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Kim K, Niederdeppe J, Kalaji M, Scolere L, Porticella N, Mathios A, Avery R, Dorf M, Greiner Safi A, Byrne S. Contingent Effects of E-Cigarette Warning Label Messages on Cognitive Elaboration and Fear Among U.S. Youth Ages 14-17 by Vaping Experience and Peer Vaping Behavior. HEALTH COMMUNICATION 2024:1-13. [PMID: 39192551 DOI: 10.1080/10410236.2024.2394260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
The U.S. Food and Drug Administration (FDA) currently requires a warning about the addictive nature of nicotine to be placed on electronic cigarette advertisements and packaging. To consider the value of additional warning messages on public health outcomes, this study examines the additive effect of new warnings that are based on recent claims from U.S. federal authorities. We conducted a secondary analysis of recent data from 1,202 U.S. youth ages 14-17 to test the impact of exposure to additional warnings placed on advertisements for vaping products on cognitive elaboration, fear, and willingness to vape and smoke. This investigation also looked closely at effects on youth who may have increased risk of future vaping due to prior vaping experiences or having friends who vape. Exposure to the alternative warnings did not amplify cognitive elaboration compared to the current FDA warning alone, but it did increase fear. Youth elaboration on both the benefits and risks of vaping was associated with willingness to both vape and smoke, but fear was not associated with either outcome. The effects of warning label exposure and cognitive elaboration varied by prior vaping experience and having at least one friend who vapes. We conclude by discussing the implications of this contingent pattern of effect and association.
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Affiliation(s)
- Kwanho Kim
- Department of Communication, Cornell University
| | - Jeff Niederdeppe
- Department of Communication, Cornell University
- Cornell Jeb E. Brooks School of Public Policy, Cornell University
| | - Motasem Kalaji
- Department of Communication Studies, California State Northridge
| | - Leah Scolere
- Department of Design and Merchandising, Colorado State University
| | | | - Alan Mathios
- Cornell Jeb E. Brooks School of Public Policy, Cornell University
- Department of Economics, Cornell University
| | - Rosemary Avery
- Cornell Jeb E. Brooks School of Public Policy, Cornell University
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Wysota CN, Duan Z, Wang Y, Niaura RS, Abroms LC. Noticing Voluntary E-Cigarette Warning Labels and Associations With Harm Perceptions and Use Intentions: A Baseline Cross-Sectional Analysis of Wave 4 of the Population Assessment of Tobacco and Health Study Prior to the Food and Drug Administration Mandate. Am J Health Promot 2024:8901171241249144. [PMID: 38709540 DOI: 10.1177/08901171241249144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
PURPOSE To examine the effect of e-cigarette warning labels (EWLs) prior to the August 2018 FDA-warning label mandate to establish a baseline for future research. DESIGN Cross-sectional survey. SETTING United States. PARTICIPANTS A cohort of adult participants in the Population Assessment of Tobacco and Health (PATH) study (n = 30,004) at Wave 4 (Dec 2016-Jan 2018). MEASURES Correlates (e.g., sociodemographics, substance use, social influence, cigarette warnings, and mental health) of noticing EWLs in the past 30-days (noticed vs did not notice), perceived harm of e-cigarettes/nicotine (from 1 = not at all harmful to 5 = extremely harmful), relative harm of e-cigarettes (from 1 = less harmful to 3 = more harmful than cigarettes), intention to quit (yes/no) and intention to try e-cigarettes (from 1 = definitely not to 4 = definitely yes). RESULTS The prevalence of noticing EWLs was 22.1%. Those who currently use electronic nicotine products, established and experimentally, were more likely to notice EWLs relative to never users (aOR = 3.55; 95% CI: 2.96-4.25; P < .001 and aOR = 2.42; 95% CI: 1.88-3.10; P < .001, respectively). Those with past 30-day alcohol and cigarette use were less likely to notice EWLs (aOR = .27; 95% CI: .24-.31 and aOR = .91; 95% CI: .83-.99; respectively). Those who noticed cigarette warnings were more likely to notice EWLs (aOR = 12.00; 95% CI: 10.46-13.77; P < .001). Among those who noticed EWLs, there were higher odds of perceiving e-cigarettes to be equally or more harmful than cigarettes (aOR = 1.15; 95% CI: 1.02-1.30), but no association was found between noticing EWLs and perceived harm of e-cigarettes/nicotine or use intentions. CONCLUSION Noticing voluntary EWLs was not associated with increased perceived harm of e-cigarettes and nicotine harm, or e-cigarette use intentions. Future research is warranted to examine the effect of the FDA mandated EWLs.
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Affiliation(s)
- Christina N Wysota
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Yan Wang
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Raymond S Niaura
- School of Global Public Health, New York University, New York, NY, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Safi AG, Kalaji M, Avery R, Niederdeppe J, Mathios A, Dorf M, Byrne S. Examining Perceptions of Uncertain Language in Potential E-Cigarette Warning Labels: Results from 16 Focus Groups with Adult Tobacco Users and Youth. HEALTH COMMUNICATION 2024; 39:460-481. [PMID: 36717390 PMCID: PMC10387126 DOI: 10.1080/10410236.2023.2170092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
E-cigarette use among youth presents a public health risk. Yet, cigarette smokers who substantially reduce their smoking or switch completely from traditional combustible cigarettes could benefit. As science about e-cigarettes is continually emerging, any potential warnings are likely to contain uncertain language. Hedged verbiage may impact decision making. To assess reactions, we conducted 16 online focus groups; 8 with youth (n = 32, grouped by gender and by vaping experience) and 8 with adult tobacco users (n = 37, grouped by smokers, dual users of e-cigarettes and cigarettes, and former smokers who switched to e-cigarettes). Each focus group viewed and discussed 8 potential warnings messages. We conducted an inductive thematic analysis of the reactions to warning messages that contain uncertain language. Respondents' reactions were often negative, but varied based on specific usages of uncertainty, existing beliefs about uncertainty in law and science, and smoking/vaping use patterns that supported the use of uncertainty related to e-cigarettes. Many youth (and some adults) believed that uncertain language enabled audiences to minimize the likelihood of harm or interpreted it as meaning there are both healthy and unhealthy e-cigarettes. This qualitative study provides evidence that the use of types of uncertain language, the frequency of that use, and/or the selection of particular words in warnings, might not achieve the intended public health aims of increasing understanding of risk, deterring youth uptake, and/or facilitating a substantial switch from cigarettes. The use of certain types of uncertain language appears to have significant potential to bring unintended consequences. Suggestions for research and policy are included.
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Affiliation(s)
- Amelia Greiner Safi
- Department of Public and Ecosystem Health, Cornell University, USA
- Department of Communication, Cornell University, USA
| | - Motasem Kalaji
- Department of Communication Studies, California State University Northridge, USA
| | - Rosemary Avery
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, USA
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | - Alan Mathios
- Jeb E. Brooks School of Public Policy, Cornell University, USA
| | | | - Sahara Byrne
- Department of Communication, Cornell University, USA
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Arshad H, Jackson SE, Kock L, Ide-Walters C, Tattan-Birch H. What drives public perceptions of e-cigarettes? A mixed-methods study exploring reasons behind adults' perceptions of e-cigarettes in Northern England. Drug Alcohol Depend 2023; 245:109806. [PMID: 36907122 DOI: 10.1016/j.drugalcdep.2023.109806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/16/2022] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Despite growing evidence that e-cigarettes are likely less harmful than cigarettes, perceptions of equal or more harm have increased worldwide. This study aimed to identify the most common reasons behind adults' perceptions of the (i) relative harm of e-cigarettes compared with cigarettes and (ii) effectiveness of e-cigarettes for smoking cessation. METHODS Adults (N = 1646) from Northern England were recruited through online panels from December-March 2017/2018, using quota sampling to guarantee socio-demographic representativeness. Qualitative content analysis of open-ended responses was performed with codes representing reasons for a given perception about e-cigarettes. Percentages of participants who gave each reason for each perception were calculated. RESULTS 823 (49.9%) participants agreed that e-cigarettes were less harmful than cigarettes, 283 (17.1%) disagreed, and 540 (32.8%) were undecided. The most common reasons for agreeing that e-cigarettes were less harmful than cigarettes were that they produce no smoke (29.8%) and fewer toxins (28.9%). Those who disagreed were most concerned about a perceived lack of trustworthy research (23.7%) and safety issues (20.8%). Lacking knowledge (50.4%) was the most common reason for being undecided. 815 (49.5%) of participants agreed that e-cigarettes were an effective smoking cessation aid, 216 (13.2%) disagreed, and 615 (37.4%) were undecided. The most common reasons participants gave for agreeing were related to e-cigarettes being successful smoking replacements (50.3%) and advice from family, friends or health professionals (20.0%). Respondents who disagreed were most concerned about e-cigarettes being addictive (34.3%) and containing nicotine (15.3%). Lacking knowledge (45.2%) was the most common reason for being undecided. CONCLUSIONS Negative perceptions of e-cigarette harm were driven by concerns about a perceived lack of research and safety issues. Adults who viewed e-cigarettes as ineffective for smoking cessation feared that they perpetuate nicotine addiction. Campaigns and guidelines that address these concerns may help promote informed perceptions.
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Affiliation(s)
- Humairah Arshad
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Loren Kock
- Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05405, US
| | | | - Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK.
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Kalaji M, Mathios AD, Skurka C, Niederdeppe J, Byrne S. Youth and Young Adult-targeted E-cigarette Warnings and Advertising Messages: An Experiment with Young Adults in the US. JOURNAL OF HEALTH COMMUNICATION 2022; 27:574-584. [PMID: 36322452 PMCID: PMC10868649 DOI: 10.1080/10810730.2022.2138640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Warnings specifically focused on harm to younger users have been understudied in vaping warning research, even while vaping products may appeal specifically to a younger population through implicit advertising strategies. This study examined how youth and young adult-focused e-cigarette health warning messages and implicit advertising strategies influence affective responses, risk perceptions, cognitive elaboration about e-cigarette harms, and willingness to vape in the future. We recruited young adults (who, at the time, were not smoking combustible cigarettes) aged 18-25 to participate in an online survey experiment with a 3 (warning label type: current FDA/youth and young adult risk-focused/none) × 3 (advertising health message strategy: explicit/implicit/none) + 3 (non-vaping products control) design. The results show a main effect for warning such that both FDA and targeted warnings increased negative affect and decreased positive affect compared to no warning. Moreover, the youth and young adult-focused warning boosted youth-specific harm beliefs and cognitive elaboration relative to control and the FDA warning, which did not differ from one another. Implicit health messages produced greater positive affect relative to explicit messages and no message, but the ad strategy manipulations did not influence other outcomes. While the population studied here with a single exposure reported no effects of either manipulation on willingness to vape, previous research has associated similar emotions and cognitions with lowered intentions to vape. Regulatory bodies should consider further exploration of vaping warnings that emphasize youth and young adult-specific harms to educate young people about relevant risks.
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Affiliation(s)
- Motasem Kalaji
- Department of Communication Studies, Mike Curb College of Arts, Media, and Communication, California State University Northridge, Northridge, CA
| | - Alan D Mathios
- Jeb E Brooks School of Public Policy, Cornell University, Ithaca, NY
| | - Chris Skurka
- Department of Film Production and Media Studies, Donald P. Bellisario College of Communications, Penn State University, University Park, PA
| | - Jeff Niederdeppe
- Jeb E Brooks School of Public Policy, Cornell University, Ithaca, NY
- Department of Communication, Cornell University, Ithaca, NY
| | - Sahara Byrne
- Department of Communication, Cornell University, Ithaca, NY
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AlMoosawi S, Bajec M, Mainy N, Kallischnigg G, Zwisele B, Fischer K, Magnani P, Roulet S. Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons. SSM Popul Health 2022; 18:101123. [PMID: 35669892 PMCID: PMC9162949 DOI: 10.1016/j.ssmph.2022.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Risk perception (RP) is central to smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assessed temporal trends in the health RP of a novel heated tobacco product, IQOSTM, relative to cigarettes, among current IQOSTM users. Methods The analyses included repeated cross-sectional data from online surveys in Germany (2018–19), Italy (2018–19), and Japan (2016–17, 2017–18, and 2018–19) among a random sample of current adult IQOSTM users from local registers of IQOSTM users. The health RPs of cigarettes and IQOSTM were assessed using the ABOUT™–Perceived Risk instrument, and their difference was described as the relative RP of IQOSTM to cigarettes (RPCig:IQOSTM). Results After adjustment for covariates, the relative RPCig:IQOSTM was higher in 2018 than in 2019 (0.93; standard error, 0.33; P = 0.005). This was driven by an increase in the RP of IQOSTM over time in Italy (2018: 42.6 [95% CI, 41.6–43.5]; 2019: 44.4 [43.4–45.4]) and Japan (2017: 44.0 [43.1–44.9); 2018: 45.9 [45.2–46.7]; 2019: 48.6 [47.9–49.4]), while the RP of cigarettes remained stable. Conclusions The relative RP of IQOSTM decreased over time, driven by an increase in the RP of IQOSTM, in agreement with epidemiological studies indicating a temporal reduction in the relative RP of smoke-free TNPs. Continued surveillance of the RP of novel TNPs is warranted to inform effective TNP risk communication and ensure that adults smokers who would otherwise continue to smoke understand the relative risks of novel TNPs. Risk perception is central to smokers' decision to switch from cigarettes. Little is known of temporal changes in risk perception of novel tobacco products. Risk perception of heated tobacco increased in Italy and Japan. Difference in risk perception of heated tobacco relative to cigarettes declined.
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Affiliation(s)
- Suzana AlMoosawi
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
- Corresponding author.
| | - Martha Bajec
- Bajec Senseworks consulting, Hamilton, L9A 1L5, Ontario, Canada
| | - Nelly Mainy
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Gerd Kallischnigg
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Bertram Zwisele
- ARGUS – Statistics and Information Systems in Environment and Public Health GmbH, Karl-Heinrich-Ulrichs-Straße 20a, DE-10785, Berlin, Germany
| | - Karina Fischer
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Pierpaolo Magnani
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
| | - Steve Roulet
- PMI R&D, Philip Morris Products S.A., Quai Jeanrenaud 5, CH-2000, Neuchâtel, Switzerland
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Taylor EV, East KA, McNeill A, Cummings M, Thrasher J, Fong GT, Quah ACK, McDermot M, Li G, Borland R, Hammond D, Aleyan S, Hitchman SC. Changes in responses to nicotine vaping product warnings and leaflets in England compared with Canada, the US and Australia: findings from the 2016-2018 ITC Four Country Smoking and Vaping Surveys. Tob Control 2022; 31:107-111. [PMID: 33115961 PMCID: PMC8079549 DOI: 10.1136/tobaccocontrol-2020-055739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS In May 2017, black-and-white text nicotine addiction warning labels ('warnings') and health and safety leaflets ('leaflets') became mandatory for nicotine vaping products (NVPs) in England, in accordance with the European Union's Tobacco Products Directive. We compared changes over time in noticing warnings and leaflets, recall of warnings about nicotine and concerns about using NVP due to noticing warnings in England, compared with Canada, the US and Australia, where no warnings and leaflets were mandated. DESIGN 19 005 adult (aged 18+) NVP users, smokers and quitters of cigarettes and NVP from the 2016 and 2018 International Tobacco Control Four Country Smoking and Vaping Surveys in England, Canada, the US and Australia, recruited via probability and non-probability sampling. FINDINGS Noticing warnings increased in England from 4.9% (2016) to 9.4% (2018) (adjusted OR/AOR=1.64, 95% CI=1.15-2.36); this change was larger than changes in Canada (AOR=2.51, 95% CI=1.71-3.69) and the US (AOR=2.22, 95% CI=1.45-3.39). Recall of a nicotine warning increased in England from 86% (2016) to 94.9% (2018) (AOR=5.50, 95% CI=1.57-19.27) but not significantly elsewhere. Noticing leaflets increased in England from 14.6% (2016) to 19.1% (2018) (AOR=1.42, 95% CI=1.15-1.74); this change was larger than in Canada (AOR=1.42, 95% CI=1.12-1.79), the US (AOR=1.55, 95% CI=1.17-2.06) and Australia (AOR=1.51, 95% CI=1.02-2.22). Among those noticing warnings, concern about NVP use did not change significantly between 2016 and 2018 (all countries p>0.081). CONCLUSIONS Introduction of mandatory NVP warnings and leaflets in England was associated with small increases in noticing them but not with changes in concerns about NVP use.
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Affiliation(s)
- Eve Violet Taylor
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Katherine A East
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Shaping Public Health Polices to Reduce Inequalities and Harm (SPECTRUM), London, UK
| | - Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA,Hollings Cancer Centre, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James Thrasher
- Health Promotion, Education and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA,Tobacco Research Department, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Geoffrey T Fong
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada,Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Máirtín McDermot
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Grace Li
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia,Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Aleyan
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sara C Hitchman
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Halvaiepour Z, Nosratabadi M. Explaining the Craving for Cigarette Smoking Based on Adverse Childhood Experiences and Subjective Socioeconomic Status among University Students in Isfahan, Iran. Subst Use Misuse 2022; 57:940-947. [PMID: 35317713 DOI: 10.1080/10826084.2022.2052100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Adverse childhood experiences are linked to a wide range of physical, social, sexual, and family dysfunctions. These experiences, such as smoking, may have negative health consequences. Objective: The goal of this study was to explain the desire to smoke in university students in Isfahan, Iran based on adverse childhood events and subjective socioeconomic status. Methods: This cross-sectional study was conducted on 450 young adults who were recruited randomly from Isfahan universities in 2020. To collect data, a checklist of adverse childhood events, craving for smoking, and a question about subjective socioeconomic status were used. Multivariate logistic regression was used to analyze the data. Results: According to the findings, 46.5 percent of all university students had at least one Adverse Childhood Experience, and 68.8 percent of all university students had some level of smoking craving. Controlling for demographic variables, respondents with one to five adverse childhood experiences (OR: 1.84; 95 percent of CI: 1.11-3.04) and six or more adverse childhood experiences (OR: 5.37; 95 percent of CI: 2.58-11.71) were more likely to crave smoking than respondents with no adverse childhood experiences. Furthermore, among all students, a higher subjective socioeconomic status reduced the likelihood of smoking by 19%. Conclusions and implications: It can be concluded that university students who have had adversity in their childhood are more likely to engage in high-risk behaviors like smoking. Because smoking is recognized as a coping mechanism for stressful events, it is suggested that personal, local, and national strategies aimed at young adults in Iran be developed.
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Affiliation(s)
| | - Mehdi Nosratabadi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Erku DA, Bauld L, Dawkins L, Gartner CE, Steadman KJ, Noar SM, Shrestha S, Morphett K. Does the content and source credibility of health and risk messages related to nicotine vaping products have an impact on harm perception and behavioural intentions? A systematic review. Addiction 2021; 116:3290-3303. [PMID: 33751707 DOI: 10.1111/add.15473] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/02/2020] [Accepted: 02/24/2021] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on (i) whether and how various risk messages about nicotine vaping products (NVPs) alter harm perception and behavioural intentions of smokers and non-smokers and (ii) how trust in sources of NVP risk communication affects message reception and behavioural intentions. METHODS Seven electronic databases and reference lists of relevant articles were searched for articles published up to April 2020. Experimental and quasi-experimental studies on message effects and cross-sectional studies on source credibility were included. The Newcastle-Ottawa Scale and the Evidence Project Risk of Bias Tool were used to assess the quality of observational and intervention studies, respectively. For each outcome variable, we indicated whether there was an effect (as a 'yes' or 'no') and used effect direction plots to display information on the direction of effects. RESULTS Nicotine addiction messages resulted in greater health and addiction risk perceptions, relative risk messages comparing the health risks of NVPs to cigarette smoking increased the perception that NVPs are less harmful than combustible cigarettes, and a nicotine fact sheet corrected misperceptions of nicotine and NVPs. Smokers' intention to purchase, try or switch to NVPs was higher when exposed to a relative risk message and lower when exposed to nicotine addiction warnings. Trust in NVP risk information from public health agencies was associated with lower odds of; (i) NVP use and (ii) perceiving NVPs as less harmful, whereas those who trusted information from NVP companies were more likely to perceive NVPs as less harmful than combustible cigarettes. CONCLUSIONS Relative risk messages may help improve the accuracy of harm perceptions of nicotine vaping products and increase smokers' intentions to quit smoking and/or to switch to vaping, although the literature is nascent.
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Affiliation(s)
- Daniel A Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, UK
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.,Queensland Alliance for Environmental Health Sciences, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-3365, USA
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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10
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Kimber C, Cox S, Frings D, Albery IP, Dawkins L. Development and testing of relative risk-based health messages for electronic cigarette products. Harm Reduct J 2021; 18:96. [PMID: 34496865 PMCID: PMC8424813 DOI: 10.1186/s12954-021-00540-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to (1) develop and test a selection of relative risk messages for e-cigarette products; (2) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and (3) explore differences between smokers, non-smokers and dual users. METHOD Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. RESULTS On all three constructs combined, the two TPD messages rated the highest, closely followed by four relative risk messages "Completely switching to e-cigarettes lowers your risk of smoking related diseases", "Use of this product is much less harmful than smoking", "Completely switching to e-cigarettes is a healthier alternative to smoking", and "This product presents substantially lower risks to health than cigarettes" which did not differ statistically from the TPD messages. Non-smokers rated TPD1 significantly higher overall than dual users. Dual users rated "This product is a safer alternative to smoking" significantly higher than non-smokers. Messages did not differ on understandability. CONCLUSIONS These alternative messages provide a useful resource for future research and for policy makers considering updating e-cigarette product labelling.
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Affiliation(s)
- Catherine Kimber
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Sharon Cox
- Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Daniel Frings
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Ian P. Albery
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
| | - Lynne Dawkins
- Centre for Addictive Behaviour Research, Division of Psychology, School of Applied Sciences, London South Bank University, 103 Borough Road, London, SE1 0AA UK
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Brown R, Van Godwin J, Page N, Bauld L, McKell J, Hallingberg B, Maynard O, Blackwell A, Moore G. Implementation of e-cigarette regulation through the EU Tobacco Products Directive (2016) in Wales, Scotland and England from the perspectives of stakeholders involved in policy introduction and enforcement. Tob Prev Cessat 2021; 7:36. [PMID: 34046533 PMCID: PMC8138946 DOI: 10.18332/tpc/134370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION From May 2016, the European Union introduced the Tobacco Products Directive (TPD) regulations, which included restrictions to advertising and new safety and labeling standards for e-cigarette products. This represented the first supranational policy regulating e-cigarette sales and marketing. This study explores perceptions of TPD and its implementation in Wales, Scotland and England, from perspectives of stakeholders involved in tobacco and e-cigarette policy and implementation in each nation. METHODS Semi-structured qualitative interviews were completed with 12 stakeholders from government and third sector organizations in the UK involved in tobacco control policy-making processes, and Trading Standards Officers from 13 UK local authorities. Data were analyzed thematically and a sub-sample double-coded. RESULTS Stakeholders held varying views of e-cigarettes, recognizing potential benefits and harms of both the products and the new policy actions. Nevertheless, most perceived TPD to be a positive step in introducing regulation for e-cigarettes. Compliance was perceived as high across nations, although stakeholders highlighted product adaptations to circumvent restrictions, and absence of controls on non-nicotine products. Budgetary and staffing limitations also meant that capacity to communicate new measures, and enforce change, was limited. This led to a gap occupied by industry representatives, who played a substantial role in preparing retailers for adoption of new measures. CONCLUSIONS TPD policy roll-out was largely perceived positively and as having been effectively implemented. However, contribution of industry to communication of new measures and absence of resourcing for effective communication perhaps introduced widespread innovations within regulations. While largely viewed positively, some refinements to device regulations were proposed.
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Affiliation(s)
- Rachel Brown
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Jordan Van Godwin
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Nick Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
| | - Linda Bauld
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- SPECTRUM Consortium, United Kingdom
| | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, Stirling, United Kingdom
| | - Britt Hallingberg
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
| | - Olivia Maynard
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Anna Blackwell
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, United Kingdom
- SPECTRUM Consortium, United Kingdom
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12
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Moore G, Brown R, Page N, Hallingberg B, Maynard O, McKell J, Gray L, Blackwell A, Lowthian E, Munafò M, Mackintosh AM, Bauld L. Young people's use of e-cigarettes in Wales, England and Scotland before and after introduction of EU Tobacco Products Directive regulations: a mixed-method natural experimental evaluation. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102795. [PMID: 32854047 PMCID: PMC7773804 DOI: 10.1016/j.drugpo.2020.102795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/24/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Young people's experimentation with e-cigarettes has increased in recent years, although regular use remains limited. EU Tobacco Products Directive (TPD) regulations introduced packet warnings, advertising restrictions, and regulated nicotine strength from 2016, in part due to concerns regarding use by young people. This paper examines e-cigarette use trajectories before and after TPD. METHODS E-cigarette use data were obtained from School Health Research Network/Health Behaviour in School-aged Children surveys in Wales and Smoking Drinking and Drug Use surveys in England. Data from Wales were analysed using segmented logistic regression, with before and after regression analyses of English data. Semi-structured group interviews included young people aged 14-16 years in Wales, England and Scotland in 2017 and 2018. RESULTS In Wales, ever use of e-cigarettes increased over time, but under a range of assumptions, growth did not appear to continue post-TPD. A small and non-significant change in trend was observed post-implementation (OR=0.96; 95%CI=0.91 to 1.01), which increased in size and significance after adjusting for ever smoking (OR=0.93; 95%CI=0.88 to 0.98). There was little increase in regular e-cigarette use from 2015 to 2017 in Wales. However, ever and regular use increased from 2014 to 2016 in England. Young people in all nations described limited interactions with components of TPD, while describing e-cigarette use as a 'fad', which had begun to run its course. CONCLUSIONS This study provides preliminary evidence that young people's e-cigarette experimentation may be plateauing in UK nations. The extent to which this arises from regulatory changes, or due to a fad having begun to lose its appeal among young people in the UK countries, remains unclear. These trends contrast to those observed in North America, where newer products whose EU market entry and marketing have been impacted by TPD, have gained traction among young people. Long-term monitoring of e-cigarette use trends and perceptions among young people remain vital.
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Affiliation(s)
- Graham Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University; SPECTRUM Consortium, UK.
| | - Rachel Brown
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University
| | - Nicholas Page
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University
| | - Britt Hallingberg
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, Wales, UK
| | - Olivia Maynard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK/UK Centre for Tobacco and Alcohol Studies (UKCTAS) and School of Psychological Science, University of Bristol, Bristol, UK
| | - Jennifer McKell
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
| | - Anna Blackwell
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK/UK Centre for Tobacco and Alcohol Studies (UKCTAS) and School of Psychological Science, University of Bristol, Bristol, UK
| | - Emily Lowthian
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, Cardiff University
| | - Marcus Munafò
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK/UK Centre for Tobacco and Alcohol Studies (UKCTAS) and School of Psychological Science, University of Bristol, Bristol, UK; SPECTRUM Consortium, UK
| | - Anne-Marie Mackintosh
- Institute for Social Marketing, University of Stirling and UK Centre for Tobacco and Alcohol Studies
| | - Linda Bauld
- Usher Institute of Population Health Sciences & Informatics, University of Edinburgh; SPECTRUM Consortium, UK
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Malt L, Verron T, Cahours X, Guo M, Weaver S, Walele T, O’Connell G. Perception of the relative harm of electronic cigarettes compared to cigarettes amongst US adults from 2013 to 2016: analysis of the Population Assessment of Tobacco and Health (PATH) study data. Harm Reduct J 2020; 17:65. [PMID: 32948187 PMCID: PMC7501702 DOI: 10.1186/s12954-020-00410-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have been characterised as significantly less harmful than cigarettes by many health agencies and regulators globally. In this study, we examined to what extent perceived relative harms of e-cigarettes compared to cigarettes have changed in the USA. METHODS We analysed the data from the longitudinal and nationally representative, Population Assessment of Tobacco and Health Study to assess the relative perceived harm of e-cigarettes amongst US adults between 2013 and 2016. RESULTS The proportion of US adults who correctly perceived e-cigarettes as less harmful than cigarettes decreased each year from 41.1% (CI 40.1-42.1%) in 2013-2014, 31.5% (CI 30.8-32.2%) in 2014-2015 and 25.3% (CI 24.6-26.0%) in 2015-2016. Concurrently, the proportion of US adults who perceived e-cigarettes as equally, or more, harmful than cigarettes increased from 53.7% (CI 52.3-55.1%), 64.9% (CI 63.6-66.2%) to 72.7% (CI 71.5-73.9%) respectively. The proportion of US adults who held negative relative harm perceptions of e-cigarettes increased regardless of current smoking or vaping status by 24.6% and 29.6% respectively within 3 years. In Wave 3, the proportion of current smokers who perceived the relative harm of e-cigarettes as less harmful was lower at 29.3% (CI 28.2-30.4%) compared to current e-cigarette users at 43.5% (CI 40.3-46.7%). Former smokers who used e-cigarettes and believed that they were equally, or more, harmful than cigarettes in 2014-2015 had significantly higher rates of smoking relapse in the following year, 29% and 37% (p < 2.2e-16), respectively, compared to those with positive relative harm perceptions who reported relapse rates of 19%. CONCLUSIONS In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms. Further research is required to elucidate why the relative harm of e-cigarettes is misunderstood and continues to deteriorate.
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Affiliation(s)
- Layla Malt
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Thomas Verron
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Xavier Cahours
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Mengran Guo
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Sarah Weaver
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Tanvir Walele
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Grant O’Connell
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
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Ward E, Anholt C, Gentry S, Dawkins L, Holland R, Notley C. A Qualitative Exploration of Consumers' Perceived Impacts, Behavioural Reactions, and Future Reflections of the EU Tobacco Products Directive (2017) as Applied to Electronic Cigarettes. Tob Use Insights 2020; 13:1179173X20925458. [PMID: 32612402 PMCID: PMC7307283 DOI: 10.1177/1179173x20925458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/14/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Electronic cigarette regulations included in the Tobacco Products Directive (TPD), Article 20, implemented in Europe by May 2017, aimed to improve safety for e-cigarette consumers, and prevent uptake among non-smokers, particularly young people. Before implementation, there were significant concerns from consumers, industry, and some in the scientific community about the potential negative impact of the TPD on people using e-cigarettes to remain abstinent from smoking. To date, there is limited evidence on how the TPD has affected consumers. This study aimed to add insight into how consumers perceived and experienced the regulations. METHODS Qualitative data, collected between March 2018 and March 2019, relating to participant views of the TPD were extracted from 160 interviews/extended surveys of e-cigarette consumers as part of a wider study into e-cigarette use trajectories (ECtra study). Data were thematically analysed. RESULTS Awareness of the TPD among consumers was not universal. Participants' smoking behaviour did not appear to be influenced by the legislation. Participants were reassured by manufacturing regulations and requirements for ingredients labels. Participants responded negatively to changes perceived to cause inconvenience and extra plastic waste. The product restrictions prompted some participants to purchase non-compliant products illegally, potentially putting their safety at risk. CONCLUSIONS E-cigarette regulation should focus on ensuring product safety. Raising awareness of the TPD among consumers and smokers could be beneficial.
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Affiliation(s)
- Emma Ward
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Claudia Anholt
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, London, UK
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
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15
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Kimber C, Frings D, Cox S, Albery IP, Dawkins L. Communicating the relative health risks of E-cigarettes: An online experimental study exploring the effects of a comparative health message versus the EU nicotine addiction warnings on smokers' and non-smokers' risk perceptions and behavioural intentions. Addict Behav 2020; 101:106177. [PMID: 31753541 PMCID: PMC6891257 DOI: 10.1016/j.addbeh.2019.106177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This study investigated the effects of the European Union Tobacco Products Directive [EU-TPD] Article 20 E-cigarette (EC) health warnings ("This product contains nicotine which is a highly addictive substance. [It is not recommended for non-smokers.]") and a comparative harm message ("Use of this product is much less harmful than smoking" [COMP]) on smokers' and non-smokers' perceptions and behavioural intentions. METHODS 2495 UK residents (1283 smokers and 1212 non-smokers) self-reported perceived harm, addictiveness, EC effectiveness, social acceptability, and intentions to purchase and use EC, and in smokers, intentions to quit and intentions to use EC in future quit attempts. These were measured before and after exposure to EC images containing either the TPD, COMP, TPD + COMP or no message. RESULTS Non-smokers had higher harm, addictiveness and lower social acceptability perceptions. TPD presence increased, whilst COMP decreased, harm and addictiveness perceptions in both groups. For smokers only, harm perceptions were lower following exposure to COMP alone vs. no message. For non-smokers the TPD increased harm perceptions vs. no message. There were no effects on social acceptability, EC effectiveness or use intentions. In smokers only, purchase and quit intentions were higher following exposure to the COMP alone. CONCLUSION TPD messages may be effective smoking prevention tools, although the COMP message was more effective in reducing harm perceptions and increasing use intentions in smokers. That COMP did not increase use intentions in non-smokers suggest that such exposures may potentially act as an effective harm reduction tool without resulting in increased uptake among non-smokers.
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Affiliation(s)
- Catherine Kimber
- Centre for Addictive Behaviours Research, Division of Psychology, School of Applied Sciences, 103 Borough Road, London South Bank University, London SE1 0AA, United Kingdom.
| | - Daniel Frings
- Centre for Addictive Behaviours Research, Division of Psychology, School of Applied Sciences, 103 Borough Road, London South Bank University, London SE1 0AA, United Kingdom.
| | - Sharon Cox
- Centre for Addictive Behaviours Research, Division of Psychology, School of Applied Sciences, 103 Borough Road, London South Bank University, London SE1 0AA, United Kingdom.
| | - Ian P Albery
- Centre for Addictive Behaviours Research, Division of Psychology, School of Applied Sciences, 103 Borough Road, London South Bank University, London SE1 0AA, United Kingdom.
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, Division of Psychology, School of Applied Sciences, 103 Borough Road, London South Bank University, London SE1 0AA, United Kingdom.
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16
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Sontag JM, Wackowski OA, Hammond D. Baseline assessment of noticing e-cigarette health warnings among youth and young adults in the United States, Canada and England, and associations with harm perceptions, nicotine awareness and warning recall. Prev Med Rep 2019; 16:100966. [PMID: 31453077 PMCID: PMC6704048 DOI: 10.1016/j.pmedr.2019.100966] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Health warnings on tobacco products can inform users of potential risks. However, little is known about young people's exposure to health warnings on e-cigarette products. This baseline assessment of young people's noticing e-cigarette warnings uses nationally representative data from three countries. Data were collected under Wave 1 of the ITC Youth Tobacco and E-cigarette Survey, conducted in Canada, England, and the US. Online surveys were completed by 16–19-year-olds in July/August 2017 (n = 12,064), when warnings were either newly required (England) or voluntarily carried by some manufacturers (US, Canada). Analyses examined prevalence and correlates of noticing warnings and associations between noticing warnings and product perceptions, adjusting for country, sex, age, race/ethnicity, and cigarette/e-cigarette use status. About 12% reported noticing warnings on e-cigarette packaging in the past 30 days. Noticing warnings was significantly more likely among youth in England (AOR = 1.3, p < .01) and the US (AOR = 1.3, p < .01) versus Canada, and was most likely among dual e-cigarette/cigarette users (AOR = 4.69, p < .001) versus nonusers. Unaided recall of the keyword “nicotine” was low among those who noticed warnings (7.5%). However, ever e-cigarette users who noticed warnings had higher odds of knowing whether e-cigarettes contained nicotine (AOR = 2.26, p < .001). Noticing warnings was significantly associated with higher odds of believing e-cigarettes cause at least some harm to users (AOR = 1.19), are as harmful as cigarettes (AOR = 1.45), and can be addictive (AOR = 1.43). Baseline assessment reveals that youth's noticing of e-cigarette warnings and recall of nicotine-addiction messages was low. Research should track exposure over time as warning requirements are implemented across different countries. Noticing warnings on e-cig products is low in the US, England and Canada. Ever users: noticing warnings had higher odds of not knowing e-cigs have nicotine. Noticing warnings associated with higher odds of believing e-cigs can be addictive Exposure should be tracked over time as warnings are implemented across countries. Exposure to e-cig warnings may influence harm perceptions and use intentions.
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Affiliation(s)
- Jennah M. Sontag
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ 08901, USA
- Corresponding author.
| | - Olivia A. Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ 08901, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults' E-Cigarette Perceptions and Use Intentions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020184. [PMID: 30634618 PMCID: PMC6352031 DOI: 10.3390/ijerph16020184] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 11/17/2022]
Abstract
Although e-cigarettes in the United States are required to carry one nicotine addiction warning, little is known about the impact of other potential e-cigarette warning themes, nor about pairing warnings with messages that communicate e-cigarettes' reduced-harm potential relative to cigarettes. We randomly assigned 876 young adults (ages 18⁻29) to view e-cigarette ads in a 3 × 2 plus control online experiment that varied by warning theme (i.e., nicotine addiction; nicotine's impact on adolescent brain development; presence of harmful chemicals) and warning type-i.e., the presence ("relative harm warning") or absence ("standard warning") of a relative harm (RH) statement in the warning label ("e-cigarettes may cause harm to health but are less harmful than cigarettes"). Warning believability, informativeness, understandability and support were high across conditions and there were no significant differences by warning theme on e-cigarette harm perceptions or use intentions nor on nicotine (mis)perceptions. Perceived warning effectiveness for discouraging youth initiation was higher for the "brain" and "chemicals" warnings compared to the addiction warning. Warnings with the included RH statement were perceived as less believable and credible and were less frequently correctly recalled. Research should continue to investigate the impact of different e-cigarette warning themes and formats with priority audiences.
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