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

Owusu, Daniel; Lawley, Rachel; Yang, Bo; Henderson, Katherine; Bethea, Brittaney; LaRose, Christopher; Stallworth, Sam; Popova, Lucy

doi:10.1136/tobaccocontrol-2018-054883

Cited by 21 publications

(25 citation statements)

References 33 publications

(44 reference statements)

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“…In our qualitative study of comparative risk messages, we also observed that the mentioning of specific ingredients in e-cigarettes, including nicotine and formaldehyde, made participants perceive e-cigarettes as very harmful, and they were skeptical that e-cigarettes are less harmful than cigarettes. Additionally, comparative risk messages that compared toxic chemicals in cigarettes and e-cigarettes were consistently viewed as factual [18]. These findings, together with our results showing significant impact of Formaldehyde on the outcomes, suggest the need to communicate about contents of e-cigarettes, including the presence of toxic chemicals such as formaldehyde.…”

Section: Plos Onesupporting

confidence: 61%

An experimental study of messages communicating potential harms of electronic cigarettes

2020

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There has been an upsurge of e-cigarette use in the United States in recent years. While ecigarettes may contain lower levels of toxic chemicals than combusted cigarettes, they still pose serious health hazards, including increased risk for heart and respiratory disease. Despite these risks, public awareness of the health harms of e-cigarettes remains low. Thus, it is important to educate the public about the potential harms of e-cigarettes. This study took themes commonly found in antismoking messages and used them to develop messages about harms of e-cigarettes. A national sample of 2801 current smokers and nonsmokers (aged 18+ years) were randomized to view one of four e-cigarette messages (harmful effect of chemicals, uncertainty about ingredients, distrust of big tobacco, or cost of vaping) or a control message (bottled water ad). Participants' reactions to the messages and behavioral intentions were assessed immediately following the exposure. MANOVA examined effects of the messages on blocks of the outcome variables and univariate analyses estimated adjusted means for each experimental condition for each outcome. The message about harmful chemicals was perceived as the most informative and effective and elicited the highest levels of negative emotions (Ps<0.05). However, on measures of actual effectiveness, the other messages performed equally well. Specifically, messages with different themes (harmful chemicals, uncertainty about ingredients, anti-industry, or financial cost) increased perceived risk of e-cigarettes, support for e-cigarette control, and lowered self-exempting beliefs and intentions to use e-cigarettes (Ps<0.05). Themes commonly used in anti-smoking messages may be effective in educating the public about the potential harm of e-cigarettes. The observed differential effects of the messages suggest the need to use multiple themes in a public education campaign about e-cigarettes.

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Section: Plos Onesupporting

confidence: 61%

An experimental study of messages communicating potential harms of electronic cigarettes

2020

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“…This is important given that harm reduction appears to be conditional on completely switching (and not dual product use) [ 11 ]. However, the limited research on this wording so far is somewhat mixed on whether consumers understand what it means [ 12 , 13 , 14 ]. Camel’s proposed ads also include modified exposure claims (e.g., stating that “scientific studies have shown that Camel Snus contains less of the harmful chemicals than cigarette smoke”) as well as several statements attempting to connect the role of combustion with modified risk and exposure (e.g., “no smoke = less risk”).…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative research is important for exploring consumer perceptions and understanding of comparative risk messages and potential variations for developing new ones [ 6 ]. However, limited such investigation exists outside of the industry’s own research [ 12 , 14 , 18 ]. This is important given recommendations for independent MRTP studies outside of the industry [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages

Wackowski

Rashid

Greene

et al. 2020

IJERPH

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Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain “modified risk tobacco product” (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21–66) and young adult (YA) non-smokers (ages 18–25) (n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about “switching completely.” However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included “smoker” language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences.

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“…Correcting misperceptions about SHA without deterring full transition from smoking to ENDS use will require nuanced communications that balance encouragement and uncertainty. Recent findings suggest relative risk messages that compare smoking and vaping may foster more cautious beliefs, though these require testing with more diverse samples 24–26 37…”

Section: Discussionmentioning

confidence: 99%

It’s Just Steam: a qualitative analysis of New Zealand ENDS users’ perceptions of secondhand aerosol

et al. 2020

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IntroductionMany smokers who begin using electronic nicotine delivery systems (ENDS) report vaping in settings where they would not have smoked and believe secondhand aerosol (SHA) is simply steam. However, current understanding of how ENDS users differentiate between secondhand smoke and SHA, or how vaping norms develop, is limited.MethodsWe conducted in-depth, semi-structured interviews with 39 current ENDS users (dual users and former smokers, now exclusive ENDS users) from New Zealand to explore participants’ perceptions of SHA. We probed how these perceptions arose and examined implications for vaping practices and policy. We managed the data using NVivo V.11 and used a thematic analysis approach to interpret the transcripts.ResultsParticipants had limited understanding of SHA, its constituents or its possible effects on others. They drew on the absence of harm information, and their sensory experiences and perceptions of others’ views of vaping, to support the conclusion that SHA posed few, if any, risks to bystanders. Yet despite this perception, some felt they should recognise others’ rights to clean air and most would not vape around children to avoid setting an example.ConclusionsIn the absence of trusted information, participants used sensory heuristics to rationalise their ENDS practices. Policy-makers face the challenge of correcting misperceptions about SHA without deterring full transition from smoking to ENDS use. They could consider including vaping in current smoke-free area policies; this measure would signal that SHA is not harmless, and could protect clean-air settings and reduce potential normalisation of vaping among non-smokers.

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

Cited by 21 publications

References 33 publications

An experimental study of messages communicating potential harms of electronic cigarettes

An experimental study of messages communicating potential harms of electronic cigarettes

Smokers’ and Young Adult Non-Smokers’ Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages

It’s Just Steam: a qualitative analysis of New Zealand ENDS users’ perceptions of secondhand aerosol

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