Vaping in the News: The Influence of News Exposure on Perceived e-Cigarette Use Norms

Measurement of social norms for entertainment-education

BACKGROUND

While there has been a marked increase in measurement and scholarship surrounding social norms in recent years, there is little evidence related to social norms measurement in the context of health campaigns utilizing entertainment-education. Entertainment-education goals and objectives have shifted over time to include social norms and an update is needed to merge contemporary practice with the most recent measures from the literature. The aim of the present study was to analyze commonly used quantitative measures and their properties for social norms and entertainment-education, specifically on the topic of family planning, to bolster ongoing research and practice efforts by validating items for social norms measurement in entertainment-education programs.

METHODS

The study used data from a survey conducted with 438 married women aged 19-34 in the Central Province of Zambia in 2019 who were exposed to the entertainment-education initiative Kwishilya (Over the Horizon), a Bemba-language, 156-episode radio program designed to shift social norms on family planning. Multiple items were included to measure descriptive norms, injunctive norms, and outcome expectations. Exploratory factor analysis and estimates of scale reliability were conducted to understand the properties and structure of the social norms items.

RESULTS

Results showed a five-factor solution best fit the data, which accounted for 45.7% of the variance, exhibited fair reliability, and loaded largely as expected.

CONCLUSIONS

This study provides a useful tool for practitioners and scholars to use globally to measure important social norms constructs in entertainment-education.

Interpersonal communication and perceived norms as social influence mechanisms of e-cigarette use among adults: a systematic review

Background: Given the increasing popularity of e-cigarette use among adults and the ongoing debate about the benefits and the potential adverse health risks associated with e-cigarette use, it is critical to identify the correlates of e-cigarette use. Prior research has found associations between interpersonal communication, perceived norms, and adults' e-cigarette use, but the evidence has yet to be summarized and synthesized.Objectives: This paper reviewed empirical studies examining the relationship between interpersonal communication, perceived norms, and e-cigarette use among adults.Methods: Following PRISMA guidelines, articles were searched on DOAJ, EMBASE, Europe PubMed Central, Google Scholar, PsychINFO, PubMed, Web of Science, and the reference list of the retrieved studies for studies that examined social influence on e-cigarette use. Three reviewers independently screened 1,713 non-duplicate papers and further screened the full text of 195 articles for inclusion.Results: Thirty studies (30), consisting of quantitative (n = 25) and qualitative (n = 5) data, were included in this review. The twenty-five (25) quantitative studies consisted of both cross-sectional (n = 20) and longitudinal (n = 5) studies. Interpersonal communication portraying e-cigarettes as beneficial or harmful was found to increase e-cigarette use and quit attempts, respectively. Across study designs, greater perceptions of others' e-cigarette use or approval were related to more frequent e-cigarette use.Conclusions: The findings highlight that e-cigarette-related interpersonal communication and perceived norms are associated with e-cigarette use. These factors may be useful targets in brief interventions. However, most of the included studies were cross-sectional, limiting the ability to establish clear cause-and-effect relationships; therefore, more longitudinal studies are needed.

Where Do Perceived Norms Supporting Child Corporal Punishment Come From? A Study of Low-Income Parents

Although the influence of perceived norms on health behavior has been well researched, the sources of normative perceptions remain understudied. Drawing on the theory of normative social behavior, this study investigated factors shaping descriptive norms associated with child corporal punishment among a sample of low-income Black, Hispanic, and White parents (N = 260). Hierarchical regression results showed that childhood experiences of corporal punishment, direct observation, and interpersonal communication valence were significantly associated with descriptive norms. Path analysis confirmed the direct association between descriptive norms and behavioral intentions, as well as the mediating role of descriptive norms in linking the norm sources and behavioral intentions. Results also revealed that interpersonal network size and interpersonal communication valence jointly affected descriptive norms among parents who talked to others in their proximal networks about applying this disciplinary measure. Theoretical and practical implications were discussed.

Electronic cigarette social norms among adolescents in New South Wales, Australia

The use of electronic cigarettes (e-cigarettes) is common and increasing, especially among youth. In 2022/2023, 30% of 12- to 17-year-olds reported ever using e-cigarettes in Australia-a >50% increase from 2017 (14%). Several adverse e-cigarette health effects have been identified and most effects remain unknown. Social norms, rules that govern social behaviours, are associated with current and future adolescent e-cigarette use. Understanding social norms in Australian adolescents is critical to the development of targeted and effective e-cigarette prevention activities. This study aims to explore e-cigarette social norms among adolescents living in New South Wales, Australia. A total of 32 online single or paired semi-structured qualitative interviews were conducted involving 46 participants aged 14-17 years, as part of the Generation Vape project. Reflexive thematic analysis was applied within a constructivist perceptive. Adolescents perceived e-cigarettes use as prolific among their peers, with use considered common, acceptable and normal. Fuelled by social exposure to e-cigarettes, 'everyone' was generally thought to be using them (descriptive norms). E-cigarette use was considered so entrenched that it was part of adolescent identity, with abstinence regarded as atypical. Use was driven by an internalised desire to fit it (injunctive norm), rather than being attributed to overt/external 'peer-pressure'. Positive e-cigarette norms exist among Australian adolescents with norm formation strongly influenced by social exposure, including e-cigarette promotion. Prevention efforts should include limiting adolescent exposure to e-cigarette marketing to help redefine existing pro-e-cigarette social norms and protect health.

Testing the influence of harm reduction messages on health risk attitudes, injunctive norms and perceived behavioral control

BACKGROUND

E-cigarettes can potentially be a harm reduction pathway for adults who smoke and who are seeking to make the complete switch from cigarettes. However, often people who smoke believe that e-cigarettes are just as damaging as cigarettes to their health. From a harm reduction perspective, the key question is whether providing information about the reduced toxicant intake of e-cigarettes, compared to cigarettes, could influence their perceptions and whether there are certain message features that might further support this transition.

METHODS

In this experiment (n = 305), we test whether a harm reduction (reduced toxicant intake, complete switch) message will influence the health risk attitudes, injunctive norms and perceived behavioral control of people who smoke, compared to those who do not view a message and whether including a "smoking cue" within the message influences their response.

RESULTS

Results indicate that those who viewed the harm reduction message with a smoking cue had lower health risk attitudes than those who did not view a message (p = 0.025) and higher injunctive norms than those who viewed the message without a smoking cue (p = 0.006).

CONCLUSIONS

These findings demonstrate that a harm reduction message with a smoking cue can influence the perceptions of adults who smoke, lowering health risk attitudes and increasing injunctive norms.

Effects of Moral Frames Within Vaping Prevention Messages on Current smokers' Support for Electronic Cigarette Regulations

Given the rise of communication campaigns to prevent and reduce the use of electronic nicotine delivery systems among minors nationwide, it is important to examine whether certain preventive messages will spill over to affect current adult smokers' support for and compliance with vaping regulations. Drawing upon the Moral Foundations Theory, the current study experimentally examined the effects of moral frames on current adult smokers' support for vape-free policies and marketing restrictions. An online sample of current smokers (N = 630) was randomly assigned to a 3 (moral frames in vaping prevention : care, purity, non-moral control) × 2 (priming of anti-smoking messages: yes or no) between-subject survey experiment. Compared with non-moral framed messages, smokers exposed to both care and purity framed messages were more likely to support vape-free policies in public places. Such effects were stronger for smokers with higher pre-treatment endorsement of the purity value, driven less by anger or disgust but more by smokers' updating of both self-oriented and secondhand harm perceptions. Moral frames, especially those appealing to care and purity moral values, are thus promising messaging strategies for vaping prevention communication campaigns in terms of increasing current smokers' support for vape-free policies. The results also help improve our understanding of the moral roots of health policy opinions and the potential of deploying moral framing to improve message design for health campaigns.

Examining Sources of Social Norms Supporting Child Corporal Punishment Among Low-Income Black, Latino, and White Parents

Child corporal punishment is a prevalent public health problem in the US. Although corporal punishment is sustained through parents' perceptions of social norms supporting this discipline behavior, little research has investigated where these normative perceptions come from. To fill this gap, we conducted 13 focus groups including 75 low-income Black, Latino, and White parents across five states in the US. Results revealed that one influential source of Black and White parents' perceived norms was their positive framing of corporal punishment experiences during childhood. Furthermore, Black parents formed normative perceptions based on identification with parents in their racial/ethnic group, while White parents did so with parents sharing the same generation. Results are interpreted in light of the false consensus effect and self-categorization theory. In contrast, Latino parents viewed their childhood experience of corporal punishment as negative and distanced their parenting practices from those practiced in their countries of origin, suggesting an influence of acculturation. Their perceived norms were likely transmitted through interpersonal communication within their social networks. These findings shed light on how social norms are formed and in turn guide parents' use of corporal punishment as a tool to discipline children.

A Snapshot of Parenting Practices Useful for Preventing Adolescent Vaping

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Youth with more parental knowledge perceive higher vaping prevalence.

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Youth with more parental knowledge perceive greater vaping harm.

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Youth with more parental knowledge perceive less accepting of vaping.

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Youth with greater parental media mediation report less lifetime vaping.

Introduction

Smoking research demonstrates that parents can influence their adolescent’s tobacco smoking perceptions and behaviors, but little is known about the protective effects of different parenting practices on adolescent vaping. In this study we investigate how adolescent perceptions of parents’ knowledge of their activities and parental media mediation are associated with adolescents’ perceptions of vaping and adolescent vaping behaviors.

Method

Six hundred thirty-nine youth (65.7% female, average age: 14.71 years old) recruited through 4-H clubs in nine states participated in a study evaluating a substance use intervention program. Because the evaluation design could influence participants, we used only baseline data. An online self-reported survey was administrated. Most youth self-identified as White (87.3%) and only handful youth indicated Asian (3.4%), African American (3.4%), American Indian (1.1%), and other or unreported (4.8%). Approximately 60% of youth lived in small town or rural areas in US.

Results

Analyses revealed that parental knowledge was positively related with adolescent perceived harm of vaping and perceived prevalence of vaping, but was negatively related with perceived acceptability of vaping and social expectancy of vaping. In addition, youth who reported greater parental media mediation were more likely to perceive the harm of vaping and less likely to vape compared with youth with lower parental media mediation.

Conclusion

These findings suggest that parental education about vaping, including those promoting conversations regarding vaping and vaping ads, may be important to the prevention of adolescent vaping.

How Do Social Network Sites Influence Workout Intentions: A Social Norm Approach

People share their workout experiences on social network sites (SNSs). The present study examined how perceived exposure to these workout-related SNS posts may affect individuals' engagement in physical activities through perceived descriptive and injunctive norms of workout in their network, and how self-efficacy in workout moderated the effect of perceived descriptive norm on their workout intention, which was measured in general and specific ways. An online survey was conducted with a convenience sample of 807 responses in China. Results show that perceived descriptive norm of workout in one's network mediated the relationship between perceived exposure to workout-related SNS posts and perceived injunctive norm. In addition, self-efficacy in workout moderated the effect of perceived descriptive norm on workout intention-both general and specific-but the normative influence was stronger at a low level of self-efficacy compared to a high level. Furthermore, perceived injunctive norm only predicted the general rather than specific workout intention, suggesting that the perception of most people's approval might not be priority when people consider details about workout. These findings develop the theory of normative social behavior by illustrating the relationship between perceived descriptive and injunctive norm and shed light on the relative strength of the motivating factors of workout in different situations.

Are smokers scared by COVID-19 risk? How fear and comparative optimism influence smokers' intentions to take measures to quit smoking

Research suggests that smoking may compound the risk of serious health problems to smokers who contract COVID-19. This study examines whether and how exposure to news stories reporting the severe COVID-19 risk to smokers may influence smokers’ emotional responses (fear, anxiety, and sadness) and intentions to take measures to quit smoking. Current smokers in the US participated in an online experiment (N = 495) and were randomized to read smoking risk news stories or news stories reporting the combined risk of smoking and COVID-19. We found that combined risk news stories lead to participants feeling more fearful and sadder than when they viewed smoking risk news stories (M = 5.74; SD = 2.57 vs. M = 5.20; SD = 2.74; p < .05). Fear fully mediated the effect of news exposure on intentions to take measures to quit smoking (ß = .09; SE = 05; 95% CI [.010, .200]). Moreover, moderated-mediation analyses revealed that the mediating effect of fear was conditioned on the levels of comparative optimism, such that the association between fear and intentions to take measures to quit smoking was only significant among smokers whose comparative optimism was at the mean score (ß = .16; SE = 05; 95% CI [.071, .250]), and for those whose comparative optimism was high (ß = .27; SE = .06; 95% CI [.146, .395]). These results suggest that fear of the pandemic and optimism might play important roles in predicting and explaining the association between exposure to news stories and intentions to take measures to quit smoking. Messages about heightened risk of COVID-19 complications for smokers that increase fear might be an effective strategy to motivate smokers to quit. Such messages should be used to turn the adversity of COVID-19 pandemic into an intervention opportunity to reduce tobacco-related disease.

Using a mixed methods approach to identify public perception of vaping risks and overall health outcomes on Twitter during the 2019 EVALI outbreak

INTRODUCTION

Vaping product use (i.e., e-cigarettes) has been rising since 2000 in the United States. Negative health outcomes associated with vaping products have created public uncertainty and debates on social media platforms. This study explores the feasibility of using social media as a surveillance tool to identify relevant posts and at-risk vaping users.

METHODS

Using an interdisciplinary method that leverages natural language processing and manual content analysis, we extracted and analyzed 794,620 vaping-related tweets on Twitter. After observing significant increases in vaping-related tweets in July, August, and September 2019, additional human coding was completed on a subset of these tweets to better understand primary themes of vaping-related discussions on Twitter during this time frame.

RESULTS

We found significant increases in tweets related to negative health outcomes such as acute lung injury and respiratory issues during the outbreak of e-cigarette/vaping associated lung injury (EVALI) in the fall of 2019. Positive sentiment toward vaping remained high, even across the peak of this outbreak in July, August, and September. Tweets mentioning the public perceptions of youth risk were concerning, as were increases in marketing and marijuana-related tweets during this time.

DISCUSSION

The preliminary results of this study suggest the feasibility of using Twitter as a means of surveillance for public health crises, and themes found in this research could aid in specifying those groups or populations at risk on Twitter. As such, we plan to build automatic detection algorithms to identify these unique vaping users to connect them with a digital intervention in the future.

From the Deeming Rule to JUUL-US News Coverage of Electronic Cigarettes, 2015-2018

INTRODUCTION

News media may influence public perceptions and attitudes about electronic cigarettes (e-cigarettes), which may influence product use and attitudes about their regulation. The purpose of this study is to describe trends in US news coverage of e-cigarettes during a period of evolving regulation, science, and trends in the use of e-cigarettes.

METHODS

We conducted a content analysis of e-cigarette topics and themes covered in US news articles from 2015 to 2018. Online news databases (Access World News, Factiva) were used to obtain US news articles from the top 34 circulating newspapers, four national wire services, and five leading online news sources.

RESULTS

The number of articles increased by 75.4% between 2015 and 2018 (n = 1609). Most articles focused on policy/regulation (43.5%) as a main topic, followed by health effects (22.3%) and prevalence/trends (17.9%). Discussion about flavor bans quadrupled (6.1% to 24.6%) and discussion of youth e-cigarette use was most prevalent (58.4%) in 2018, coinciding with an increase in coverage about JUUL. JUUL was mentioned in 50.8% of 2018 articles. Across years, articles more frequently mentioned e-cigarette risks (70%) than potential benefits (37.3%).

CONCLUSIONS

E-cigarettes continue to be a newsworthy topic, with coverage both reflecting numerous changes and events over time, and providing repeated opportunities for informing the public and policymakers about these novel products. Future research should continue to track how discourse changes over time and assess its potential influence on e-cigarette perceptions and policy changes.

IMPLICATIONS

E-cigarette news coverage in the United States increased between 2015 and 2018 and predominantly focused on policy and regulation. Notable spikes in volume were associated with some but not all major e-cigarette events, including the FDA's deeming rule, Surgeon General's report, and release of the National Youth Tobacco Survey data in 2018. Coverage of the 2018 National Academy of Medicine, Engineering, and Sciences report on the Public Health Consequences of E-cigarettes received minimal news coverage. The high volume in 2018 was driven in large part by coverage of the e-cigarette brand JUUL; over half of news articles in 2018 referenced JUUL specifically.

Harm perceptions and tobacco use initiation among youth in Wave 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study

In the US, youth attribute higher levels of harm and addictiveness to cigarettes relative to other tobacco products. Monitoring harm perceptions across a range of tobacco products is important when forecasting risk for experimentation. This study examined data from US youth (N = 10,081) ages 12-17 from the Population Assessment of Tobacco and Health (PATH) Study who completed both Wave 1 (2013-2014) and Wave 2 (2014-2015) interviews. Analyses assessed: (1) trends in perceived harm and addictiveness of products over time, (2) whether perceived harm and addictiveness of a product at Wave 1 predicted trying that product for the first time by Wave 2, and (3) whether trying a product between Waves 1 and 2 predicted a decrease in one's perceived harm and addictiveness of that product. Levels of perceived harmfulness and addictiveness significantly increased between Wave 1 and Wave 2 for all products (χ² (range): 7.8-109.2; p's ≤ 0.02). Compared to those with "high" perceived harmfulness of a tobacco product at Wave 1, those with "low" and "medium" perceived harmfulness had a significantly increased probability of use of that product at Wave 2. For all products, Wave 1 youth never tobacco users who tried a product (vs. did not) at Wave 2 had a significantly higher probability of being in the "low" category of perceived harmfulness at Wave 2. Among US youth, there is a bidirectional relationship between harm perceptions and product use. Understanding how changes in perceptions translate to changes in tobacco use could inform efforts to prevent tobacco initiation in youth.