-Oct'22): (1) stopping smoking, (2) initiation of ever smoking and/or vaping, and (3) uptake of past 30-day smoking and/or vaping. Multinomial logistic regressions were used, adjusting for sociodemographic factors. Results: Among young adults who smoked but did not vape at baseline (n = 687), the perception that vaping is less harmful than smoking (vs. equally/more harmful, or don't know) was associated with stopping smoking and now vaping at follow-up (adjusted Relative Risk Ratio (aRRR)=1.69, 95%CI = 1.02 to 2.81, p = .04). Initiation of ever smoking/vaping, or uptake of past 30-day smoking/vaping, were not common during the study period and there was little evidence that these outcomes were associated with relative vaping harm perceptions at baseline. Conclusions: Among young adults who smoke, perceiving vaping as less harmful than smoking was associated with switching from smoking to vaping six years later. Few young adults who did not smoke or vape initiated these behaviors during the study period. Implications: This is the first study in England to find that young adults who smoked and who accurately perceived vaping as less harmful than smoking were more likely to switch to vaping 6 years later. This is consistent with prior studies among adults and highlights the need for interventions to improve the pervasive misperceptions about vaping that are currently observed among young adults who smoke.

UR - https://www.scopus.com/pages/publications/105011490739

U2 - 10.1093/ntr/ntaf018

DO - 10.1093/ntr/ntaf018

M3 - Article

C2 - 39947229

SN - 1462-2203

VL - 27

SP - 1479

EP - 1485

JO - Nicotine and Tobacco Research

JF - Nicotine and Tobacco Research

IS - 8

ER -

Perceived Harm of Vaping Relative to Smoking and Associations with Subsequent Smoking and Vaping Behaviors among Young Adults: Evidence from a UK Cohort Study

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