The Effects of E-Cigarette Warning Labels among Yong Adult Non-Smokers. Darren Mays, PhD, MPH Georgetown University

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1 The Effects of E-Cigarette Warning Labels among Yong Adult Non-Smokers Darren Mays, PhD, MPH Georgetown University

2 Acknowledgments Co-Authors Georgetown: Clayton Smith, BA, Andrea Johnson, MPH, CHES, Kenneth P. Tercyak, PhD Schroeder Institute: Ray Niaura, PhD Funding/Disclosure This study was supported by the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) Center for Tobacco Products under NIH grant number K07CA This work was also supported in part by the Georgetown Lombardi Comprehensive Cancer Center Support grant number P30CA Manuscript preparation was also supported in part by a scholarship from The Mary Elizabeth Groff Surgical Medical Research and Education Charitable Trust. The study sponsors had no role in the study design; in the collection, analysis and interpretation data; in the writing of the report; and in the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

3 E-Cigarettes and Young Adults E-cigarette advertising, use increasing Market dominated by cigarette companies Young adults are a priority market ~95% reached by e-cigarette ads Vulnerable to tobacco experimentation, transitions Novelty appeals to this group

4 E-Cigarette Advertising & Warnings? How do e-cigarette ads affect perceptions? What are the effects of manufacturers and FDA s proposed warnings? Rolling Stone, February 2015 Do ads/warnings affect perceptions of other products, e.g., cigarettes?

5 Study Design Overview Young adults, years of age, nonsmokers Recruited through crowdsourcing site (mturk) Pre-exposure measures Demographics, tobacco use behaviors Two experimental manipulations E-cigarette ad stimuli, cigarette ad stimuli

6 E-Cigarette Ad Stimuli Conditions: 3 (MarkTen, Vuse, Blu) x 3 (ad, ad with warning, warning only) Outcomes: Perceived harm & addictiveness (absolute & relative), thoughts about not using e-cigarettes, visual attention, behavioral intentions What effects do e-cigarette ads and warnings have on product perceptions, reactions to warnings, and behavioral intentions?

7 E-Cigarette Ad Stimuli

8 Cigarette Ad Conditions Conditions: Randomized to 1 of 3 cigarette ads (Camel, Marlboro, or Newport) Outcomes: Perceived harm & addictiveness (absolute & relative), behavioral intentions Is there any effect of e-cigarette ads and warnings on reactions to ads for and perceptions of combustible cigarettes?

9 Sample Characteristics n = 441 N or Mean % or Std Dev. Demographics Age (M, SD) Male Gender White Race Education Some College or Higher Fully Time Employment Income > $50,000/Year Heard of E-Cigs? Ever Used E-Cig? E-Cig Advertising Exposure Cigarette Smoking Never Smoker Tried Smoking (< 100 Lifetime Cigs) Experimenter (>= 100 Lifetime Cigs) No significant differences by study conditions.

10 Perceived Harm & Addictiveness of E-Cigarettes Very Harmful Somewhat Harmful Slightly Harmful 2.0 Not At All Harmful 1.0 Harm Addiction Ad Only Ad With Warning Warning Only Significant effect for ad/warning condition. Brand main effect and brand x ad/warning n.s. Adjusted for prior e-cig use and e-cig ad exposure.

11 Perceived Harm & Addictiveness of E-Cigarettes Compared with cigarettes Much More 5.0 More 4.0 About the Same Less Much Less 1.0 Harm Addiction Ad Only Ad With Warning Warning Only Significant main effect for ad/warning condition. Main effect for brand and brand x ad/warning n.s.. Adjusted for prior e-cig use and e-cig ad exposure.

12 Thoughts About Not Using E-Cigarettes Strongly Agree Neutral Strongly Disagree 1.0 All Blu MarkTen Vuse Ad Only Ad With Warning Warning Only Main effect for ad/warning condition significant. Across all brands Ad Only < Ad with Warning < Warning Only (p s <.001). Ad/warning condition x brand interaction p =.059. Within brands Ad Only > Ad With Warning > Warning Only (p s <.01).

13 Attention to Stimuli

14 Perceived Harm & Addictiveness of Cigarettes Perceptions of Cigarettes Very Harmful Somewhat Harmful 3.0 Slightly Harmful 2.0 Not At All Harmful 1.0 Harm Addiction Ad Only Ad With Warning Warning Only No significant main effects for ad/warning condition, e-cig brand, or cig brand. E-cig brand x ad/warning and cig brand x ad/warning interactions n.s. Adjusted for prior e-cig use, prior cigarette use, and e-cig ad exposure.

15 Perceived Harm & Addictiveness of Cigarettes Compared with e-cigarettes Much More More About the Same 3.0 Less 2.0 Much Less 1.0 Harm Addiction Ad Only Ad With Warning Warning Only Significant ad/warning effect. Main effects for e-cig brand, cig brand, and e-cig brand x ad/warning and cig brand by ad/warning n.s. Adjusted for prior e-cig use, prior cigarette use, and e-cig ad exposure.

16 Conclusions Text-based warning messages by themselves influenced perceptions in a way that may dissuade e-cigarette use, but not when they appeared on ads. Future research directions/needs: Prospective studies Alternative strategies for designing warnings? Interventions other than warning labels?

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