Considerations and Future Research Directions for E-Cigarette Warnings—Findings from Expert Interviews

Wackowski, Olivia A; Hammond, David; O’Connor, Richard J.; Strasser, Andrew A.; Delnevo, Cristine D.

doi:10.3390/ijerph14070781

Cited by 24 publications

(22 citation statements)

References 19 publications

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“…Because some people may misunderstand e-cigarette health warnings, 26 unintended consequences of the warnings are a concern. 27 E-cigarette warnings could result in misperceptions that e-cigarettes are as harmful as cigarettes, potentially driving people away from vaping and towards smoking cigarettes. 27 However, we consider an alternative possibility that e-cigarette warnings could in fact discourage both vaping and smoking.…”

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confidence: 99%

“…27 E-cigarette warnings could result in misperceptions that e-cigarettes are as harmful as cigarettes, potentially driving people away from vaping and towards smoking cigarettes. 27 However, we consider an alternative possibility that e-cigarette warnings could in fact discourage both vaping and smoking. We examined these questions in an experiment on e-cigarette warnings.…”

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confidence: 99%

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Impact of e-cigarette health warnings on motivation to vape and smoke

Brewer¹,

Jeong

Hall³

et al. 2019

Tob Control

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BackgroundA prevailing hypothesis is that health warnings for electronic cigarettes (e-cigarettes) could drive people away from vaping and towards smoking cigarettes. We consider an alternative hypothesis that e-cigarette warnings discourage both vaping and smoking.MethodsParticipants were a national convenience sample of 2218 US adults who used e-cigarettes, cigarettes or both. In August 2018, we randomised participants to one of three warning types (control text about littering, text-only e-cigarette warning or pictorial e-cigarette warning). We further randomised participants viewing e-cigarette warnings to one of three topics (nicotine addiction, health hazards of use, or both health hazards and harms of use). The preregistered primary outcome was intentions to quit vaping among e-cigarette users. Secondary outcomes included interest in smoking and Tobacco Warnings Model constructs: attention, negative affect, anticipated social interactions and cognitive elaboration.ResultsText warnings elicited higher intentions to quit vaping than control among e-cigarette users (d=0.44, p<0.001), and pictorial warnings elicited still higher intentions to quit vaping than text (d=0.12, p<0.05). Text warnings elicited lower interest in smoking compared with control among smokers (p<0.05); warnings had no other effects on interest in smoking among smokers or non-smokers. Text warnings about health hazards elicited higher intentions to quit vaping than nicotine addiction warnings. E-cigarette warnings also increased Tobacco Warnings Model constructs.DiscussionE-cigarette health warnings may motivate users to quit vaping and discourage smoking. The most promising warnings include health hazards (other than nicotine addiction) and imagery. We found no support for the hypothesis that e-cigarette warnings could encourage smoking cigarettes.

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confidence: 99%

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confidence: 99%

Impact of e-cigarette health warnings on motivation to vape and smoke

Brewer¹,

Jeong

Hall³

et al. 2019

Tob Control

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“…Based on our review, most ecigarette users from the selected study stated that e-cigarette was perceived less harm than tobacco cigarettes. The study highlights the need to design public health messages that accurately interpret the scientific data on the potential harm of e-cigarette and clearly differentiate the absolute from the relative harm of e-cigarette 24 .…”

Section: Perceived Harm and Addictiveness Of Ecigarettementioning

confidence: 99%

Perceived Harm and Addictiveness of e-Cigarette: A Systematic Review

Kristina

Permitasari

Intihan

et al. 2019

J. Manaj. dan Pelayanan Farm.

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The popularity of electronic nicotine delivery systems (ENDS), also known as e-cigarette, has been growing rapidly in the past years. Therefore, it is also important to explore how e-cigarette users perceive its harm and addiction risk. The aim of this study is to review and determine perceived harm and addictiveness of e-cigarette among e-cigarette users. We conducted a systematic review for published articles in English that had reported about perceived harm and addictiveness of e-cigarette published during year 2008 to 2018. Relevant studies were located through an extensive search from three electronic databases (PubMed, Science Direct, and Cochrane Database of Systematic Reviews) and Google Scholar on October 2018. Key terms used were “perceived harm”, “perceived risk”, “harm and addictiveness”, “belief”, “electronic cigarette”, “e-cigarette”, and “vaping”. A result of 88 studies were retrieved and reviewed. After further inspection of references from the collected studies, only 5 selected studies met all inclusion criteria. The final studies consisted of three cross-sectional studies, one longitudinal, and one prospective study. E-cigarette were perceived harmless and less addictive than cigarettes among its users with many predictors associated, including sex, age, race, education, advertisement and health belief for smoking cessation. Compared to non-users, e-cigarette users were significantly less likely to worry about the health risks, either its harm or addictiveness. E-cigarette was perceived harmless and less addictive than tobacco cigarettes. Further study about e-cigarette profile is particularly important to design public health messages that accurately interpret the scientific data on the potential harm and addictiveness of e-cigarette.

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“…According to one focus group study, the FDA addiction warning has limited impact on tobacco users who already know nicotine is addictive, but it might inform young non-users [ 12 ]. However, some experts in tobacco warning research are concerned about whether this warning resonates with young people [ 13 ]. In general, expert opinions and focus group interviews show that modified risk or reduced risk statements that claim ENDS to be less harmful may increase ambiguity about risks, particularly among nonsmokers [ 13 , 14 , 15 , 16 ]…”

Section: Introductionmentioning

confidence: 99%

The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS)

Shang

Weaver

Zahra

et al. 2018

IJERPH

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(1) Background: Several brands of electronic nicotine delivery systems (ENDS) carry voluntary health warning messages. This study examined how potential exposure to ENDS magazine ads with these voluntary health warnings were associated with the perceived harmfulness of ENDS. (2) Methods: Risk perception measures and self-reported exposure to ENDS ads were obtained from the 2014 Georgia State University (GSU) Tobacco Products and Risk Perceptions Survey of a nationally representative sample of U.S. adults. We examined the association between potential exposure to magazine ads with warnings and the perceived harms of ENDS relative to cigarettes, using binary logistic regressions and controlling for general ENDS ad exposure and socio-demographic characteristics. (3) Results: Potential exposure to ENDS magazine ads with warnings was associated with a lower probability of considering ENDS to be more or equally harmful compared to cigarettes, particularly among non-smokers (OR = 0.16; 95% CI: 0.04–0.77). In addition, ad exposure, ENDS use history, race/ethnicity, gender, education, and income were also associated with harm perceptions. (4) Conclusions: This study did not find evidence that magazine ads with warnings increased misperceptions that ENDS are equally or more harmful than cigarettes. With more ENDS advertisements carrying warnings, more research is needed to determine how the warnings in advertisements convey relative harm information to consumers and the public.

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Considerations and Future Research Directions for E-Cigarette Warnings—Findings from Expert Interviews

Cited by 24 publications

References 19 publications

Impact of e-cigarette health warnings on motivation to vape and smoke

Impact of e-cigarette health warnings on motivation to vape and smoke

Perceived Harm and Addictiveness of e-Cigarette: A Systematic Review

The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS)

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