Perceptions of e-cigarettes and heated tobacco products among never users of nicotine in the European Union.

Introduction: Emerging tobacco and nicotine products, such as e-cigarettes and heated tobacco products (HTPs), are gaining popularity, particularly among young people. This study examines the perceptions of e-cigarettes and HTPs among nicotine-naive individuals and their variations across sociodemographic subgroups.

Methods: We conducted a cross-sectional analysis of the Special Eurobarometer 99.3 (May-June 2023) among never users of tobacco or nicotine products in the European Union (EU) (n = 13 436). We estimated the weighted prevalence of perceptions of e-cigarettes and HTPs: appeal, perceived effectiveness for smoking cessation, support for them being regulated like cigarettes, and support for keeping them out of sight in points-of-sale. Multi-level Poisson regression models examined associations of sociodemographic factors with these perceptions.

Results: Among never users in the EU, 2.6% found e-cigarettes appealing, while 2.0% found HTPs appealing. 50.8% and 58.8% of participants supported strict regulations and point-of-sale restrictions for these products, respectively. Younger age groups were more likely to find e-cigarettes (Prevalence Ratio [PR] = 1.70, for ages 15-39 vs. 55+) and HTPs (PR = 1.88, PR = 1.54 for ages 15-24 and 25-39) appealing and view them as effective for smoking cessation. Support for regulations similar to cigarettes was higher among women, individuals with higher education, those living with children, and those without financial difficulties.

Conclusion: While the appeal of these products to never users remained low overall, the study found that young people were more likely to find them appealing, posing a risk for experimentation. Meanwhile, over 50% of respondents supported stricter regulations, which could influence policy changes in this area.

Implications: Although appeal of e-cigarettes and Heated Tobacco Products (HTPs) was relatively low among people who have never used e-cigarettes, HTPs or smoking tobacco in the European Union, appeal was higher among younger age groups, which are often targeted by the industry. We also found substantial support for stricter regulatory policies for e-cigarettes and HTPs across the EU. These findings might encourage governments to increase restrictions around these emerging nicotine and tobacco products.