Effects of Health Messages on Public Perception of E-cigarettes: An Experimental Study (Preprint)

BACKGROUND Health authorities across nations differ markedly on their position regarding electronic cigarettes. For example, the Royal College of Physicians in the United Kingdom promoted e-cigarettes as a harm-reduction alternative to cigarettes, whereas the United States Centers for Disease Control and Prevention warned against the use of e-cigarettes. OBJECTIVE This study tests the effects of these different policy messages on the public’s perception of e-cigarettes. METHODS Participants (N=20,055) were sampled from an online panel with members from 19 major Chinese cities, and were randomized into three groups. Group 1 received brief messaging on e-cigarettes equivalent to the UK position, Group 2 received messaging equivalent to the US position, and Group 3 served as a control.Harm of cigarettes and e-cigarettes were rated on a 1–10 scale. Cigarettes smokers were asked if they intended to use e-cigarettes in a future quit attempt. RESULTS The group exposed to the US message rated e-cigarettes as significantly more risky than the control group, 5.87 (95%CI, 5.81-5.93) vs. 5.49 (5.43-5.55). The UK message group had a similar rating to the control, 5.42 (5.36-5.48). A lower percent of smokers in the US message group, 53.9% (51.8-56.0), intended to use e-cigarettes in future attempts to quit smoking than the control group, 60.1% (58.0-62.2), which was similar to that of the UK message group, 60.3% (58.3-62.4). CONCLUSIONS Messages from health authorities that cast e-cigarettes chiefly in a negative light could significantly increase the perceived risks of e-cigarettes and decrease smokers’ intentions to use e-cigarettes to quit smoking. In addressing the risk of e-cigarettes, policymakers should consider the net effect of a policy so as to maximize its potential to save lives.