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

Abstract

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.

Reactions to messages about smoking, vaping and COVID-19: two national experiments

“…This finding builds on a prior study showing e-cigarette warnings discouraged both vaping and smoking. 47 Future research Strengths of our experiments include the use of a randomised design, measurement of a primary outcome with strong psychometric properties, 49 and creation of realistic stimuli mirroring actual messages from public health organisations. Limitations include the brief exposure to stimuli in an online study, precluding assessment of behaviour.…”

“…This finding builds on a prior study showing e-cigarette warnings discouraged both vaping and smoking. 47 Future research will clarify the extent to which messages have beneficial spillover effects on behavioural outcomes, as well as whether there are any circumstances in which these messages have unintended consequences.…”

Warnings and packaging

“…Brewer 8 and colleagues (Editor's choice) conducted a randomised trial to examine whether warnings on Electronic Nicotine Delivery Systems (ENDS) about nicotine and addiction, which do not appear on cigarettes, could induce smoking. They showed that the warnings discouraged vaping, but found no evidence that ENDS warnings encouraged smoking.…”

Machine Learning-Based Nicotine Addiction Prediction Models for Youth E-Cigarette and Waterpipe (Hookah) Users

“…Compared to other tobacco products, e-cigarettes have a minimal requirement for a warning label [ 61 ]. Warnings of nicotine addiction on e-cigarette packaging can motivate users to quit [ 62 ] and it can be the case with government’s recommended labels. However, warning labels provided by tobacco companies, on the other hand, are shown to be harder to read and understand [ 63 ].…”