How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes

Pepper, Jessica K.; Byron, Michael; Ribisl, Kurt M.; Brewer, Noel T.

doi:10.1016/j.ypmed.2016.12.025

Cited by 28 publications

(33 citation statements)

References 23 publications

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“…At first glance, this finding confirms one argument against the support for safer alternatives (gum, patches, etc.) - with the use of e-cigarettes, smokers become addicted to another nicotine product [37]. Based on increasing evidence that e-cigarettes are a low-toxicant nicotine product with little or no carcinogenic activity, the long-term risk will probably be lower than for smoking tobacco [52,59,60].…”

Section: Discussionmentioning

confidence: 99%

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Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

Lehmann

Kühn²,

Reimer³

2017

Eur Addict Res

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Aims: The aim of the study was to characterize e-cigarette users in terms of their consumption patterns, motives, and the perceived health benefits they experience from using e-cigarettes. Design: The study was a cross-sectional online survey in 2015. A total of 3,320 German e-cigarette users were enrolled. A total of 91.5% were former tobacco smokers, 7.5% used both e-cigarettes and tobacco products, 1.0% were never-smokers. Results: No differences were found between ex-smokers and dual users with regard to sociodemographic and smoking history (mean age 40.8 years, 81% men, 45% with a high school degree or above). Both groups had smoked 26.4 tobacco cigarettes a day for 22 years, had unsuccessfully tried to quit smoking using various other nicotine replacement products, and had used e-cigarettes for an average of 2 years. Ex-smokers consumed lower nicotine strength and more liquid per month, experienced more positive health changes, and had made vaping their hobby. Never-smokers were about 5 years younger, used liquid without nicotine and without tobacco flavor, and had no physical dependency. Conclusions: E-cigarettes were primarily used as an alternative to smoking and a substitute for nicotine. More dual users than ex-smokers used e-cigarettes in places where smoking is forbidden. Positive health changes were more pronounced in ex-smokers than dual users.

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Section: Discussionmentioning

confidence: 99%

“…The health potential and health risk of dual use is still unclear because no behavior modification takes place. It is possible that it keeps smokers from quitting smoking and health benefit depends on the reduction of the quantity of smoking [37,38]. …”

Section: Introductionmentioning

confidence: 99%

Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

Lehmann

Kühn²,

Reimer³

2017

Eur Addict Res

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“…41 The survey also assessed interest in e-cigarette use among current e-cigarette users (ie, planned to stop (coded as 1), decrease (2), continue (3) or increase (4) vaping); interest in cigarette use among current smokers (ie, planned to stop (coded as 1), decrease (2), continue (3) or increase (4) smoking); and interest in cigarette use among non-smokers (ie, planned to start smoking (no coded as 0, yes coded as 1). 42 The survey also assessed behavioural antecedents from the UNC Tobacco Warnings Model (TWM), a model that proposes mechanisms by which warnings impact tobacco product use, 36 including negative affective reactions to the messages (ie, fear, anxiety, disgust, sadness, guilt), 38 43 44 cognitive elaboration (ie, thinking about health problems, information conveyed and quitting e-cigarettes) 37 45 46 and anticipated social interactions about the messages. 47 48 The survey assessed message reactance 49 50 and anticipated avoidance of the messages.…”

Section: Methodsmentioning

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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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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“…Recently, researchers have begun evaluating messages about comparative risks of electronic and combusted cigarettes 17–24. Quantitative studies of comparative risk messages have reported mixed findings.…”

Section: Introductionmentioning

confidence: 99%

“…Quantitative studies of comparative risk messages have reported mixed findings. While some studies found that comparative risk messages may encourage smoking cessation,20 24 reduce perceived risk of e-cigarettes relative to cigarettes, and may not change dual use intentions,21 24 others found that comparative risk messages may increase dual use intentions among smokers 21 22. Given the mixed findings and the challenges of developing comparative risk communication about e-cigarettes, there is a need for an in-depth understanding of the impacts and important aspects of comparative risk messages.…”

Section: Introductionmentioning

confidence: 99%

‘The lesser devil you don’t know’: a qualitative study of smokers’ responses to messages communicating comparative risk of electronic and combusted cigarettes

et al. 2019

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IntroductionCommunicating to smokers that e-cigarettes deliver lower levels of harmful chemicals than combusted cigarettes is a challenging issue. This study qualitatively explored smokers’ interpretations of messages communicating the risk of e-cigarettes relative to cigarettes (comparative risk messages).MethodWe developed 12 print comparative risk messages and evaluated them in 12 focus groups with 72 adult smokers (18+ years old) in Atlanta, Georgia.ResultsParticipants interpreted uncertainty about health effects of e-cigarettes as an indicator of significant unknown risks, which some believed to be potentially more severe than the known effects of cigarettes (such as cancer and heart disease). Also, participants were sceptical about the lower risk claims. Some participants misinterpreted what ‘switching completely’ or ‘switching 100% of the time’ means, perceiving switching from e-cigarettes to combusted cigarettes as comparable with the use of both products. When chemicals in e-cigarettes were mentioned (eg, nicotine or formaldehyde), participants viewed e-cigarettes as very harmful and had difficulty reconciling this belief with the reduced risk claim. Comparative risk messages emphasising smoking risks were perceived as effective. Participants also appreciated being given an option to switch if they cannot quit. Participants suggested the inclusion of more facts and statistics and a credible message source (eg, public health agencies) to increase message effectiveness.ConclusionComparative risk messages may be more acceptable to smokers if they show direct comparisons of the number of toxic chemicals in cigarettes and e-cigarettes, are attributed to a credible source(s), and emphasise smoking risks.

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How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes

Cited by 28 publications

References 23 publications

Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

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

‘The lesser devil you don’t know’: a qualitative study of smokers’ responses to messages communicating comparative risk of electronic and combusted cigarettes

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