Perceived Harms and Social Norms in the Use of Electronic Cigarettes and Smokeless Tobacco.

Perceptions of harms and social norms influence the use of conventional tobacco cigarettes, but little research is available about their combined relationship with e-cigarette and smokeless tobacco use. We conducted a cross-sectional survey of 309 individuals from central Illinois. We explored (1) demographic predictors of perceived harms and social norms related to e-cigarette and smokeless tobacco use, and (2) whether perceived harms, social norms, or both were important predictors of e-cigarette and smokeless tobacco use. E-cigarette perceptions of harm were consistent across all demographic characteristics. Smokeless tobacco perceptions of harm were unrelated to age, race, and sex, but lower education and income were associated with lower perceived harm (p < .05). E-cigarette social norms were less favorable among non-whites (p < .05) but did not vary by other demographic characteristics. Only less education was associated with more favorable social norms of smokeless tobacco (p < .05). Higher perceived harms were related to lower use of e-cigarettes and smokeless tobacco (p < .05). Perceived social norms were not associated with product use. This study provides preliminary support for implementing broad-based health messaging efforts that focus more on the potential harms of e-cigarette and smokeless tobacco use than on social norms.