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. 2019 Jul 10;28(e1):e64-e70.
doi: 10.1136/tobaccocontrol-2018-054878. Online ahead of print.

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

Noel T Brewer  1   2 , Michelle Jeong  3 , Marissa G Hall  4   2 , Sabeeh A Baig  4   5 , Jennifer R Mendel  2 , Allison J Lazard  2   6 , Seth M Noar  2   6 , Madeline R Kameny  4 , Kurt M Ribisl  4   2
Affiliations

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

Noel T Brewer et al. Tob Control. .

Abstract

Background: A 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.

Methods: Participants 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.

Results: Text 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.

Discussion: E-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.

Keywords: addiction; electronic nicotine delivery devices; nicotine; packaging and labelling; prevention.

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Conflict of interest statement

Competing interests: None of the authors have received funding from tobacco product manufacturers. NTB and KMR have served as paid expert consultants in litigation against tobacco companies. The other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
E-cigarette warnings used in the experiment.
Figure 2
Figure 2
Impact of warnings on intentions to quit using e-cigarettes. Error bars show standard errors. 1=no intention; 4=high intention.
See this image and copyright information in PMC

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