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Open AccessArticle

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

1
Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ 08901, USA
2
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
3
Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
4
Department of Epidemiology & Biostatistics, Rutgers School of Public Health, Piscataway, NJ 08854, USA
5
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
6
Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT 05405, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(2), 184; https://doi.org/10.3390/ijerph16020184
Received: 21 September 2018 / Revised: 21 December 2018 / Accepted: 7 January 2019 / Published: 10 January 2019
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. View Full-Text
Keywords: e-cigarettes; tobacco warnings; risk communication; health communication; risk perceptions e-cigarettes; tobacco warnings; risk communication; health communication; risk perceptions
MDPI and ACS Style

Wackowski, O.A.; Sontag, J.M.; Hammond, D.; O’Connor, R.J.; Ohman-Strickland, P.A.; Strasser, A.A.; Villanti, A.C.; Delnevo, C.D. The Impact of E-Cigarette Warnings, Warning Themes and Inclusion of Relative Harm Statements on Young Adults’ E-Cigarette Perceptions and Use Intentions. Int. J. Environ. Res. Public Health 2019, 16, 184.

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