//BTH#1- Do health warnings on e-cigarettes stop smokers from vaping?

Behind the Headlines is a regular feature taking a slightly deeper dive into a piece of recent media coverage of NGP research.

This edition’s story:

 ‘Do severe health warnings on e-cigarettes stop smokers from vaping?’

In November 2019, The Independent reported that the “severity of health warnings on e-cigarette packaging may deter smokers from switching to vaping”.

Their story summarised a new paper published in the journal Addictive Behaviours suggesting EU health warnings  about vaping health risks may reduce its effectiveness as a harm reduction measure. “Using reduced risk messaging was more successful in encouraging tobacco smokers to switch to vapes, without enticing non-smokers to start”, the article stated.

How was the research conducted?

The Centre for Addictive Behaviours Research conducted the original study, in which 2,495 UK residents participated (1283 smokers; 1212 non-smokers). Participants were asked to rate the electronic vapour product (EVP) before and after viewing different health warnings online between December 2018 and January 2019.

Participants self-reported perceived: “harm, addictiveness, EVP [referred to as e-cigarette, or EC] effectiveness, social acceptability, intentions to purchase and use EVP and in smokers” as well as “intentions to quit and intentions to use EVP in future quit attempts”.

The perception and behavioural intentions toward EVPs were measured before and after exposure to product images containing one of the following health warnings:

• An EU Tobacco Products Directive (TPD) warning, like: “This product contains nicotine which is a highly addictive substance. It is not recommended for non-smokers”.
• A comparative harm message, like: “Use of this product is much less harmful than smoking”.
• Both the EU Tobacco Products Directive warning and comparative harm messaging, such as “This product contains nicotine which is a highly addictive substance. Use of this product is much less harmful than smoking”.
• No message at all.

What did the study authors find?

• EU “Tobacco Products Directive messages may be effective smoking prevention tools”.
• Comparative harm messaging “was more effective in reducing harm perceptions and increasing [EVP] use intentions in smokers”.
• Comparative harm messaging “did not increase use intentions in non-smokers [and] suggest[s] that such exposures may potentially act as an effective harm reduction tool without resulting in increased uptake among non-smokers”.

Our take on the research…

The study suggests that, unfortunately, current on-pack TPD messaging may be discouraging adults smokers from considering Next Generations Products (NGPs) as there is no mention of potential harm reduction. This suggests regulators are missing an opportunity to properly educate adult smokers around the concept of harm reduction and how all nicotine-continuing products exist on a spectrum of risk [LINK]– with traditional cigarettes containing the most toxicants.

Encouragingly, the study also suggests a switch to comparative harm messaging may increase smokers’ intention to try EVPs without also encouraging non-smokers to use such products – potentially great news in terms of furthering the cause of tobacco harm reduction.

We urge regulators to take note.

Did the study have any limitations?

A few, which we’ve noted below:

• The sample was self-selecting.

If participants volunteer themselves, it can introduce response bias. For example, you are more likely to take part in a study on different types of chocolate if you already like confectionary.

• Intention is not use.

This study investigates the impact of messaging on intention to use, not actual use. More research would be required to understand how intention translates into actual product usage.

• In socio-demographic terms, the sample is limited.

The study uses UK, mostly ‘white’ (93%) participants. Extrapolating these findings from one group to more diverse populations is problematic. Although the study findings are promising, more research in other countries and with broader demographic groups would be needed to further validate the conclusion.

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