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Background: Tobacco harm perceptions are important factors in why individuals may initiate, substitute, and/or engage in dual or poly-tobacco use patterns. Identifying correlates of these perceptions is important for understanding why these cognitions may exist and help provide intervention targets. The purpose of the current study was to examine perceptions of harm and addiction among a sample of cigarette and electronic cigarette (e-cigarette) users and examine whether these perceptions differ by demographics, other substance use, and tobacco use history.

Methods: The current sample consisted of 29 individuals who consented to participate in a clinical laboratory study of dual cigarette and e-cigarette users during 2015-2016. Screening data for this secondary analysis included demographics, substance use, other tobacco use history, and perceptions of harm and addiction. Perception items asked about the health risk level for cigarettes and e-cigarettes and the level of harm compared to regular cigarettes and likelihood of addiction for variety of tobacco products (e.g., e-cigarettes, snus, nicotine replacement therapies [NRT]). Descriptive statistics followed by independent T-tests were used to explore differences in perception items by demographics, other substance use, and tobacco use history (p

Results: The sample’s mean age was 39 years, and a majority were White males. Half of the sample completed some college or higher. Past 30-day alcohol use (55%) and ever trying marijuana (62%) were prevalent, and most were not concurrently using other tobacco products (79%). A majority (78%) reported that cigarettes were at least somewhat risky to health, while only 48% reported the equivalent for e-cigarettes. Participants rated most tobacco products as about same harm level or higher compared to regular cigarettes except for roll-your-own cigarettes, e-cigarettes, and NRT. All participants perceived regular cigarettes and chewing tobacco as having at least a moderate addiction risk. E-cigarettes and NRT had the lowest addiction risk ratings. Only perceptions of snus addiction risk differed by gender with males reporting higher ratings. By race, ratings for addiction risk for e-cigarettes and NRT differed significantly with Whites reporting lower ratings. Lifetime marijuana users had significantly higher harm perception ratings for e-cigarettes. Perceived addiction risk for regular cigarettes and e-cigarettes was significantly lower among those who used other tobacco products.

Discussion: Among this sample, perceptions of harm and addiction were lower for e-cigarettes and NRT relative to regular cigarettes and other tobacco products. There were few perceptions that differed by demographics and other substance/tobacco use history. Dual users who used other tobacco products were more likely to perceive lower risks for cigarettes and e-cigarettes. This association may be because lower addiction perceptions drive greater tobacco use or alternative. Current findings support future investigation of harm and addiction perceptions particularly among individuals who use more than one tobacco product.

Funding: This research was supported by an Internal Grant from Virginia Commonwealth University’s School of Nursing and the National Cancer Institute of the National Institutes of Health under Award Number R21CA184634 and the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

Publication Date


Subject Major(s)



Psychology, cigarette, electronic cigarette, e-cigarette, dual user, perceptions of harm, perceptions, risk to health, health, perceptions of addiction, addiction


Behavioral Disciplines and Activities | Behavior and Behavior Mechanisms | Psychiatry and Psychology | Psychology

Current Academic Year


Faculty Advisor/Mentor

Caroline Cobb


Virginia Commonwealth University. Undergraduate Research Opportunities Program

Is Part Of

VCU Undergraduate Research Posters


© The Author(s)

Recommended Citation

Rozman, J.S., Webster, P., Cobb, C.O. Perceptions of harm and addiction among dual users of cigarettes and e-cigarettes. Poster presented at: 10th Annual Poster Symposium for Undergraduate Research and Creativity at Virginia Commonwealth University; April 20th, 2016; Richmond, VA.

Perceptions of harm and addiction among dual users of cigarettes and e-cigarettes