The effect of e-cigarette warning labels on college students' perception of e-cigarettes and intention to use e-cigarettes

Lee, Hsiao-Yun; Lin, Hsien-Chang; Seo, Dong-Chul; Lohrmann, David K.

doi:10.1016/j.addbeh.2017.07.033

Cited by 35 publications

(25 citation statements)

References 31 publications

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“…Perceived Warning Effectiveness, Credibility and Support: Participants in the experimental groups viewed the warning per their condition again and were asked the extent to which they agreed (1 = strongly disagreed–4 = strongly agreed) it was believable, understandable, informative and discouraged e-cigarette use among young people and smokers [36,37,38]. Perceived credibility of the warning was measured adapting Meyer’s credibility scale (5-point semantic differential items: e.g., accurate/inaccurate, biased/unbiased; α = 0.88) [12,39].…”

Section: Methodsmentioning

confidence: 99%

The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions

Wackowski

Sontag

Hammond

et al. 2019

IJERPH

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Although e-cigarettes in the United States are required to carry one nicotine addiction warning, little is known about the impact of other potential e-cigarette warning themes, nor about pairing warnings with messages that communicate e-cigarettes’ reduced-harm potential relative to cigarettes. We randomly assigned 876 young adults (ages 18–29) to view e-cigarette ads in a 3 × 2 plus control online experiment that varied by warning theme (i.e., nicotine addiction; nicotine’s impact on adolescent brain development; presence of harmful chemicals) and warning type—i.e., the presence (“relative harm warning”) or absence (“standard warning”) of a relative harm (RH) statement in the warning label (“e-cigarettes may cause harm to health but are less harmful than cigarettes”). Warning believability, informativeness, understandability and support were high across conditions and there were no significant differences by warning theme on e-cigarette harm perceptions or use intentions nor on nicotine (mis)perceptions. Perceived warning effectiveness for discouraging youth initiation was higher for the “brain” and “chemicals” warnings compared to the addiction warning. Warnings with the included RH statement were perceived as less believable and credible and were less frequently correctly recalled. Research should continue to investigate the impact of different e-cigarette warning themes and formats with priority audiences.

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Section: Methodsmentioning

confidence: 99%

The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions

Wackowski

Sontag

Hammond

et al. 2019

IJERPH

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Garrison

O’Malley

Gueorguieva³

et al. 2018

Drug and Alcohol Dependence

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Background E-cigarettes are sold in flavors such as “Skittles,” “strawberrylicious,” and “juicy fruit,” and no restrictions are in place on marketing e-cigarettes to youth. Sweets/fruits depicted in e-cigarette advertisements may increase their appeal to youth and interfere with health warnings. This study tested a brain biomarker of product preference for sweet/fruit versus tobacco flavor e-cigarettes, and whether advertising for flavors interfered with warning labels. Methods Participants (N=26) were college-age youth who had tried an e-cigarette and were susceptible to future e-cigarette use. They viewed advertisements in fMRI for sweet/fruit and tobacco flavor e-cigarettes, menthol and regular cigarettes, and control images of fruits/sweets/mints with no tobacco product. Cue-reactivity was measured in the nucleus accumbens, a brain biomarker of product preference. Advertisements randomly contained warning labels, and recognition of health warnings was tested post-scan. Visual attention was measured using eye-tracking. Results There was a significant effect of e-cigarette condition (sweet/tobacco/control) on nucleus accumbens activity, that was not found for cigarette condition (menthol/regular/control). Nucleus accumbens activity was greater for sweet/fruit versus tobacco flavor e-cigarette advertisements and did not differ compared with control images of sweets and fruits. Greater nucleus accumbens activity was correlated with poorer memory for health warnings. Conclusions These and exploratory eye-tracking findings suggest that advertising for sweet/fruit flavors may increase positive associations with e-cigarettes and/or override negative associations with tobacco, and interfere with health warnings, suggesting that one way to reduce the appeal of e-cigarettes to youth and educate youth about e-cigarette health risks is to regulate advertising for flavors.

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“…By putting such great emphasis on the potential addictiveness of e-cigarette products, TPD health warnings may deter smokers and dissuade e-cigarettes use in quit attempts. The influence of warning addictiveness labels on e-cigarettes have been demonstrated in previous studies which suggest that exposure to these warnings can both, increase harm perceptions and reduce intentions to use [ 35 , 51 ]. In a between-subjects experiment, the addition of a warning label highlighting the addictiveness of e-cigarettes, led to an increase in risk perceptions and decrease in willingness to try the product whilst the same warning label on tobacco cigarettes did not have such an effect [ 36 ]; this suggests that the susceptibility vis-à-vis e-cigarettes’ abuse potential is greater than that of tobacco cigarettes.…”

Section: Discussionmentioning

confidence: 99%

The effects of the European e-cigarette health warnings and comparative health messages on non-smokers’ and smokers’ risk perceptions and behavioural intentions

et al. 2018

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BackgroundArticle 20 of the EU Tobacco Products Directive [TPD] stipulates that e-cigarette packets and refill products must carry a nicotine addiction health warning. Although previous studies conducted in North America have found that perceived harm, addictiveness and intention to use declined following exposure to e-cigarette health warnings, possible effects of the TPD health warnings on smokers and non-smokers has not been studied. This study will investigate the effects of the EU TPD e-cigarette health warnings and a comparative harm message (COMP; developed specifically for this study) on smokers’ and non-smokers’ perceptions of harm, addictiveness and social acceptability of e-cigarettes. Additionally, the potential effects of the TPD warnings and the COMP on smokers’ intentions to purchase and use e-cigarettes will be explored.Methods/designA sample of 2400 UK residents will be recruited in this experimental, randomised design, with Smoking status (Smoker vs. Non-smoker), TPD presence (TPD1 vs. TPD2 vs. No-TPD) and COMP presence (Presence vs. Absence) as between subjects independent variables, and Time (pre-post exposure of images) as a within subjects factor. Dependent variables comprise self-reported perceived harm, addictiveness, social acceptability, e-cigarettes’ effectiveness, intentions to purchase and use e-cigarettes. Cigarette dependence, previous e-cigarette exposure, and baseline intentions to quit will be measured as covariates.DiscussionHealth warnings, such as those implemented by the TPD, may help to prevent non-smokers from e-cigarettes use, but it is possible that they may inadvertently deter smokers from initiating use and substituting their tobacco smoking for e-cigarettes use if their content is deemed too negative. It is hoped that this study will help identify the most effective message or combination of messages that encourage use among smokers without promoting use among non-smokers.Trial registrationISRCTN registry ISRCTN76967031; date of registration: 23/10/18.

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The effect of e-cigarette warning labels on college students' perception of e-cigarettes and intention to use e-cigarettes

Cited by 35 publications

References 31 publications

The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions

The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions

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

The effects of the European e-cigarette health warnings and comparative health messages on non-smokers’ and smokers’ risk perceptions and behavioural intentions

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