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Reactions to electronic nicotine delivery system (ENDS) prevention messages: results from qualitative research used to inform FDA’s first youth ENDS prevention campaign
  1. Maria L Roditis1,
  2. Atanaska Dineva1,
  3. Alexandria Smith1,
  4. Matthew Walker1,
  5. Janine Delahanty1,
  6. Emily D'lorio1,
  7. Kristen D Holtz2
  1. 1Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, USA
  2. 2KDH Research and Communication, Atlanta, Georgia, USA
  1. Correspondence to Dr Maria L Roditis, Office of Health Communication and Education, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD 20903, USA; maria.roditis{at}


Background Youth e-cigarette use is a major public health concern. Large-scale tobacco prevention campaigns are a proven strategy to prevent tobacco use. There is a gap in understanding what types of e-cigarette prevention messages might be most effective. This study addresses this gap by reporting youth reactions to health messages aimed at preventing e-cigarette use.

Methods In 2018, twenty-four focus groups, with 159 teens (12–17) at risk for or experimenting with e-cigarettes were conducted in four cities across the USA. During focus groups, youth responded to creative concepts dealing with (1) the addictive nature of e-cigarettes, (2) the fact that e-cigarettes come in flavours, which may encourage youth initiation, and nicotine which may lead to addiction, or (3) that youth who use e-cigarettes are more likely to use cigarettes. Youth also gave feedback to specific facts about harmful and potentially harmful chemicals in e-cigarettes. Transcripts were analysed using thematic analysis.

Results Messages focusing on addiction alone did not resonate with participants. While youth found the idea that e-cigarettes may contain nicotine and can be addictive believable, with many describing personal experiences of addiction, they questioned how bad this really was, comparing addiction to e-cigarettes to things like being addicted to food. Participants wanted more information about negative consequences of vaping. Concepts paired with strong health effects messages resonated with participants.

Conclusion These focus groups clarified which e-cigarette prevention messages might be most persuasive to teens. Youth in this study responded favourably to messages stating specific health consequences of e-cigarette use.

  • advertising and promotion
  • prevention
  • priority/special populations

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  • Contributors All authors helped in the conceptualisation, writing and editing of the paper. MLR, AD and AS did the analysis of the results. MLR led the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer This publication represents the views of the author(s) and does not represent FDA/CTP position or policy.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The FDA IRB reviewed and approved the protocol for this study (ID No 17-083CTP).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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