The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS)

Introduction:
This article examines the association between potential exposure to electronic nicotine delivery system (ENDS) magazine ads with voluntary health warnings and the perceived harmfulness of ENDS. The study used data from the 2014 Georgia State University Tobacco Products and Risk Perceptions Survey of a nationally representative sample of U.S. adults. The study controlled for general ENDS ad exposure and socio-demographic characteristics.

Key Points:

* Potential exposure to ENDS magazine ads with warnings was associated with a lower probability of considering ENDS to be more or equally harmful compared to cigarettes, particularly among non-smokers.
* Ad exposure, ENDS use history, race/ethnicity, gender, education, and income were also associated with harm perceptions.
* This study did not find evidence that magazine ads with warnings increased misperceptions that ENDS are equally or more harmful than cigarettes.
* The study capitalized on the geographic variation in ENDS ads exposure and the significant variations in voluntary warnings in ENDS magazine ads in 2014 after the proposed deeming rule was issued.
* The study used multivariate analyses to assess the association between potential exposure to ENDS magazine ads with voluntary warnings and the relative harm perceptions of ENDS compared to cigarettes.
* The study also examined the associations between ad exposure across all platforms and demographic characteristics and harm perceptions.
* The study used a dichotomous variable to measure whether an ad carried voluntary warnings and a three-month moving average to measure the trend of voluntary warnings in ENDS magazine ads.

Main Message:
The study suggests that with more ENDS advertisements carrying warnings, more research is needed to determine how the warnings in advertisements convey relative harm information to consumers and the public. The study did not find evidence that magazine ads with warnings increased misperceptions that ENDS are equally or more harmful than cigarettes. The study highlights the importance of understanding how health warning messages for ENDS are framed and conveyed to consumers, which may impact the harm perceptions and use of ENDS and cigarettes.

Shang, Ce, Scott Weaver, Nahleen Zahra, Jidong Huang, Kai-Wen Cheng, and Frank Chaloupka. “The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS).” International Journal of Environmental Research and Public Health 15, no. 4 (March 23, 2018): 575. https://doi.org/10.3390/ijerph15040575.