Variation in Relative Risk Perceptions and Tobacco Use by Race and Socioeconomic Status among Older Adults who Smoke: Evidence from the Population Assessment of Tobacco and Health (PATH) Study

Introduction: Older adults who smoke face significant risk of tobacco-related disease and hold misperceptions about health risks posed by nicotine product use. This study examined whether socioeconomic status and race are associated with variation in cigarette/e-cigarette relative risk perceptions, whether relative risk perceptions are associated with tobacco use behaviors, and whether socioeconomic status and race moderate associations between perceptions and use behaviors.

Methods: Five waves of PATH Study yielded data from 1,879 adults >55 who smoked within the past 30 days during Wave 1. Adjusted longitudinal logistic models estimated associations between higher vs. lower SES ("low-SES": less than high school diploma/GED. and annual household income<$25,000) and race (White vs. Black/African American; AA) and e-cigarette/cigarette relative risk perceptions, behavioral intentions, and e-cigarette use.

Results: Lower-SES adults were more likely to report e-cigarettes were very/extremely harmful to health (AOR: 1.74, p<0.01) and less likely to report e-cigarettes were less harmful than cigarettes (AOR: 0.65, p<0.01). Black/AA adults were less likely to report that e-cigarettes were less harmful than cigarettes. Participants rating e-cigarettes as equally/more harmful than cigarettes exhibited lower odds of intending to quit smoking or switch to e-cigarettes. Finally, Black/AA adults who also perceived e-cigarettes equally/more harmful than cigarettes exhibited greater odds of trying to reduce rather than quit smoking (AOR: 1.58, p=0.02).

Conclusions: Many older adults who smoke perceive e-cigarettes as equally or more harmful than cigarettes, particularly low-SES and Black/AA older adults. Differences in relative risk perceptions among high priority populations could negatively influence cessation attempts and switching behaviors.

Implications: This study found that Black/AA and low-SES older adults who smoke cigarettes were more likely to perceive e-cigarettes as harmful or more harmful than cigarettes. The absence of accurate, evidence-based information regarding the relative health risks associated with the long-term use of various tobacco products may impede policy efforts to reduce disparities in smoking-related disease through increased cessation and/or harm reduction.