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Original research
Synthetic nicotine descriptors: awareness and impact on perceptions of e-cigarettes among US youth
  1. Sarah D Kowitt1,2,
  2. Andrew B Seidenberg3,
  3. Nisha C Gottfredson O’Shea4,
  4. Caroline Ritchie2,
  5. Emily F Galper5,
  6. Erin L Sutfin6,
  7. Paschal Sheeran2,7,
  8. Seth M Noar2,5
  1. 1Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
  4. 4Research Triangle Institute, Research Triangle Park, North Carolina, USA
  5. 5Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  6. 6Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  7. 7Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Sarah D Kowitt, Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; kowitt{at}email.unc.edu

Abstract

Background Electronic cigarettes (e-cigarettes) are being advertised and sold with synthetic nicotine. Little research has examined youth awareness of synthetic nicotine or the impact of synthetic nicotine descriptors on perceptions of e-cigarettes.

Methods Participants were a sample of 1603 US adolescents (aged 13–17 years) from a probability-based panel. The survey assessed knowledge of nicotine source in e-cigarettes (from ‘tobacco plants’ or ‘other sources besides tobacco plants’) and awareness of e-cigarettes containing synthetic nicotine. Then, in a between-subjects experiment with a 2×3 factorial design, we manipulated descriptors on e-cigarette products: (1) nicotine label (inclusion of the word ‘nicotine’: present or absent) and (2) source label (inclusion of a source: ‘tobacco-free’, ‘synthetic’ or absent).

Results Most youth were either unsure (48.1%) or did not think (20.2%) that nicotine in e-cigarettes comes from tobacco plants; similarly, most were unsure (48.2%) or did not think (8.1%) that nicotine in e-cigarettes comes from other sources. There was low-to-moderate awareness of e-cigarettes containing synthetic nicotine (28.7%), with higher awareness among youth who use e-cigarettes (48.0%). While no main effects were observed, there was a significant three-way interaction between e-cigarette status and the experimental manipulations. The ‘tobacco-free nicotine’ descriptor increased purchase intentions relative to ‘synthetic nicotine’ (simple slope: 1.20, 95% CI 0.65 to 1.75) and ‘nicotine’ (simple slope: 1.20, 95% CI 0.67 to 1.73) for youth who use e-cigarettes.

Conclusions Most US youth do not know or have incorrect beliefs about the sources of nicotine in e-cigarettes and describing synthetic nicotine as ‘tobacco-free nicotine’ increases purchase intentions among youth who use e-cigarettes.

  • nicotine
  • packaging and Labelling
  • electronic nicotine delivery devices

Data availability statement

Data are available on reasonable request to SMN at noar@unc.edu.

https://doi.org/10.1136/tc-2023-057928

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    Data availability statement

    Data are available on reasonable request to SMN at noar@unc.edu.

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    Footnotes

    • Presented at The article contents were presented at the March 2023 annual meeting of the Society for Research on Nicotine and Tobacco.

    • Contributors SDK, AS, CR and SMN conceptualised the study. SMN acquired funding and CR conducted project administration. SDK analysed the data and drafted the first version of the manuscript. All authors interpreted the data and critically revised the manuscript for important intellectual content. SMN serves as the guarantor for the study.

    • Funding This project was supported by grant number R01DA049155 from the National Institute on Drug Abuse and FDA Center for Tobacco Products (CTP). SDK’s work on this paper was supported by the National Cancer Institute and FDA CTP under grant number K01CA265886.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

    • Competing interests SMN served as a paid expert witness in litigation against tobacco and e-cigarette companies.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.