Communicating the Relative Health Risks of E-Cigarettes: An online experimental study exploring the Effects of a Comparative Health Message versus the EU Nicotine Addiction Warnings on Smokers’ and Non-Smokers’ Risk Perceptions and Behavioural Intentions

This is an online experimental study which aimed to compare the effects of viewing two different health messages presented on e-cigarette packs. The messages were the EU Tobacco Product Directive (TPD) message, “This product contains nicotine which is a highly addictive substance. [It is not recommended for non-smokers]” and a comparative harm message (COMP), “Use of this product is much less harmful than smoking”. E-cigarette packs with no message served as a control condition. 2495 UK residents (1283 smokers and 1212 non-smokers) provided rating on the following dependent variables (DVs): harm, addictiveness, e-cigarette effectiveness for smoking cessation, social acceptability, intentions to purchase and use e-cigarettes, before (pre/Time 1) and after (post/Time 2) viewing the e-cigarette packs. Smokers also rated intentions to quit and intentions to quit using an e-cigarette. In some conditions, the TPD and COMP messages were presented alone, and in some conditions, they were presented together.
Primary Analysis: used a series of ANCOVAs with 3 between subjects factors: Smoking Status (Smoker vs. Non-smoker); TPD Presence (Present vs. Absent); and COMP Presence (Present vs. Absent). DVs were Time 2 ratings of harm, addictiveness, social acceptability, effectiveness, intention to quit, intention to purchase, and intention to use e-cigarettes, controlling for Time 1 measurements. Planned a-priori comparisons, at each level of smoking status were conducted between a) TPD alone vs. i) TPD+COMP, ii) no TPD/no COMP iii) no TPD/COMP; and COMP alone vs. i) TPD+COMP, ii) no TPD/no COMP, iii) TPD/no COMP.
Secondary Analysis: The above ANCOVAs were repeated i) controlling for cigarette dependence, previous e-cigarette exposure, and baseline intentions to quit and, ii) exploring the interactions with demographic variables (age, sex and occupation).

Funding: This study was funded by Cancer Research UK’s Population Research Committee (CRUK Grant Number: 25855).

Link to protocol: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-01...
 
Link to trial registry: https://www.isrctn.com/ISRCTN76967031
 
Link to published paper:  https://www.sciencedirect.com/science/article/pii/S0306460319308846?...

Link to OSF with secondary analysis by sociodemographic factors: https://osf.io/fhwnq

Data were collected between December 2018 and January 2019 from 2495 UK residents (1283 smokers and 1212 non-smokers. Participants were enrolled via a recruitment panel agency MRFGR (Market Research Focus Group Recruiter) which used a point-based system for payment with each participant receiving 6 points for participation. The sample was matched to the target population of non-smokers and smokers’ demographics in the general population using ONS data concerning age, gender and socio-economic status (SES). Inclusion criteria were: adults aged 18+, resident in the UK, and fluent in English. Exclusion criteria were: under 18 years of age, resident outside of the UK, exclusive vapers, dual users (concurrent use of EC and any tobacco product).
Participants first provided demographic information and smokers were asked about their cigarette dependence (using the Fagerström Test of Cigarette Dependence; FTCD) and motivation to quit (using the Motivation to Stop Smoking Scale; MTSS). Before presentation of the e-cigarette packs, all participants were asked about e-cigarette perceived harm, addictiveness, social acceptability, effectiveness, intentions to purchase and use of e-cigarettes (each rated on 7-point Likert Scales). Smokers were also asked about their intentions to quit and intentions to use e-cigarettes in future quit attempts. Each participant was then randomised to one of six messages displayed on EC pack images:
TPD1 – shorter version of the TPD health warning as used in the UK
TPD2 – longer version of the TPD health warning, including ‘It is not recommended for non-smokers”
COMP health message
TPD1 + COMP
TPD2 + COMP
No message
They then viewed four EC packs containing one of the messages as above each for 30 seconds. This was followed by some unrelated filler questions (e.g. “which e-cigarette did you think looked most like a cigarette?”) used to minimise bias. Then the same questions (perceived harm, addictiveness etc) were completed again. Finally, participants were asked to freely recall the message and to recognise it from a list of all messages presented. Time 1 and 2 measures are labelled as ‘pre’ and ‘post’ in the SPSS dataset.
As per our published protocol, outliers were calculated (±2.5 SD) for each variable. Variables to identify outliers by message type and smoking status are included at the end of the SPSS datafile.

Variable List (Data Dictionary)

V1 & 2: Participant ID numbers
V3 & 4: Used for the independent variables to code whether a) TPD and b) COMP messages is present or absent
V5 – 12: Demographic information, age, sex, gender, ethnicity, occupational status
V13 – 21: Smoking status, frequency & quit attempts
V22 – 27: Methods used in quit attempts
V28: Past e-cigarette use
V29: Motivation to Stop Smoking Scale (MTSS)
V30 – 36: Fagerström Test of Cigarette Dependence (FTCD) individual items and total score
V37 – 40: Pre-exposure ratings of e-cigarette harmfulness, addictiveness, effectiveness for smoking cessation and social acceptability.
V41 – 44: Post-exposure ratings of e-cigarette harmfulness, addictiveness, effectiveness for smoking cessation and social acceptability.
V45 – 48: Pre-exposure ratings of intentions to purchase and use e-cigarettes in the next month and 6-months
V49 – 52: For smokers only, pre-exposure ratings of intentions to quit and to quit using an e-cigarette in the next month and next 6-months
V53 – 56: Post-exposure ratings of intentions to purchase and use e-cigarettes in the next month and 6-months
V57 – 60: For smokers only, post-exposure ratings of intentions to quit and to quit using an e-cigarette in the next month and next 6-months
V61 – 64: Filler questions
V65: Message condition (1-6)
V66 – 70: Recall questions related to noticing the message, free-recall & recognition
V71: Device used to complete the survey
V72: Conditions used for planned comparisons TPD (any) alone; COMP alone; both TPD & COMP; neither
V73 – 98: Used for identifying outliers for each DV by message type and smoking status.