Harm Perception of Electronic Nicotine Delivery System Versus Regular Cigarettes in Singapore: Findings from a Nationwide Study.

backgroundSingapore has strict regulations for electronic nicotine delivery system (ENDS). Hence, its residents may have different risk perceptions of ENDS compared to countries with more liberal measures. This study examined the prevalence of perceived risk of harm for ENDS versus cigarettes, their correlates, and the moderating effect of smoking status on significant associations in Singapore.

methodThis cross-sectional study utilized data from the Health and Lifestyle survey. The outcome was perceived risk of harm for ENDS versus regular cigarettes, categorized into "less harmful" and "about the same level of harm/more harmful." The correlates of interest were sociodemographic characteristics, depressive symptoms, anxiety symptoms, and smoking status. Correlates were examined using multivariable logistic regression. The moderating effect of smoking status was examined using interaction terms.

resultsA total of 6508 participants completed the question on perceived harm. Approximately 10.4% of them perceived ENDS to be less harmful than regular cigarettes. Moreover, 15.0% of never-smokers, 16.6% of former smokers, and 9.2% of ever-smokers reported that ENDS was less harmful than regular cigarettes. The following groups were more likely to perceive ENDS as less harmful than regular cigarettes: younger individuals, males, former smokers, current smokers, and those with higher depressive symptoms. Smoking status moderated the association between age group and perceived risk of harm.

conclusionThe harm perception of ENDS versus regular cigarettes is lower than in other countries. Future studies can examine the mediating role of harm perception of ENDS versus regular cigarettes on the association between depression and ENDS usage.