Patient-led, home-based follow-up for colorectal cancer: DISTANCE multicentre stepped-wedge cluster randomised trial.

Despite all tobacco products, including e-cigarettes, having clear negative health harms, it is increasingly recognized that such tobacco products exist on a continuum of harm or risk. Previous literature has described and utilized this continuum of harm concept to determine which tobacco products may be more or less harmful (e.g., based on the amount of toxic chemicals, cancer risk). The U.S. Food and Drug Administration (FDA) acknowledges the relative risks of different tobacco products and potential for adults who smoke to lower their risk by completely switching to products such as e-cigarettes or smokeless tobacco. FDA additionally acknowledges the need to prevent youth use of all tobacco products. Why is it important to assess whether youth perceive the tobacco product continuum of harm accurately? Previous research has shown that lower perceived harm has been associated with a higher risk of actual tobacco use, including initiation and continued use. On one hand, youth may misperceive that (1) all tobacco products are equally harmless, (2) all tobacco products are equally harmful, or (3) certain products that pose a lower risk of harm (e.g., e-cigarettes and smokeless tobacco) are more harmful than combustible cigarettes. Such misperceptions may influence youth to try using more harmful products, such as combustible cigarettes, which have long-term health consequences, such as tobacco-related cancers. On the other hand, having accurate perceptions of the relative harms of tobacco products may not necessarily be beneficial when it comes to youth tobacco use prevention. For instance, if youth who are tobacco-naïve perceive e-cigarettes to be much less harmful than combustible cigarettes, they may be more susceptible to trying e-cigarettes because they think that e-cigarettes do not have health harms. Thus, assessing youth’s perceptions of tobacco products may be particularly relevant for youth prevention efforts and education strategies that incorporate the concept of a continuum of harm. Moreover, understanding the characteristics of youth who misperceive the health harm continuum of tobacco products has important implications regarding health equity. Previous studies have found that sociodemographic factors, including identifying as socioeconomically disadvantaged or sexual and gender minorities, were associated with lower harm perceptions of tobacco products. These minoritized groups experience more minority-related stressors, making them more susceptible to use substances. Both lower harm perceptions of tobacco products and the experience of minority stress may contribute to the increased susceptibility of substance use for minoritized groups. Previous work utilizing latent class analysis has examined perceived harm of different levels of cigarette use among youth; however, there was no classification into different harm perceptions across different tobacco products use.