The impacts of electronic cigarette health warning labels on use intentions and perceptions: A cross-sectional study of US and Israeli adults who use tobacco

Authors

Zongshuan Duan, Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.
Hagai Levine, Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel.
Yael Bar-Zeev, Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel.
Yuxian Cui, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Cassidy R. LoParco, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Lorien C. Abroms, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Amal Khayat, Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel.
Carla J. Berg, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.

Document Type

Journal Article

Publication Date

10-1-2023

Journal

Journal of public health research

Volume

12

Issue

4

DOI

10.1177/22799036231214396

Keywords

E-cigarettes; health communication; health warning labels; risk perceptions; tobacco control

Abstract

BACKGROUND: Health warning labels (HWLs) are evidence-based tobacco control strategies; however, their application to e-cigarettes and related impacts (e.g. on perceived risk), including across countries with different regulations, are understudied. DESIGN AND METHODS: Using 2021 survey data from 927 US and Israeli adults reporting past-month tobacco use, multivariate analyses examined: (1) sociodemographics in relation to self-reported impact of e-cigarette HWLs (i.e. more concerned about e-cigarette use, reassured, no effect) among those who noticed e-cigarette HWLs (multinomial regressions); and (2) HWL impacts in relation to use intentions and perceived addictiveness and harm (linear regressions). RESULTS: Among those who noticed HWLs ( = 835, 90.1%), 34.1% reported HWLs resulted in greater concern about e-cigarette use, 45.5% no effect, and 20.4% reassurance. Factors associated with greater concern (vs no effect) included e-cigarette non-use (vs use; aOR = 1.69, 95% CI:1.22, 2.38), US (vs Israel) resident (aOR = 1.65, 95% CI:1.16, 2.34), age 18-25 (vs 36-45; aOR = 1.72, 95% CI:1.11, 2.67), and more education (aOR = 1.85, 95% CI:1.30, 2.63). Factors associated with being reassured (vs no effect) included use of cigarettes (aOR = 1.71, 95% CI:1.06, 2.75), e-cigarettes (aOR = 2.64, 95% CI:1.77, 3.94), and other tobacco (aOR = 2.11, 95% CI:1.39, 3.21), and Israeli resident (aOR = 2.33, 95% CI:1.47, 3.70). Not noticing HWLs (vs no effect) correlated with lower intentions (β = -0.44, 95% CI:-0.87, -0.01), perceived addictiveness (β = -0.61, 95% CI:-1.05, -0.18), and harm (β = -0.56, 95% CI:-0.95, -0.18); reassurance correlated with greater use intentions (β = 0.48, 95% CI:0.12, 0.83); and greater concern was unassociated with use intentions or perceived risk. CONCLUSION: Effects of differing e-cigarette HWLs in distinct subpopulations warrant research. Despite being noticed, they may have no effect or encourage e-cigarette use.

APA Citation

Duan, Zongshuan; Levine, Hagai; Bar-Zeev, Yael; Cui, Yuxian; LoParco, Cassidy R.; Wang, Yan; Abroms, Lorien C.; Khayat, Amal; and Berg, Carla J., "The impacts of electronic cigarette health warning labels on use intentions and perceptions: A cross-sectional study of US and Israeli adults who use tobacco" (2023). GW Authored Works. Paper 3785.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3785

Department

Prevention and Community Health