PT  - JOURNAL ARTICLE
AU  - Noel T Brewer
AU  - Michelle Jeong
AU  - Marissa G Hall
AU  - Sabeeh A Baig
AU  - Jennifer R Mendel
AU  - Allison J Lazard
AU  - Seth M Noar
AU  - Madeline R Kameny
AU  - Kurt M Ribisl
TI  - Impact of e-cigarette health warnings on motivation to vape and smoke
AID  - 10.1136/tobaccocontrol-2018-054878
DP  - 2019 Aug 01
TA  - Tobacco Control
PG  - e64--e70
VI  - 28
IP  - e1
4099  - http://tobaccocontrol.bmj.com/content/28/e1/e64.short
4100  - http://tobaccocontrol.bmj.com/content/28/e1/e64.full
SO  - Tob Control2019 Aug 01; 28
AB  - Background A prevailing hypothesis is that health warnings for electronic cigarettes (e-cigarettes) could drive people away from vaping and towards smoking cigarettes. We consider an alternative hypothesis that e-cigarette warnings discourage both vaping and smoking.Methods Participants were a national convenience sample of 2218 US adults who used e-cigarettes, cigarettes or both. In August 2018, we randomised participants to one of three warning types (control text about littering, text-only e-cigarette warning or pictorial e-cigarette warning). We further randomised participants viewing e-cigarette warnings to one of three topics (nicotine addiction, health hazards of use, or both health hazards and harms of use). The preregistered primary outcome was intentions to quit vaping among e-cigarette users. Secondary outcomes included interest in smoking and Tobacco Warnings Model constructs: attention, negative affect, anticipated social interactions and cognitive elaboration.Results Text warnings elicited higher intentions to quit vaping than control among e-cigarette users (d=0.44, p<0.001), and pictorial warnings elicited still higher intentions to quit vaping than text (d=0.12, p<0.05). Text warnings elicited lower interest in smoking compared with control among smokers (p<0.05); warnings had no other effects on interest in smoking among smokers or non-smokers. Text warnings about health hazards elicited higher intentions to quit vaping than nicotine addiction warnings. E-cigarette warnings also increased Tobacco Warnings Model constructs.Discussion E-cigarette health warnings may motivate users to quit vaping and discourage smoking. The most promising warnings include health hazards (other than nicotine addiction) and imagery. We found no support for the hypothesis that e-cigarette warnings could encourage smoking cigarettes.