Introduction:
France has the second-largest proportion of current electronic cigarette (EC) users in the EU (6,7%1) and a relatively high smoking prevalence (25.3% daily smokers, 2021), notably among lower-educated people (32.0%). EC appears as a potentially effective smoking cessation method2 (being less harmful than combustible cigarettes (CCs))3. Perceptions of harm are a determinant of initiation of use; this study aims to analyse these perceptions of EC and its flavours in the French population in 2021.

Material and Methods:
The Cancer Barometer (INCa and SpFrance) is a cross-sectional phone-administered survey conducted on a representative sample of the general population in France in 2021 (n=4938, 15 to 85 y.o ). Perceptions of the harmfulness of ECs and flavours were assessed 1/directly on health, 2/ for cancer risks, and 3/ for EC compared to CCs harmfulness. Descriptive analyses and Binomial and multinomial logistic regressions were used.

Results:
74.6% of people surveyed considered ECs to be quite or very harmful to their health: especially women (OR=1.54 [1.09-2.16]) and persons under 55 y.o. (notably, 25-34, OR=3.91 [2.30-6.66]). On the contrary, highly-educated people (Master’s degree [Md], OR=0.47 [0.25-0.87]) and occasional smokers (OR=0.47 [0.25-0.88]) were less likely to share this opinion. Compared to CCs, 53% of respondents perceived it as more harmful, notably those with incomes under 1100€ (≥1800€, OR= 0.50 [0.29-0.84]), lower-educational level (Md, OR=0.34 [0.14-0.82]) and never-smokers (current users, OR=0.37 [0.18-0.75]). E-liquid flavours were perceived by 42.2% as rather, 17.7% as very and 10.1% as extremely harmful. Regarding EC use and cancer, 79.4% agreed that EC use may lead to developing cancer, especially among people under 45 y.o. (notably, 25-34, OR=3.09 [2.03-4.71]), while higher-educated people were less likely to perceive a link between EC use and cancer (Md, OR=0.60 [0.38-0.93]). Finally, 23.9% strongly and 49.8% somewhat agreed that EC flavours might lead to cancer.

Conclusions:
This is the first nationally representative study in France analysing EC and flavours harmfulness perceptions of the general population. It reveals fairly negative perceptions, contrasting with popularized scientific evidence, and points towards avenues for further research.