Elsevier

Preventive Medicine

Volume 81, December 2015, Pages 268-274
Preventive Medicine

Public support for selected e-cigarette regulations and associations with overall information exposure and contradictory information exposure about e-cigarettes: Findings from a national survey of U.S. adults

https://doi.org/10.1016/j.ypmed.2015.09.009Get rights and content

Highlights

  • We assessed public support among U.S. adults for six e-cigarette regulations.

  • The highest level of support was for restricting e-cigarette access and marketing to youth.

  • Restricting use of flavors in e-cigarettes was the least supported.

  • People exposed to information about e-cigarettes were less likely to support policies to restrict youth access, require nicotine and harmful ingredient labeling, and require addiction warnings.

Abstract

Objective

We assessed public support for six e-cigarette regulations and examined whether self-reported exposure to e-cigarette information and contradictory e-cigarette information were associated with support.

Method

We conducted an online survey among a nationally representative sample of 527 U.S. adults in July 2014. Weighted, fully adjusted multinomial logistic regression models predicted support for banning e-cigarettes in smoke-free areas, prohibiting e-cigarette sales to youth, requiring addiction warnings, banning flavors, requiring labeling nicotine and harmful ingredients, and banning youth-targeted marketing.

Results

Between 34% and 72% supported these six policies (disagreed 6–24%; no opinion 18–38%). We found higher support for policies to protect youth (prohibit sales to youth and youth-targeted marketing) and to require labeling e-cigarette constituents (nicotine and harmful ingredients). Banning the use of flavors in e-cigarettes was the least supported. Overall information exposure predicted lower relative risk of support for three policies (prohibit sales to youth, nicotine and harmful ingredient labeling, addiction warnings). In comparison, contradictory information exposure predicted lower relative risk of support for two policies (prohibit sales to youth, nicotine and harmful ingredient labeling).

Conclusions

Exposure to overall and conflicting information about e-cigarettes in the public sphere is associated with reduced support for certain proposed e-cigarette policies. These findings are important for policymakers and tobacco control advocates involved in promulgation of e-cigarette policies. The results provide insights on which policies may meet some public resistance and therefore require efforts to first gain public support.

Introduction

In April 2014, the U.S. Food and Drug Administration (FDA) Center for Tobacco Products issued a proposed deeming rule to extend its regulatory authority over electronic cigarettes (e-cigarettes) and other tobacco products (U.S. Food and Drug Administration, 2014). While federal regulations for e-cigarettes are pending public comment as of August 2015, states and local communities have started introducing laws to regulate e-cigarette use, youth access, and taxation (Gourdet et al., 2014, American Nonsmokers' Rights Foundation, 2015, Marynak et al., 2014, Paradise, 2014). For instance, as of July 2015, three states (New Jersey, Utah, and North Dakota) and 394 local governments have banned indoor use of e-cigarettes in smoke-free areas (American Nonsmokers' Rights Foundation, 2015). Gauging public support for these policies can help policymakers and tobacco control advocates prioritize among different policy options. Surveying public opinion about e-cigarette regulations would also contribute to determining which policies require efforts to obtain broad public support in order to ensure successful implementation and enforcement. For instance, prior research has found that smokers who supported smoking bans within bars and restaurants were more likely to comply with these bans (Borland et al., 2006).

Some studies have reported public opinion about various e-cigarette regulations in recent years (Majeed et al., 2014, Tan et al., 2014, Wackowski and Delnevo, 2015, Martínez-Sánchez et al., 2014). In 2012, 40% of a national sample of U.S. adults in 2012 were uncertain about allowing e-cigarette use in smoke-free areas, while 37% opposed and 23% agreed that e-cigarette use should be allowed (Majeed et al., 2014). In a national survey in 2013, respectively, 46%, 31%, and 26% of U.S. adults felt that vaping indoors in restaurants, indoors in bars/casinos/clubs, and at parks should never be allowed (Tan et al., 2014). A national sample of current smokers reported strong support (84–88%) for regulations of e-cigarettes by the FDA for safety and quality, requiring warning labels about potential risks, and imposing a minimum age for sales. In contrast, support was lower (41–56%) for banning e-cigarette indoor use, flavorings, and advertising (Wackowski and Delnevo, 2015).

Research suggests that advertising, entertainment media, and discussion within one's social networks may have an adverse impact on opinions about tobacco control policies (Tan et al., 2014, Blake et al., 2009a, Blake et al., 2009b). However, these studies tended to measure overall exposure to tobacco-related information (i.e., about smoking or about e-cigarettes) in various channels as a predictor of public opinion without taking into account potential effects of exposure to conflicting information surrounding tobacco. Due to product advertising, media coverage, and debate about potential risks and benefits (Schripp et al., 2013, Cahn and Siegel, 2011, Maziak, 2014, Chapman, 2014, Polosa et al., 2013, Ragsdale, 2014, Rooke and Amos, 2013, Tierney, 2011, Richardson et al., 2014, Kim et al., 2014, Pepper et al., 2014a), the public may be encountering conflicting information about the safety of e-cigarettes. In a national survey, for example, U.S. adults reported being exposed to a mix of both positive and negative information about e-cigarettes from sources such as advertising, media (e.g., news), and interpersonal discussions (Tan et al., 2014, Tan et al., 2015). One concern is that conflicting information about e-cigarettes could potentially reduce public support for e-cigarette regulations, similar to backlash resulting from conflicting information observed in other health contexts including nutrition and childhood vaccinations (Nagler, 2014, Caplan, 2011, Kelly et al., 2009, Poland and Spier, 2010).

To examine public support for different e-cigarette regulations, we conducted an online survey among a national sample of U.S. adults and measured the level of support for six different e-cigarette policies (ban in smoke-free areas, prohibit sales to youth, require addiction warning, ban use of flavors, require ingredient labeling, and ban youth-targeted advertising). This study further examined whether support for these policies was associated with overall exposure to e-cigarette information from media and interpersonal sources. To evaluate potential effects of conflicting information about e-cigarettes, we also analyzed the association between policy support and exposure to contradictory e-cigarette information from these sources.

Section snippets

Study sample and data collection

Study participants were members of KnowledgePanel (maintained by GfK), a nationally representative online research panel. Unlike Internet convenience panels or “opt-in” panels that include only individuals who have Internet access and volunteer themselves to participate in research studies, KnowledgePanel members have been recruited by probability-based sampling of households (random-digit dial (RDD) and more recently address-based sampling (ABS)). Only households sampled through these

Sample characteristics

The mean age of the sample was 51.8 years, 50% were female, 75% were non-Hispanic white, 31.5% completed college education or higher, 13% were current cigarette smokers, and 4% have used e-cigarettes in the past 30 days. Of those who have ever tried e-cigarettes, 53% were current smokers, 24% were non-smokers, and 24% were former smokers. Other characteristics of the sample and weighted distributions (matching the CPS data) are summarized in Table 1. Those who responded in the third round were

Discussion

Based on the premise that having broad public support for tobacco control policies is an important step to successful implementation and enforcement of such policies (Borland et al., 2006, Burstein, 2003), we first sought to survey the level of public support for various e-cigarette policies that were being introduced at the state and local levels. We found majority support for five of the six proposed policies and varying levels of public support depending on the specific policy in question.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgments and Funding

Preparation of this article was supported by the SNU Invitation Program for Distinguished Scholar, the ICT R&D program of MSIP/IITP [2013-005-002-013, How to create an ICT-based eco-system for content industry], and grant no. 2015S1A58017994 from the National Research Foundation of Korea to Chul-joo Lee. Andy Tan conducted this work while an assistant professor at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health. Cabral Bigman conducted this work while an assistant

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