Effects of E-Cigarette Health Warnings and Modified Risk Ad Claims on Adolescent E-Cigarette Craving and Susceptibility

Introduction A between-subjects experiment examines the effects of different warning types and modified risk e-cigarette ad claims on adolescent e-cigarette craving and future e-cigarette susceptibility for two different themes. One theme focuses on nicotine and addiction, and the other on the effects of potentially harmful constituents (eg, flavored chemicals and lung disease). Methods The effects of warning type (control, text-only, graphic health warning [GHW] and text) and modified risk e-cigarette ad claims (control, exposure reduction, risk reduction) are tested experimentally with two different arms (themes) for a sample of 1011 adolescents who had tried either e-cigarettes or cigarettes. Results For addiction, the text-only warning led to significantly less e-cigarette susceptibility than the no warning control condition. As expected, there were no differences between the GHW + text condition and text-only or control conditions for e-cigarette craving. An interaction between warning type and modified risk claims revealed significantly fewer e-cigarette cravings and less susceptibility for the text-only warning and no claim (control) condition than for any other condition. For fatal lung disease, the GHW + text condition led to fewer e-cigarette cravings and less susceptibility than the text-only warning and no warning (control) conditions. Conclusions Warning type effects can be very different under different themes (eg, addiction, fatal lung disease). In general, our results point to the effectiveness of the text-only warning for addiction and GHW + text for fatal lung disease. Relative exposure and risk modification claims (eg, less nicotine; less addicting) tend to undercut addiction warnings. Implications More than one type of e-cigarette warning may be necessary as e-cigarette research evolves. Our results show different warning type effects (eg, text-only; GHW + text) on e-cigarette craving and future susceptibility for adolescent experimenters depending on the risk theme (eg, addiction; lung disease) and presence of ad claims (eg, exposure and risk reduction). As research emerges on risks associated with e-cigarette use, it is important to first know what at-risk populations (eg, adolescents) believe about such risks. Such research will aid our understanding of what types of warnings might be most effective, especially in the presence of ad claims.