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

Abstract

(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.

Messages matter: The Tobacco Products Directive nicotine addiction health warning versus an alternative relative risk message on smokers' willingness to use and purchase an electronic cigarette

“…Research on e-cigarette health warnings is limited to date and has been concentrated in the US and Canada. In a nationally representative sample of US adults, exposure to e-cigarette magazine adverts containing a negatively framed health warning did not increase the probability of rating e-cigarettes to be more or equally harmful compared to cigarettes, particularly in non-smokers ( Shang et al, 2018 ). However, findings from six small focus groups with e-cigarette users and smokers suggests that health warnings including statements that e-cigarettes can be poisonous, contain toxins or are “not a safe alternative to smoking” could reduce appeal among smokers who may be considering e-cigarettes for smoking cessation ( Wackowski et al, 2016 ).…”

Baseline assessment of noticing e-cigarette health warnings among youth and young adults in the United States, Canada and England, and associations with harm perceptions, nicotine awareness and warning recall

“…A similar warning (“This product contains nicotine. Nicotine is an addictive chemical.”) and conspicuous packaging requirements (30% of front and back, 12-point font minimum) was made effective for e-cigarettes in the United States in August 2018, although most e-cigarette manufacturers in the US voluntarily carried some unstandardized form of warning before then (Shang et al, 2018). Content and formatting standards required by regulations are important given that they may enhance warning effectiveness (Hammond, 2011).…”

An experimental study of messages communicating potential harms of electronic cigarettes

“…With the implementation of a national youth e-cigarette use prevention campaign [ 29 ], and the FDA’s deeming rule requiring e-cigarette manufacturers to include warning statements about nicotine [ 30 , 31 ], a few studies have assessed impacts of e-cigarette health warnings, predominantly industry-style warning labels, and reported mixed findings. While some studies found that health warning labels increased risk perception and reduced intention to try e-cigarettes [ 24 , 32 , 33 ], others found that the addiction warning did not increase or showed an inconsistent effect on risk perception of e-cigarettes [ 34 , 35 ]. Research on e-cigarette prevention messages and campaigns is nascent [ 36 – 38 ], but indicates that they might be effective in increasing perceived risk and reducing use intentions [ 38 ].…”