Perceived harmfulness of e-cigarettes and heated tobacco products compared to cigarettes: Findings from the 2020 ITC Malaysia survey.

Abstract

Misperceptions about nicotine product harms may influence product use and switching behaviors. Data were from the 2020 International Tobacco Control (ITC) Malaysia Survey, a nationally representative survey of 1047 adults aged ≥ 18 who smoked cigarettes at least monthly and had smoked ≥ 100 cigarettes (n = 1047). Respondents reported awareness of HTPs and ECs and perceived harmfulness relative to cigarettes. For regression analyses, perceived harmfulness vs cigarettes were categorized as less harmful, equally/more harmful, or don't know; for HTP-EC comparisons, categories were HTP more harmful, equally/EC more harmful, or don't know. Overall, 53.4% respondents had heard of HTPs, with lower awareness among women, ethnic minorities, and those with lower educational attainment. Among those aware of HTPs, 39.7% perceived HTPs as less harmful and 38.9% as equally harmful as cigarettes. Ethnic minority respondents were more likely to perceive HTPs as equally/more harmful than cigarettes or to report don't know, while those with secondary or lower education had lower odds of reporting don't know. Among adults aware of ECs, 46.4% perceived ECs as less harmful than cigarettes, while 29.7% and 14.1% perceived them as equally or more harmful. Respondent aged ≥ 40 had higher odds of perceiving ECs as equally/more harmful than cigarettes or reporting don't know. When comparing HTPs and ECs directly, 49.5% perceived them as equally harmful and 25.3% perceived HTPs as more harmful than ECs, while respondents aged ≥ 40 were more likely to report don't know. Perceptions of harm varied across products and sociodemographic groups, indicating gaps in understanding nicotine product harms.