Background:
Perception of risk deters teenage smoking but less is known about e-cigarettes and risk perception.

Objective:
To examine the degree of risk that teenagers perceive from cigarette and e-cigarette use. To describe gender differences in perceived risk.

Methods:
The European School Survey Project on Alcohol and other Drugs (ESPAD) surveyed 1967 students, born in 2003, in a nationally stratified random sample of 50 schools in Ireland. Variables included perceived risk of harm from occasional smoking, smoking a pack of cigarettes or more per day, and using e-cigarettes once or twice. Descriptive and bivariate analyses were performed using Stata version 16.

Results:
Asked about risk from smoking cigarettes occasionally, 12.7% (n=245) reported ‘no risk’, 34% (n=658) ‘moderate risk’, 27.4% (n=531) ‘slight risk’, and 22.7% (n=440) ‘great risk’. Males perceived ‘no risk’ (15.2%, n=142) more than females (10.3%, n=103) (p<0.01), while more females perceived ‘slight/moderate’ risk. Regarding risk from smoking a pack or more of cigarettes a day, a majority (69%, n=1359) perceived ‘great risk’, 15.8% (n=306) ‘moderate risk’, and 6% (n=116) ‘no risk’. Statistically significant gender differences (p<0.01) were observed with more male (8.6%, n=81) than female students (3.5%, n=35) perceiving ‘no risk’. More females (73.7%, n=734) than males (65.7%, n=616) perceived ‘great risk’ in smoking a pack or more a day (p<0.001). Regarding risk from trying e-cigarettes once or twice, almost half (46.3%, n=893) perceived ‘no risk’, 37.2% (n=718) ‘slight risk’, and 4.2% (n=81) ‘great risk’. More males (51.1%, n=477) than females (41.8%, n=416) perceived ‘no risk’, and more females (4.5%, n=45) than males (3.9%, n=36) perceived ‘great risk’ (p<0.001).

Conclusions:
Teenagers perceive cigarettes to have much greater risk than e-cigarettes. Teenage girls perceive significantly greater risk than boys in both cigarette and e-cigarette use. More clarity is required about e-cigarette risk in health education programs.