Effects of brief exposure to misinformation about e-cigarette harms on twitter: a randomised controlled experiment

Abstract

ObjectivesTo assess the effect of exposure to misinformation about e-cigarette harms found on Twitter on adult current smokers’ intention to quit smoking cigarettes, intention to purchase e-cigarettes and perceived relative harm of e-cigarettes compared with regular cigarettes.SettingAn online randomised controlled experiment conducted in November 2019 among USA and UK current smokers.Participants2400 adult current smokers aged ≥18 years who were not current e-cigarette users recruited from an online panel. Participants’ were randomised in a 1:1:1:1 ratio using a least-fill randomiser function.InterventionsViewing 4 tweets in random order within one of four conditions: (1) e-cigarettes are just as or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) e-cigarette harms are uncertain, and (4) a control condition of tweets about physical activity.Primary outcomes measuresSelf-reported post-test intention to quit smoking cigarettes, intention to purchase e-cigarettes, and perceived relative harm of e-cigarettes compared with smoking.ResultsAmong US and UK participants, after controlling for baseline measures of the outcome, exposure to tweets that e-cigarettes are as or more harmful than smoking versus control was associated with lower post-test intention to purchase e-cigarettes (β=−0.339, 95% CI −0.487 to –0.191, p<0.001) and increased post-test perceived relative harm of e-cigarettes (β=0.341, 95% CI 0.273 to 0.410, p<0.001). Among US smokers, exposure to tweets that e-cigarettes are completely harmless was associated with higher post-test intention to purchase e-cigarettes (β=0.229, 95% CI 0.002 to 0.456, p=0.048) and lower post-test perceived relative harm of e-cigarettes (β=−0.154, 95% CI −0.258 to –0.050, p=0.004).ConclusionsUS and UK adult current smokers may be deterred from considering using e-cigarettes after brief exposure to tweets that e-cigarettes were just as or more harmful than smoking. Conversely, US adult current smokers may be encouraged to use e-cigarettes after exposure to tweets that e-cigarettes are completely harmless. These findings suggest that misinformation about e-cigarette harms may influence some adult smokers’ decisions to consider using e-cigarettes.Trial registration numberISRCTN16082420.

Emotional Responses and Perceived Relative Harm Mediate the Effect of Exposure to Misinformation about E-Cigarettes on Twitter and Intention to Purchase E-Cigarettes among Adult Smokers

“…Details of the message stimuli selection from Twitter are described elsewhere [ 20 ]. Briefly, we conducted a keyword search of 1% of tweets relevant to e-cigarette harms on Twitter between January and September 2019 (n = 499 tweets).…”

“…Next, we chose four tweets for the three conditions: (1) E-cigarettes are as or more harmful than smoking, (2) E-cigarettes are completely harmless, and (3) Uncertainty. It is important to understand the effects of exposure to Tweets that include uncertainty of e-cigarette harms, as media and public discourse around this topic have included uncertainty as evidence-based information around e-cigarette harms have been developing [ 20 ]. The control condition comprised four tweets about physical activity.…”

“…After randomization to a condition, participants saw one tweet at a time in random order and were asked questions on the perceived effectiveness and likelihood of engagement with the tweet. They next completed post-test measures of emotional responses and behavioral intention [ 20 ], beliefs of e-cigarette harms, their tobacco use behaviors, media exposure and use, and sociodemographic characteristics.…”

“…We aimed to analyze whether emotions and perceived relative harms of e-cigarettes, elicited by exposure to e-cigarette misinformation, influenced adult smokers’ intention to purchase e-cigarettes. In a previously published paper using these data, we found that condition (either viewing tweets that e-cigarettes were just as or more harmful than smoking, e-cigarettes were completely harmless, e-cigarette harms were uncertain, or control tweets about physical activity) was associated with intention to purchase e-cigarettes and perceived relative harm perceptions and was not associated with quit intention [ 20 ].…”

How to Combat Health Misinformation: A Psychological Approach

“…6 Exposure to misinformation about e-cigarettes can influence people’s self-reported decision to purchase them. 7 And, starting in the 1950s, major tobacco companies have sought to undermine, downplay, or discredit scientific evidence of the dangers of smoking tobacco products through aggressive marketing and public relations campaigns, 8 and likely with some success: a study in which participants were shown YouTube videos containing misleading information about tobacco products showed that people who watched such a video subsequently had more positive attitudes towards such products than a control group. 9…”