Introduction:
Despite an aim to achieve a first smoke-free generation by 2030, smoking prevalence in France is still high (25.3% daily smokers), especially in young people (28.7% of 18-24 age-group)i. E-Cigarettes (ECs) have recently given rise to scientific debate, particularly given the lack of data on smoking cessation effectiveness, health impact, and user trajectories (French HCSP reportii). To denormalise tobacco in young French people, their perception of EC harmfulness is key.

Material and Methods:
The 2021 Cancer Barometer is a French cross-sectional phone survey conducted on a representative sample of the general population (n=4938) including young people (15-24 years; n=727). EC use in this cohort was defined as having ever tried ECs and being or not a current user. Perceptions of the harmfulness of ECs, flavourings, and nicotine were assessed regarding (1) health, (2) cancer risks, and (3), for ECs, compared to Conventional Cigarettes (CCs). Descriptive analyses and logistic regressions were used.

Results:
Most young French people aged 15-24 had tried ECs before (53.6%), more than any other age-group (OR=21.19, ref. 55-75 years [14.25-31.51]). In 2021, 8.4% of young people currently used ECs. They perceive ECs as somewhat (44.7%) or very harmful for health (33.4%), and less harmful than CCs (52.7% less harmful, and 35.6% equally harmful). They believe EC use may lead to cancer (83.4%), more than older cohorts (OR=2.06 [1.26-3.35]). Young people perceive nicotine contained in some ECs as somewhat (40.2%) or very harmful for health (46.8%) – significantly more likely to share this opinion (OR=5.33 [2.36-12.01]). The same applies to nicotine ECs, with 87.8% perceiving them as a cancer risk, an opinion linked with age (15-24 years, OR=2.73 [1.52-4.88]). Most young people consider the flavourings included in some ECs as somewhat or quite harmful for health (65.6%) and perceive them as a potential cancer risk (68.5%).

Conclusions:
This is the first nationally representative study in France and Europe with such a detailed analysis of EC perceptions in young people. This cohort has a greater overall perception of the risks of these products than older cohorts, showing encouraging progress in nicotine behaviour prevention, but also highlighting misconceptions of the links of ECs and nicotine with cancer.