Effect of warning statements in e‐cigarette advertisements: an experiment with young adults in the United States

Abstract

Background and Aims This on-line experiment examined whether the addition of ingredient- or industry-themed warning statements in television advertisements for e-cigarettes would affect young adults’ craving for and risk perceptions of e-cigarettes and combustible cigarettes, as well as intent to purchase e-cigarettes. Design Advertisements for two leading e-cigarette brands were edited to contain a warning statement about product ingredients or about the tobacco industry. Participants were assigned randomly to one of eight treatments or one of two brand-specific control conditions without any warning statement. Participants Young adults (n=900, ages 18–34 years) in a web panel were recruited from three groups: recent e-cigarette users, current smokers who used combustible cigarettes exclusively and non-users of either product. Measurements Craving and risk perceptions (addictiveness, harmful to health in general, harmful to others) were measured separately for e-cigarettes and combustible cigarettes. The Juster scale measured intention to purchase e-cigarettes. Findings Exposure to both types of warnings was associated with lower craving for e-cigarettes among e-cigarette users and smokers who experienced any craving (P <0.01) and lower intention to purchase among all participants (P <0.001). Only exposure to ingredient-themed warnings was associated with lower craving for combustible cigarettes (P<0.05). Participants who saw industry-themed warnings reported greater perceptions of general harm (P<0.001), but also rated e-cigarettes as less addictive than the control conditions (P<0.05). Conclusion The addition of ingredient- or industry-themed warning statements to e-cigarette television advertising similarly reduces craving and purchase intent for e-cigarettes, but has inconsistent effects on perceived risks.

E-cigarettes Warning Labels and Modified Risk Statements: Tests of Messages to Reduce Recreational Use

“…Additionally, smoking men who viewed the FDA proposed text at 30% of package perceived e-cigarettes as riskier than those who viewed the MarkTen text and the abstract text, but not those who viewed the smaller FDA text. As noted above, in a prior study on e-cigarettes, it was found that warning labels that mentioned e-cigarette ingredients did not increase risk perceptions; 31 however, in this study, the FDA proposed text at 30% of package, which mentions the product ingredient nicotine, generated higher ratings of risk perceptions among non-smoking women and smoking men.…”

“…30 In a study varying the warning statements on e-cigarette television advertisements, only those warning statements that focused on the negative aspects of the e-cigarette industry increased risk perceptions, whereas those that focused on the e-cigarette ingredients did not. 31 …”

Overview of Electronic Nicotine Delivery Systems: A Systematic Review

“…348,403,712,720 Exposure to industry and ingredient warnings is associated with lower odds of intent to purchase ENDS. 714,734,747 Several studies have reported the presence of interior and exterior ENDS advertisements at tobacco retail outlets, 702,704,705,729 including one study which found that the ENDS advertisements featured flavored products at the eye level of children. 705 The total expenditure for ENDS advertisements across all media channels is increasing annually, 748,749 with a 52% increase from 2013 to 2014.…”

A fMRI study on the impact of advertising for flavored e-cigarettes on susceptible young adults

“…Nicotine is an addictive chemical” (FDA, 2016a). Beginning work suggests that e-cigarette health warnings can influence risk perceptions (Lee et al, 2017; Sanders-Jackson et al, 2015a). However, images of flavors on advertisements may interfere with health warning labels.…”