Communicating the Relative Health Risks of E-Cigarettes

Summary of Study

Bottom Line: How best to communicate risks of vaping to deter non-smokers while seeking to attract smokers to switch to a less harmful product remains an ongoing question. This study finds that comparative warning messages, which highlight the harm reduction benefits of e-cigarettes (EC), can encourage smokers to switch to ECs. Any future communication strategy should include a comparative health message rather than just a traditional warning label illustrating associated EC risks.

Traditional warning messages which focus solely on the potential of EC to lead to or continue addiction may maintain public misperceptions of the harms of EC and discourage use among smokers. Comparative health messages, which focus on the reduced risks of EC in relation to tobacco smoking, may provide a viable alternative encouraging EC use as a quit aid.

In this study, 2,495 UK residents self-reported perceived harm, addictiveness, EC effectiveness, social acceptability, and intentions to purchase and use EC, and in smokers, intentions to quit and intentions to use EC in future quit attempts. These were measured before and after exposure to EC images containing either traditional or comparative health warnings or no message.

Smokers perceived ECs as less harmful, less addictive, and more socially acceptable than non-smokers. ECs were perceived as more harmful following exposure to the traditional harm messages by both smokers and non-smokers.

Following exposure to the comparative health message, ECs were perceived as less harmful by both smokers and non-smokers. 

When compared with no message, reduction in perceptions of EC harm was shown after exposure to the comparative message alone only in smokers. This suggests that adding the comparative health message as a stand-alone message to EC packs may reduce smokers’ harm perceptions of EC while leaving non-smokers’ EC harm perceptions unaffected.

For perceptions of EC addictiveness, the traditional and the comparative health messages differed significantly. Perceptions of EC addictiveness increased in both smokers and non-smokers following exposure to the traditional relative to those exposed to no messages and those exposed to the comparative one. Similarly, smokers and non-smokers exposed to the comparative message perceived EC as less addictive compared to those exposed to the traditional one.

For EC purchase intentions, smokers reported increased intentions to buy in the next month (although not in the next 6 months) compared to non-smokers. Critically, in smokers (not non-smokers), exposure to the comparative message increased intentions to purchase an EC in the next month compared to exposure to the traditional messages.

The finding that perceptions of harm differed between smokers and non-smokers following exposure to the comparative message suggests that smokers may be more receptive to this message than non-smokers. This is encouraging to the extent that reduced harm messages which convey relative risks and encourage a switch away from smoking is important for smokers, but at the same time should not encourage use among non-smokers.

Exposure to the comparative warning led to greater quit intentions compared to the traditional one. Therefore, this study demonstrates that presenting a message that conveys the relative risks of EC to smoking can increase EC purchase and quit intentions in smokers.

Read the full study here