UCSF

Introduction. Prevalence of e-cigarette use is increasing among older conventional cigarette smokers (≥ 45 years); of concern, cessation attempts with e-cigarettes may result in dual use. Risk and benefit perceptions are an important factor in the decision to use tobacco, but most research has focused on younger adults. This study investigated older smokers’ attitudes, beliefs, and perceptions about e-cigarettes and explored how these beliefs are associated with smoking behavior.

Methods. This was a secondary analysis of a 2014 cross-sectional study. QualtricsPanel was used to obtain a random national sample of current cigarette smokers 45 years and older (N = 498), and Qualtrics research platform was used to conduct the password-protected survey.

Results. About 75% of participants would like to quit cigarettes and 77% believed e-cigarettes help smokers quit cigarettes. While 60% have already tried e-cigarettes, 35% intend to try e-cigarettes within the next six months.

Current e-cigarette users (within last 30 days) agreed more strongly than non-users that e-cigarettes: help smokers quit cigarettes (p < .001); are safer (p = .002) and cleaner (p < .001) than cigarettes; and are acceptable according to friends (p = .010) and family (p = .007).

Smokers considering quitting (within six months) agreed more strongly that cigarettes are harmful to themselves (p <.001) and others (p <.001) than those not considering quitting. Meanwhile, those not considering quitting smoking believed more strongly that friends (p <.001) and family (p <.001) think it is okay to use cigarettes.

Smokers’ likelihood of trying e-cigarettes (within six months) was associated with beliefs that e-cigarettes: are safer (ρ = .408, p < .001); cleaner (ρ = .309, p < .001); help smokers quit cigarettes (ρ = .272, p < .001); and are acceptable according to friends (ρ = .518, p < .001) and family (ρ = .416, p = .001).

Conclusion. Many older smokers believe e-cigarettes will help them quit cigarettes and do not understand the health effects of e-cigarettes. Perception of social acceptability is associated with older smokers’ tobacco use patterns (i.e. using/trying e-cigarettes, quitting cigarettes). Healthcare providers should educate older smokers regarding e-cigarettes and evidence-based smoking cessation.