Testing messages about comparative risk of electronic cigarettes and combusted cigarettes

Yang, Bo; Owusu, Daniel; Popova, Lucy

doi:10.1136/tobaccocontrol-2018-054404

Cited by 38 publications

(39 citation statements)

References 67 publications

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“…Recently, researchers have begun evaluating messages about comparative risks of electronic and combusted cigarettes 17–24. Quantitative studies of comparative risk messages have reported mixed findings.…”

Section: Introductionmentioning

confidence: 99%

“…Quantitative studies of comparative risk messages have reported mixed findings. While some studies found that comparative risk messages may encourage smoking cessation,20 24 reduce perceived risk of e-cigarettes relative to cigarettes, and may not change dual use intentions,21 24 others found that comparative risk messages may increase dual use intentions among smokers 21 22. Given the mixed findings and the challenges of developing comparative risk communication about e-cigarettes, there is a need for an in-depth understanding of the impacts and important aspects of comparative risk messages.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2019

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IntroductionCommunicating to smokers that e-cigarettes deliver lower levels of harmful chemicals than combusted cigarettes is a challenging issue. This study qualitatively explored smokers’ interpretations of messages communicating the risk of e-cigarettes relative to cigarettes (comparative risk messages).MethodWe developed 12 print comparative risk messages and evaluated them in 12 focus groups with 72 adult smokers (18+ years old) in Atlanta, Georgia.ResultsParticipants interpreted uncertainty about health effects of e-cigarettes as an indicator of significant unknown risks, which some believed to be potentially more severe than the known effects of cigarettes (such as cancer and heart disease). Also, participants were sceptical about the lower risk claims. Some participants misinterpreted what ‘switching completely’ or ‘switching 100% of the time’ means, perceiving switching from e-cigarettes to combusted cigarettes as comparable with the use of both products. When chemicals in e-cigarettes were mentioned (eg, nicotine or formaldehyde), participants viewed e-cigarettes as very harmful and had difficulty reconciling this belief with the reduced risk claim. Comparative risk messages emphasising smoking risks were perceived as effective. Participants also appreciated being given an option to switch if they cannot quit. Participants suggested the inclusion of more facts and statistics and a credible message source (eg, public health agencies) to increase message effectiveness.ConclusionComparative risk messages may be more acceptable to smokers if they show direct comparisons of the number of toxic chemicals in cigarettes and e-cigarettes, are attributed to a credible source(s), and emphasise smoking risks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Key measures are shown in Table 1. Outcome variables included perceived addictiveness of nicotine and perceived risk of nicotine [5], perceived e-cigarette risk (absolute [14,15] and comparative [15,16]), and behavioral intentions (intentions to switch to e-cigarettes [15], e-cigarette and cigarette dual use intentions [15], and intentions to seek information about e-cigarettes [17][18][19][20]). Covariates included gender, age, race, education, daily vs. non-daily smoking, use of e-cigarettes (current vs. former vs. never use), quit attempt in the past 12 months, smoking identity [21], and pre-exposure perceived comparative risk of e-cigarettes, perceived addictiveness of nicotine, and perceived risk of nicotine.…”

Section: Key Measuresmentioning

confidence: 99%

Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes

Yang

Owusu

Popova

2019

IJERPH

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We examined how a nicotine fact sheet influenced smokers’ beliefs about nicotine and electronic cigarettes (e-cigarettes), a potentially less harmful alternative to conventional cigarettes. In an exploratory online experiment, 756 US adult current and recent former smokers (quit in the past 2 years) were randomized to view a nicotine fact sheet or control messages (bottled water ads). Effects of the nicotine fact sheet on perceived nicotine addictiveness, nicotine risk, comparative risk of e-cigarettes, and dual use intentions were analyzed using log-Poisson regression with robust error. Linear regression analyzed effects on perceived absolute risk and switching and information seeking intentions about e-cigarettes. Compared to control, the nicotine fact sheet doubled the probability of disagreeing that nicotine is the main cause of smoking-related disease (26.2% vs. 12.7%, RR = 2.06, 95% CI = 1.51, 2.82, p < 0.001). However, nearly three quarters of participants viewing the nicotine fact sheet still thought that nicotine is the main cause of smoking-related disease. The nicotine fact sheet increased smokers’ intentions to seek information about e-cigarettes (b = 0.45, 95% CI = 0.15, 0.74, p = 0.003). We did not find evidence suggesting unintended consequences of the nicotine fact sheet on smokers’ e-cigarettes risk perceptions or use intentions (e.g., increased dual use intentions or reduced absolute e-cigarette risk perception).

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“…Because the perception that ENDS are less harmful than cigarettes is usually cited as one of the most important reason for their use [ 8 , 9 ], it is imperative to understand how to communicate to the public about the comparative risk of ENDS and cigarettes. However, only a few studies have examined the effects of messages communicating the risk differential between ENDS and combusted cigarettes [ 10 , 11 , 12 , 13 , 14 , 15 ]. These studies found that comparative risk messages about ENDS were able to reduce smokers’ perceived risk of ENDS relative to combusted cigarettes [ 13 , 14 , 15 ], increase smokers’ interest in using ENDS [ 10 , 16 ], and reduce smoking intentions [ 15 ] and smoking behavior during the study [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, only a few studies have examined the effects of messages communicating the risk differential between ENDS and combusted cigarettes [ 10 , 11 , 12 , 13 , 14 , 15 ]. These studies found that comparative risk messages about ENDS were able to reduce smokers’ perceived risk of ENDS relative to combusted cigarettes [ 13 , 14 , 15 ], increase smokers’ interest in using ENDS [ 10 , 16 ], and reduce smoking intentions [ 15 ] and smoking behavior during the study [ 17 ]. Despite these promising findings, two studies concluded that messages presenting lower risk information about ENDS relative to cigarettes had no effects on smoking cessation intentions [ 15 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Targeted Versus Nontargeted Communication About Electronic Nicotine Delivery Systems in Three Smoker Groups

Yang

Liu

Popova

2018

IJERPH

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Background: This study used an audience segmentation and message targeting approach to identify three distinct smoker groups—Older Freedom Smokers (OFS), Reluctant Smokers (RS), and Young Enthusiasts (YE)—and examined whether an electronic nicotine delivery systems (ENDS) message targeting each smoker group (targeted message) was associated with more health-enhancing outcomes than messages targeting other groups (nontargeted messages). Methods: An online experiment was conducted among 580 adult smokers with 180 OFS, 200 RS, and 200 YE. Each smoker group viewed a targeted message and two nontargeted messages in a random order. Following the presentation of each message, participants reported their perceived message effectiveness, message reactions, ENDS- and cigarette-related beliefs, and behavioral intentions. Results: The targeted vs. nontargeted messages mostly did not produce more health-enhancing outcomes on perceptions of absolute and comparative risks of ENDS and cigarettes, response efficacy of ENDS, and self-efficacy as well as intentions to quit smoking. Conclusions: Our targeted messages did not appear to be a better choice over nontargeted messages to communicate about ENDS to smokers. Given the increasing call to accurately inform the public of the risk differences among various tobacco products, future studies should continue to explore whether targeted messages could be employed to communicate about the comparative risks of ENDS.

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Testing messages about comparative risk of electronic cigarettes and combusted cigarettes

Cited by 38 publications

References 67 publications

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

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

Effects of a Nicotine Fact Sheet on Perceived Risk of Nicotine and E-Cigarettes and Intentions to Seek Information About and Use E-Cigarettes

Targeted Versus Nontargeted Communication About Electronic Nicotine Delivery Systems in Three Smoker Groups

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