Introduction Health agencies are grappling with communicating risks of electronic cigarettes (e-cigarettes) compared with combusted cigarettes. This study examined smokers’ responses to two types of comparative risk messages with one type incorporating more negative antismoking elements in the design.
Methods In an online experiment, 1400 US adult (18+ years) current smokers and recent quitters were randomised to view one of three comparative risk messages about e-cigarettes (CR messages), one of three comparative risk messages that included more negative antismoking elements in the design (CR− messages) or a control message. Selection of outcomes was guided by the antismoking message impact framework. Multivariate analyses of covariance and logistic regression models analysed effects of messages on message evaluations, e-cigarette-related and cigarette-related beliefs and behavioural intentions.
Results Both CR and CR− messages decreased smokers’ intentions to smoke cigarettes, increased intentions to switch to e-cigarettes completely and increased perceptions that e-cigarettes are less harmful than combusted cigarettes. Neither message type increased dual use intentions relative to exclusive e-cigarettes use or smoking cessation. CR messages decreased perceived absolute risks of e-cigarettes and self-exempting beliefs about smoking, whereas CR− versus CR messages produced higher self-efficacy to quit smoking.
Conclusion Comparative risk communication might encourage smokers to switch to lower-harm tobacco products. Comparative risk messages with more negative antismoking elements in the design might be particularly effective, because they led to higher self-efficacy to quit smoking. Regulatory agencies may consider using comparative risk messages with more negative antismoking elements to educate the public about lower risk of e-cigarettes.
- harm reduction
- electronic nicotine delivery devices
- advertising and promotion
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Contributors LP and DO planned the study with contributions from BY. BY analysed the data, wrote the first draft and submitted the manuscript. LP conceived the study and supervised the data collection, analysis, interpretation and writing. All authors contributed to the writing, revision and approval of the final version.
Funding Research reported in this publication was supported by the National Institute of Drug Abuse of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products (P50DA036128) and the National Cancer Institute of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products (R00CA187460).
Competing interests None declared.
Patient consent Not required.
Ethics approval Georgia State University IRB.
Provenance and peer review Not commissioned; externally peer reviewed.