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Jones D, Morgan A, Moodie C, Alexandrou G, Ford A, Mitchell D. The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland. Nicotine Tob Res 2024:ntae107. [PMID: 38839060 DOI: 10.1093/ntr/ntae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION In the United Kingdom, e-cigarette and refill packaging must display a nicotine addiction warning. This study explored how this message is perceived, responses to alternative on-pack messages, and other options for using e-cigarette packaging to discourage youth and people who neither smoke nor use e-cigarettes while encouraging smokers to switch. AIMS AND METHODS Between August and September 2022, 16 focus groups (n = 70) were conducted to explore these topics with adolescents (n = 31, aged 11-17 years) and adults (n = 39, nonsmokers, smokers that use e-cigarettes, smokers that do not use e-cigarettes) in England and Scotland. RESULTS While several participants thought the current nicotine addiction warning could help increase awareness of nicotine addiction, most reported that it failed to capture attention and was not a deterrent. Alternative messages shown on packs (about harm, toxicity, wellness, litter, or relative risk) received mixed responses. Relative risk messages were perceived as most beneficial for smokers switching but also thought to potentially encourage uptake among nonsmokers. Some participants considered certain harm and toxicity messages to potentially dissuade uptake. Participants proposed several ideas to reduce the appeal of e-cigarette packaging and devices to deter youth uptake, including more prominent warnings, standardized packaging, and devices that are plain or include health messages. CONCLUSIONS Packaging can play a crucial role in communicating product and health messages to different consumer groups. Further consideration of how packaging and labeling can meet the needs of non-nicotine users while simultaneously reaching those who may benefit from using e-cigarettes to stop smoking is warranted. IMPLICATIONS While some viewed the nicotine addiction warning required on e-cigarettes and refill packaging in the United Kingdom as helpful in raising awareness of nicotine addiction, it did not resonate with most of our sample of adolescents and adults. The findings suggest that e-cigarette packaging could be better used to encourage smokers to switch to a less harmful alternative, with relative risk messages showing promise. Furthermore, strengthening on-pack messaging (eg increasing salience and rotating messages) and reducing the appeal of packaging (eg drab colors) and devices (eg including warnings) may help increase awareness of e-cigarette harms while deterring use among adolescents and nonsmokers.
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Affiliation(s)
- Daniel Jones
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Amber Morgan
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Georgia Alexandrou
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Wu J, Benjamin EJ, Ross JC, Fetterman JL, Hong T. Health Messaging Strategies for Vaping Prevention and Cessation Among Youth and Young Adults: A Systematic Review. HEALTH COMMUNICATION 2024:1-19. [PMID: 38742648 DOI: 10.1080/10410236.2024.2352284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This systematic review evaluates health messaging strategies for the prevention and cessation of e-cigarette use among youth and young adults. Health messaging strategies were defined as the strategic process of developing messages with the intent to shape, reinforce, or change recipients' health attitudes and behaviors. McGuire's Communication/Persuasion Model guided the analysis of the messaging strategies, focusing on the model's five communication inputs (i.e. source, message, channel, audience, destination) and 14 persuasive outcomes. Nine databases were searched from January 2007 to September 2023. The inclusion criteria encompassed studies in English that presented quantitative data on messaging strategies aimed at discouraging vaping among youth and young adults. Each study was also coded for study characteristics and the utilization of theory. Out of 6,045 studies, 25 met the inclusion criteria. The reviewed studies exhibit a diverse array of research methods and a consistent integration of theories. The review emphasizes the nuanced main and interaction effects of various communication inputs, such as message features and audience characteristics, while also pointing out a research gap in message sources. In addition, the utilization of social media for effective messaging to engage the audience requires further research. Only one study specifically evaluated messaging strategies for vaping cessation. More research is imperative to develop targeted and tailored messages that effectively prevent and reduce vaping, especially among populations at higher risk of vaping-related harms, while also leveraging effective channels and innovative communication technologies to engage the audience.
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Affiliation(s)
- Jiaxi Wu
- Annenberg School for Communication, University of Pennsylvania
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine
- Department of Epidemiology, Boston University School of Public Health
| | | | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine
| | - Traci Hong
- College of Communication, Boston 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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Sheeran P, Kenny A, Bermudez A, Gray K, Galper EF, Boynton M, Noar SM. Artificial Intelligence Simulation of Adolescents' Responses to Vaping-Prevention Messages. JAMA Pediatr 2024; 178:504-506. [PMID: 38526479 PMCID: PMC10964158 DOI: 10.1001/jamapediatrics.2024.0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/29/2024] [Indexed: 03/26/2024]
Abstract
This quality improvement study investigates if a large language model could simulate adolescents’ responses to vaping-prevention campaigns and identify the most effective messages to address the public health crisis of adolescent vaping.
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Affiliation(s)
- Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Alexander Kenny
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Andrea Bermudez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Kurt Gray
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Emily F. Galper
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Marcella Boynton
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
| | - Seth M. Noar
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill
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Galper EF, Gottfredson O'Shea N, Ritchie C, Kresovich A, Ma H, Sutfin EL, Sheeran P, Noar SM. Identifying promising themes and messages for youth vaping prevention: A national study. Soc Sci Med 2024; 348:116864. [PMID: 38608483 PMCID: PMC11056295 DOI: 10.1016/j.socscimed.2024.116864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/29/2023] [Accepted: 04/02/2024] [Indexed: 04/14/2024]
Abstract
Use of e-cigarettes and vapes among adolescents continues to be a major public health concern. Health communication efforts can discourage e-cigarette use among adolescents by influencing beliefs and behavior. However, to do so, studies need to identify the most promising themes and messages based on the latest evidence about the harms of e-cigarettes and vaping. Participants were a nationally representative sample of 1,603 US adolescents aged 13-17 years, recruited in the summer of 2022. Adolescents were randomly assigned to view 7 vaping prevention statements (one from each theme: nicotine addiction, chemical harms, health symptoms, mental health, organ effects, cosmetic effects, and monetary cost) and 1 control statement (vape litter theme) from a pool of 46 statements that were developed through a systematic process. Participants rated each statement on perceived message effectiveness (PME), awareness, and believability. Results of linear mixed models indicated that all vaping prevention themes out-performed control messages on PME, with chemical harms and organ effects having the largest effects, followed by nicotine addiction and then other themes. For most message themes, PME effects were stronger for youth susceptible to vaping compared to non-susceptible youth and users. Both awareness and believability predicted higher levels of PME. In secondary analyses, we found that statements specifying the target ("you") and longer statements were also rated higher on PME. Results suggests that the most potent vaping prevention messages for adolescents are those that focus on vape chemicals and the potential of vaping to damage organs and increase disease risk.
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Affiliation(s)
- Emily F Galper
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | - Caroline Ritchie
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alex Kresovich
- Public Health Department, NORC at the University of Chicago, Chicago, IL, USA
| | - Haijing Ma
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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6
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Niederdeppe J, Porticella NA, Mathios A, Avery R, Dorf M, Greiner Safi A, Kalaji M, Scolere L, Byrne SE. Managing a policy paradox? Responses to textual warning labels on E-cigarette advertisements among U.S. national samples of youth overall and adults who smoke or vape. Soc Sci Med 2024; 344:116543. [PMID: 38335714 PMCID: PMC10923179 DOI: 10.1016/j.socscimed.2023.116543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 11/11/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
CONTEXT Current use and potential future uptake of e-cigarettes among youth remain public health concerns in the U.S., even as people who smoke combustible cigarettes could benefit from switching completely to e-cigarettes. The U.S. Food and Drug Administration (FDA) is considering alternative warning messages, but warnings that discourage youth from use may also deter people who smoke from switching. This study tests ten pre-registered hypotheses on effects of warning messages with national samples of youth overall and adults who smoke and/or vape. METHODS NORC recruited 1639 adults (ages 18+) who smoke, vape, or use both products, from their probability-sampled AmeriSpeak Panel and augmented their AmeriSpeak Teen Panel with Lucid's nonprobability opt-in panel to recruit 1217 youth (ages 14-17) to participate in a web-based survey experiment. We randomly assigned respondents to view one of five warning label conditions and respond to measures of their e-cigarette risk beliefs, willingness to use e-cigarettes, and (among people who smoke or vape) considerations to quit these products. FINDINGS Relative to the current FDA warning about nicotine, warning messages about the harms of e-cigarette use for youth brain development did not influence risk beliefs or reduce willingness to use these products among youth. Brain development warning messages did increase beliefs about these harms among adults but did not increase quit considerations among people who vape, relative to the FDA warning. Warning messages with information about chemical constituents of vaping products and the harm of these chemicals produced higher e-cigarette quit considerations than did the FDA warning among adults who vape. CONCLUSION Potential alternative warning label messages were largely ineffective relative to the current FDA warning about nicotine, though limited evidence suggests some potential for chemical + harm messaging to encourage people who use both e-cigarettes and cigarettes to consider quitting both.
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Affiliation(s)
- Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY, 14853, USA; Cornell Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, 14853, USA.
| | | | - Alan Mathios
- Cornell Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, 14853, USA; Department of Economics, Cornell University Ithaca, NY, 14853, USA
| | - Rosemary Avery
- Cornell Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, 14853, USA
| | - Michael Dorf
- Cornell Law School, Cornell University, Ithaca, NY, 14853, USA
| | - Amelia Greiner Safi
- Department of Public & Ecosystem Health, Cornell University, Ithaca, NY, 14853, USA
| | - Motasem Kalaji
- Department of Communication Studies, California State Northridge, Northridge, CA, 91330, USA
| | - Leah Scolere
- Department of Design and Merchandising, Colorado State University, Fort Collins, CO, 80523, USA
| | - Sahara E Byrne
- Department of Communication, Cornell University, Ithaca, NY, 14853, USA
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Simonavičius E, East K, Taylor E, Nottage M, Reid JL, Arnott D, Bunce L, McNeill A, Hammond D. Impact of E-liquid Packaging on Vaping Product Perceptions Among Youth in England, Canada, and the United States: A Randomized Online Experiment. Nicotine Tob Res 2024; 26:370-379. [PMID: 37542732 PMCID: PMC10882429 DOI: 10.1093/ntr/ntad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/21/2023] [Accepted: 08/04/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed. AIMS AND METHODS A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status. RESULTS Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids. CONCLUSIONS Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions. IMPLICATIONS Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered.
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Affiliation(s)
- Erikas Simonavičius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eve Taylor
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matilda Nottage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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8
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Mylocopos G, Wennberg E, Reiter A, Hébert-Losier A, Filion KB, Windle SB, Gore G, O'Loughlin JL, Grad R, Eisenberg MJ. Interventions for Preventing E-Cigarette Use Among Children and Youth: A Systematic Review. Am J Prev Med 2024; 66:351-370. [PMID: 37802308 DOI: 10.1016/j.amepre.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Many nonregulatory interventions targeting children and youth have been implemented at three levels: directed at the individual (e.g., interactive video games), delivered to students at school (e.g., campus bans), and launched in the community (e.g., mass media campaigns). This systematic review aims to synthesize the evidence on the effectiveness of interventions aimed at preventing e-cigarette initiation among children and youth. METHODS MEDLINE, CINAHL, Embase, APA PsycINFO, and Web of Science Core Collection were searched for papers published between January 1, 2004 and September 1, 2022 that reported more than one outcome on vaping prevention among individuals aged less than 21-years-old: vaping prevalence/incidence, initiation intentions, knowledge/attitudes, and other tobacco product use prevalence/initiation intentions. Interventions were at the individual, school, or community level. The risk of bias was assessed using ROBINS-I and RoB 1. RESULTS Thirty-nine publications met the eligibility criteria. Fourteen individually-based (4 parental monitoring, 3 video games, 2 text messages, 3 graphic message themes, 2 healthcare), 19 school-based (14 educational and skill interventions, 5 vape-free policies/bans), and 6 community-based (3 social media, 3 mass media campaigns) interventions were reported. E-cigarette initiation prevention was observed with high perceived parental monitoring; however, the cross-sectional study designs precluded causal claims. There was promising but limited evidence that social-emotional skills curricula and peer leader programming prevented vaping initiation. DISCUSSION Some individual- and school-based interventions showed promise for preventing e-cigarette initiation among children and youth.
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Affiliation(s)
- Genevieve Mylocopos
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Erica Wennberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anna Reiter
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andréa Hébert-Losier
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sarah B Windle
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Jennifer L O'Loughlin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada; Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roland Grad
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mark J Eisenberg
- Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Asfar T, Oluwole OJ, Pan Y, Casas A, Garayua AMH, Schmidt M, Noar SM. Youth Exposure and Response to the FDA Health Warning Label on Electronic Cigarettes Packaging: Policy Implications. Nicotine Tob Res 2024; 26:151-160. [PMID: 37688562 PMCID: PMC10803120 DOI: 10.1093/ntr/ntad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Youth represent a high-priority group for e-cigarette health communication. This study examined youth exposure to the Food and Drug Administration (FDA) e-cigarette warning label over 4 years and its association with change in youth harm perception and intention. AIMS AND METHODS We pooled data from the 2018-2021 National Youth Tobacco Survey (age 10-17; n = 67 159). Participants were divided into four groups: never users (58.5%), susceptible nonusers (16.3%), former users (12.7%), and current users (12.5%). We examined the prevalence, time-trend, correlates, and association of youth exposure to the warning with addictiveness and harm perception, intention to use e-cigarettes, and intention to quit all tobacco products. RESULTS Only 24.5% of youth were exposed to the warning. Exposure increased from 14.9% in 2018 to 30.8% in 2019, then declined to 25.2% in 2021. Hispanic (adjusted odds ratio (aOR) = 0.76 [95% CI = 0.641 to 0.89]) and non-Hispanic black current users (0.53 [0.40 to 0.69]) were less likely to be exposed to the warning than white current users. Youth exposure was positively associated with a higher perception of e-cigarette addictiveness (1.12 [1.04 to 1.19]) and intention to quit all tobacco products (1.28 [1.13 to 1.46]). However, exposure was negatively associated with harm perception (0.91 [0.85 to 0.96]) and the intention to use e-cigarettes among e-cigarette nonusers (2.38 [1.99 to 2.84]). CONCLUSIONS The decline in youth exposure to the warning indicates wear-out effects. Strengthening the label by using compelling designs, adding themes on e-cigarette harm to youth, periodically rotating warning content, and using culturally tailored messaging may improve its impact on youth and address racial/ethnic disparities. IMPLICATIONS The FDA e-cigarette label reached only 24.5% of youth, and exposure to the warning declined to indicate wear-out effects. Exposure was significantly lower among minorities. Exposure was associated with a higher perception of e-cigarette addictiveness and intention to quit all tobacco products. Still, it did not increase harm perception or reduce intention to use e-cigarettes among nonusers. Strengthening the label by using more compelling designs, including diverse themes focusing on e-cigarette harm relevant to youth, and periodically rotating warning content may improve its impact on youth. Continued surveillance of the implementation of e-cigarette policies is needed to ensure that they equally affect youth across racial/ethnic subpopulations.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Olusanya J Oluwole
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alejandra Casas
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Michael Schmidt
- Department of Art and School of Public Health, University of Memphis, Memphis, TN, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Li Y, Duong HT, Massey ZB, Churchill V, Popova L. When Cigarette Smoking Meets COVID-19: How the Two Types of Threat and Efficacy Perceptions Interactively Predict Danger Control and Fear Control Processes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2970. [PMID: 36833665 PMCID: PMC9957251 DOI: 10.3390/ijerph20042970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Growing evidence indicates that communicating the combined risk of smoking and COVID-19 encourages smoking cessation. Guided by the Extended Parallel Process Model (EPPM), we examined how perceived threats of smoking and COVID-19 independently and interactively predicted danger control responses (i.e., quit intentions and COVID-19-protective behavioral intentions) and fear control responses (i.e., fear and fatalism). We also explored the direct and interactive impacts of perceived efficacy of quitting smoking and COVID-protective behaviors on message outcomes. Structural equation modeling results (N = 747 U.S. adults who smoke) indicated that the perceived efficacy of COVID-protective behaviors positively predicted quit intentions. Higher perceived threat of COVID-19 and greater quitting efficacy predicted higher quit intentions directly and indirectly via fear. As perceived COVID-protective efficacy increased, the positive association between perceived quitting efficacy and quit intentions also increased. Smoking-related threat and efficacy perceptions did not predict COVID-protective behavioral intentions. This study added to EPPM by considering how threat and efficacy perceptions deriving from two different yet closely related risks affect protective behaviors. Thus, combining multiple threats in a single message might be a promising strategy to motivate smoking cessation amid the pandemic.
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Affiliation(s)
- Yachao Li
- Department of Communication Studies, Department of Public Health, The College of New Jersey, Ewing Township, NJ 08628, USA
| | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA 30302, USA
| | - Zachary B. Massey
- School of Journalism, University of Missouri, Columbia, MO 65201, USA
| | - Victoria Churchill
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
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E-cigarettes: A continuing public health challenge in India despite comprehensive bans. Prev Med Rep 2023; 31:102108. [PMID: 36820378 PMCID: PMC9938321 DOI: 10.1016/j.pmedr.2022.102108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023] Open
Abstract
India has introduced comprehensive e-cigarette bans focused on protecting youth from vaping-related harm. Despite these bans, educated young people appear to be a relatively high user group, although little is known about their usage patterns. The aims of the present study were to examine educated young adults' e-cigarette-related attitudes and behaviors and their support for various e-cigarette control policies. In total, 840 tertiary-educated young adults completed an online survey. Demographic characteristics, e-cigarette and tobacco use, beliefs about e-cigarettes, exposure to e-cigarette advertising, sources of access to e-cigarettes, numbers of family members and peers who vape, and support for a range of e-cigarette policies were assessed. One-third (33%) reported never having heard of e-cigarettes/vapes, 23% reported ever using e-cigarettes, 70% reported ever using tobacco, and 8% were dual users of both e-cigarettes and tobacco. Only 8% of e-cigarette users reported daily use. Vapers sourced e-cigarettes from retail outlets (vape shops, tobacconists) and their social networks (friends, siblings). Just under two-thirds of those who were aware of e-cigarettes believed them to be harmful and to contain chemicals. Among non-users, 31% were curious about using e-cigarettes and 23% intended to use in the following year, indicating high levels of susceptibility. The results suggest that despite a complete ban, young people are still able to access e-cigarettes in India. Greater education about harms associated with vaping and more intensive monitoring and enforcement could assist in reducing uptake in relatively high-prevalence groups such as educated young adults.
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Pettigrew S, Miller M, Santos JA, Brown K, Morelli G, Sudhir T, Jun M, Jones A. Young people's support for various forms of e-cigarette regulation in Australia and the UK. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103858. [PMID: 36175316 DOI: 10.1016/j.drugpo.2022.103858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/09/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to examine young people's support for e-cigarette policies in two countries with very different e-cigarette regulatory environments - Australia and the UK. METHODS An online survey was administered to 1,185 15-24 year olds (590 from Australia, 595 from the UK). Survey items assessed demographics, use of vaping and tobacco products, exposure to others' vaping behaviours, exposure to e-cigarette advertising, perceptions of harms associated with e-cigarettes, and support for 14 e-cigarette policies. Frequencies for support were calculated for each policy by country and overall, and a mixed effects negative binomial regression was performed to identify factors associated with support. RESULTS Majority support was expressed for 10 of the 14 policies in the Australian sample and six in the UK sample. Significantly higher levels support were found among Australian respondents compared to UK respondents for all policies except one where the difference failed to reach statistical significance. Support was strongest for policies relating to preventing access by minors, including warnings on packages, and prohibiting misleading advertising. Support was weakest for policies restricting access to e-cigarettes and flavours. Factors associated with higher levels of support were harm perceptions, never having used e-cigarettes, and older age. CONCLUSIONS The results suggest general support for a broad range of e-cigarette control policies among young people in Australia and the UK, despite very different e-cigarette regulatory environments in these countries. Enhancing awareness of the potential harms associated with e-cigarette use appears to be key to optimising support for the assessed policies among members of this age group.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Mia Miller
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katherine Brown
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Georgia Morelli
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Min Jun
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Villanti AC, Wackowski OA, LePine SE, West JC, Stevens EM, Unger JB, Mays D. Effects of Vaping Prevention Messages on Electronic Vapor Product Beliefs, Perceived Harms, and Behavioral Intentions among Young Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14182. [PMID: 36361061 PMCID: PMC9655851 DOI: 10.3390/ijerph192114182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Youth have been the focus of electronic vapor product (EVP) prevention efforts though young adults had similar increases in current EVP use from 2015-2019. This study tested messages to reduce EVP use in young adults. Eight messages on vaping related harms and addictiveness combined with themes on social use and flavors were selected for inclusion in an online randomized controlled trial. Vermont young adults aged 18-24 (n = 569) were randomized to view the eight vaping prevention messages (n = 295) or eight messages on sun safety (n = 274). After completing baseline measures, participants viewed study messages and completed measures on message perceptions and perceived message effectiveness (PME), EVP-related beliefs, and EVP-related harm perceptions. Participants completed EVP-related beliefs and harm perception measures again at 1-month follow-up, as well as measures on tobacco and EVP-related behavioral intentions and behavior (ever and past 30-day use). Intervention participants reported positive impacts on vaping-related message responses. However, findings suggested no effect of vaping prevention messages on EVP-related beliefs, harm perceptions, or behaviors in the full sample. Exploratory analyses in the intervention condition showed that greater PME was associated with lower odds to intent to try cigarettes in the next year at follow-up.
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Affiliation(s)
- Andrea C. Villanti
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - S. Elisha LePine
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA
| | - Julia C. West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA
- Department of Psychological Science, University of Vermont, Burlington, VT 05401, USA
| | - Elise M. Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Jennifer B. Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032, USA
| | - Darren Mays
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH 43214, USA
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14
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Noar SM, Gottfredson NC, Kieu T, Rohde JA, Hall MG, Ma H, Fendinger NJ, Brewer NT. Impact of Vaping Prevention Advertisements on US Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2236370. [PMID: 36227597 PMCID: PMC9561946 DOI: 10.1001/jamanetworkopen.2022.36370] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Importance Understanding whether prevention advertisements reduce susceptibility to vaping is important owing to concerning levels of adolescent vaping. Objective To examine whether vaping prevention advertisements from the US Food and Drug Administration (FDA) national Real Cost campaign lead to lower susceptibility to vaping among adolescents. Design, Setting, and Participants For this 3-group randomized clinical trial with parallel assignment, participants were US adolescents aged 13 to 17 years who were susceptible to vaping or current e-cigarette users, recruited from online panels. Adolescents were randomized to 1 of 2 Real Cost vaping prevention trial groups (health harms- or addiction-themed advertisements) or to a control group (investigator-created neutral videos about vaping). Adolescents completed 4 weekly online surveys at visits 1 to 4 over a 3-week period. Data were analyzed from December 1, 2021, to August 25, 2022. Interventions Adolescents saw 3 randomly ordered 30-second video advertisements online at each of 3 weekly study visits (visits 1, 2, and 3). Main Outcomes and Measures The primary trial outcome was susceptibility to vaping. Surveys also assessed susceptibility to smoking cigarettes to examine any spillover effects of vaping prevention advertisements on smoking outcomes. Both susceptibility measures had 3 items and ranged from 1 (indicating not susceptible) to 4 (indicating highly susceptible). The primary analyses compared Real Cost groups (combined) with the control group, while exploratory analyses compared the Real Cost groups with each other. Results Participants were 1514 adolescents (1140 [75.3%] boys; mean [SD] age, 15.22 [1.18] years), including 504 randomized to the Real Cost health harms group, 506 randomized to the Real Cost addiction group, and 504 randomized to the control group. Adolescents in the Real Cost groups (combined) had lower susceptibility to vaping at visit 4 than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). The Real Cost groups did not differ from one another on susceptibility to vaping (visit 4: b = -0.05; 95% CI, -0.17 to 0.07). Adolescents in the Real Cost groups (combined) also had lower susceptibility to smoking cigarettes than those in the control group (b = -0.21; 95% CI, -0.32 to -0.10). For both vaping and smoking, Real Cost groups had less positive attitudes (vaping: b = -0.27; 95% CI, -0.40 to -0.14; smoking: b = -0.23; 95% CI, -0.39 to -0.08) compared with the control group. Conclusions and Relevance These findings suggest that vaping prevention advertisements from the FDA Real Cost campaign led to lower adolescent susceptibility to vaping and had beneficial spillover effects on cigarette smoking outcomes. Tobacco prevention campaigns can help reduce youth tobacco use. Trial Registration ClinicalTrials.gov Identifier: NCT04836455.
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Affiliation(s)
- Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Nisha C. Gottfredson
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Talia Kieu
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Jacob A. Rohde
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill
| | - Marissa G. Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
- Carolina Population Center, University of North Carolina, Chapel Hill
| | - Haijing Ma
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | | | - Noel T. Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
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