Abstract
BackgroundArticle 20 of the EU Tobacco Products Directive [TPD] stipulates that e-cigarette packets and refill products must carry a nicotine addiction health warning. Although previous studies conducted in North America have found that perceived harm, addictiveness and intention to use declined following exposure to e-cigarette health warnings, possible effects of the TPD health warnings on smokers and non-smokers has not been studied. This study will investigate the effects of the EU TPD e-cigarette health warnings and a comparative harm message (COMP; developed specifically for this study) on smokers’ and non-smokers’ perceptions of harm, addictiveness and social acceptability of e-cigarettes. Additionally, the potential effects of the TPD warnings and the COMP on smokers’ intentions to purchase and use e-cigarettes will be explored.Methods/designA sample of 2400 UK residents will be recruited in this experimental, randomised design, with Smoking status (Smoker vs. Non-smoker), TPD presence (TPD1 vs. TPD2 vs. No-TPD) and COMP presence (Presence vs. Absence) as between subjects independent variables, and Time (pre-post exposure of images) as a within subjects factor. Dependent variables comprise self-reported perceived harm, addictiveness, social acceptability, e-cigarettes’ effectiveness, intentions to purchase and use e-cigarettes. Cigarette dependence, previous e-cigarette exposure, and baseline intentions to quit will be measured as covariates.DiscussionHealth warnings, such as those implemented by the TPD, may help to prevent non-smokers from e-cigarettes use, but it is possible that they may inadvertently deter smokers from initiating use and substituting their tobacco smoking for e-cigarettes use if their content is deemed too negative. It is hoped that this study will help identify the most effective message or combination of messages that encourage use among smokers without promoting use among non-smokers.Trial registrationISRCTN registry ISRCTN76967031; date of registration: 23/10/18.
Highlights
Article 20 of the EU Tobacco Products Directive [TPD] stipulates that e-cigarette packets and refill products must carry a nicotine addiction health warning
Health warnings, such as those implemented by the TPD, may help to prevent non-smokers from e-cigarettes use, but it is possible that they may inadvertently deter smokers from initiating use and substituting their tobacco smoking for e-cigarettes use if their content is deemed too negative
This study aims to compare the effects of the European Union Tobacco Products Directive (EU-TPD) e-cigarette health warnings and a comparative harm message on smokers’ and non-smokers’ perception of harms, addictiveness, social acceptability and effectiveness of e-cigarettes as smoking cessation aids either i) as they are implemented currently or ii) as implemented with an additional comparative health message
Summary
Article 20 of the EU Tobacco Products Directive [TPD] stipulates that e-cigarette packets and refill products must carry a nicotine addiction health warning. Previous studies conducted in North America have found that perceived harm, addictiveness and intention to use declined following exposure to e-cigarette health warnings, possible effects of the TPD health warnings on smokers and non-smokers has not been studied. The potential effects of the TPD warnings and the COMP on smokers’ intentions to purchase and use e-cigarettes will be explored. Health warnings on cigarette packets can be an effective tool to increase awareness about the dangers of smoking. Research suggests that they can act as a deterrent to smoking and promote cessation [1, 2]. In addition to reducing smokers’ desire for tobacco cigarettes [3, 4], warning labels have the potential to prevent initiation in non-smokers [5]. Larger, graphic health warnings that convey a loss-framed message (focus on harms of smoking rather than gains from quitting) and lack of branding (standardised packaging), have been shown to increase attention to the message and improve perceptions of health risks and quitting-related behaviour [6,7,8,9,10,11]
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