The effect of messaging about reductions in exposure to harmful chemicals on perceived risk of JUUL e-cigarettes

Abstract

Adults who smoke (AWS) who switch completely to e-cigarettes reduce their exposures to many harmful chemicals, suggesting that switching could reduce risk. AWS who believe e-cigarettes are less harmful than cigarettes are more likely to use e-cigarettes to switch away from smoking. Yet most AWS believe e-cigarettes are at least as harmful as cigarettes. This study assessed the effect on risk perceptions of communicating that switching can reduce exposure to harmful chemicals. In a randomized experiment, AWS (n=3485), dual users of cigarettes and e-cigarettes (DU; n=1756), and nonusers of tobacco (n=7316) viewed an ad for JUUL with or without a reduced-exposure message, and completed assessments of perceived risk (PR). Message exposure decreased PR of JUUL among AWS, while increasing PR of smoking, thus increasing the perceived risk differential between the two. Among DU, the message increased PR of smoking, but did not change PR of JUUL. Among nonusers, who rated the PR of all assessed tobacco products higher than did AWS and DU, the message decreased PR of JUUL, and did not affect PR of smoking. Accurate modified exposure communications have potential to shift the perceived risk differential of smoking and e-cigarettes in a way that could benefit public health.

Randomized experiment testing the effect of messaging about reductions in exposure to harmful chemicals on intentions to use JUUL e-cigarettes among tobacco product users and nonusers

“…Analyses of comprehension showed that the message was wellunderstood and did not promote substantial misapprehensions about JUUL [23]. Analyses of risk perceptions showed that, as expected, the message also reduced perceived risk of JUUL use, and its risk relative to smoking, among AWS [24]. This effect of messaging would be expected, in turn, to increase use intentions.…”

“…The study was an experiment that randomized participants to view a video advertisement for JUUL that either included (Message condition) or did not include (Control) an exposure-reduction message, and then completed an online assessment, described below. Details of the study have been reported in [23,24] and can be found in Supplementary Material.…”

“…The nal analytic sample comprised 12,557 participants. The analysis considered three analytic groups: Adults Who Smoke (AWS) (combination of adults planning to quit and those not planning to quit smoking within 30 days) (n = 3,485), Dual Users (of cigarettes and ENDS) (n = 1,756), and Nonusers (combination of those who formerly used and never used tobacco) (n = 7,316) (see Supplementary Material), each weighted to represent those populations (see [24]). Additionally, some analyses combined the AWS and Dual Users ("Tobacco Users").…”

“…A separate item assessed participants' perceived likelihood of harm to others from JUUL using a similar scale. Shiffman et al [24] provide a detailed account of these measures, including the nding that exposure to the message signi cantly increased PRD and decreased perceived likelihood of harm to others.…”

“…To evaluate the extent to which the message's impact on risk perceptions (perceived harm to self and perceived likelihood of harm to others; [24]) accounted for any observed relationship between exposure to the message and OTU among AWS, a mediation analysis was conducted. Another mediation analysis evaluated whether the relationship between message rejection and AWS' OTU was mediated by risk perceptions.…”