Public perceptions of e-cigarettes in Belgium: absolute and relative risk in sociodemographic groups

Background

Current evidence suggests that short- to medium-term use of e-cigarettes is associated with reduced exposure to certain harmful substances for adult smokers attempting cessation. However, the use of e-cigarettes carries health risks, and therefore long-term use and use by non-smokers is strongly discouraged. This study examined the public perception of the Flemish adult population towards e-cigarettes.

Methods

Data from the 2025 Prevention Barometer, a probability based survey in Flanders (Belgium) were used (N = 3856, 18+). The distribution of harm perception towards health and the relative risk of e-cigarettes compared to tobacco cigarettes were calculated overall and by age, sex, educational attainment, making ends meet and e-cigarette user status. Multivariate logistic regressions were performed.

Results

Less than 1% of Flemish adults considered e-cigarettes not harmful at all for one’s health, 8.0% considered them slightly harmful, 36.7% moderately harmful and 54.7% very harmful. Females more frequently perceived e-cigarettes as very harmful compared to males. Non-users more often perceived e-cigarettes as very harmful compared to current users. Regarding the relative risk, 15.9% of the Flemish adults considered e-cigarettes less harmful compared to tobacco cigarettes, 48.4% considered them equally harmful, 19.6% more harmful and 16.0% reported they did not know. Females, younger age groups, being lower educated and having difficulties making ends meet more often perceived e-cigarettes as more harmful relative to tobacco smoking. Daily users more often perceived e-cigarettes as less harmful compared to non-users.

Conclusions

Perceived absolute harm of e-cigarettes in Flanders is high, but knowledge of relative harm appeared to be limited. Differences by user status suggest that experience may shape risk perceptions. These findings highlight the need for clear, evidence-based public communication on e-cigarettes and related harms.

Key messages

• In Belgium, perceived absolute harm of e-cigarettes is high, yet few adults recognize they may be less harmful than tobacco, indicating limited knowledge of relative risk.

• Risk perceptions regarding e-cigarettes differ by sex, age, socioeconomic and user status, underscoring the need for clear, evidence-based communication on their harms.