Impact of e-cigarette health warnings on motivation to vape and smoke.

Introduction:
This text is a summary of the research paper "Impact of e-cigarette health warnings on motivation to vape and smoke" by Brewer et al. The study aims to examine the impact of e-cigarette warnings on intentions to quit vaping and smoking, as well as the influence of warning type and topic on risk beliefs, message reactance, and anticipated message avoidance.

Key points:

* The study is a 2x3 factorial experiment with an additional control condition.
* Participants were randomized to one of seven conditions: control, text-only warning, pictorial warning, text-only warning about nicotine addiction, text-only warning about hazard, text-only warning about hazard and harm, and pictorial warning about nicotine addiction.
* The primary outcome was intentions to quit vaping among current e-cigarette users.
* Secondary outcomes included interest in e-cigarette use, interest in cigarette use, behavioral antecedents from the UNC Tobacco Warnings Model (TWM), risk beliefs, message reactance, and anticipated message avoidance.
* Text warnings elicited higher intentions to quit vaping than control among e-cigarette users, and pictorial warnings led to still higher intentions to quit vaping than text warnings.
* Text warnings led to more negative affect, anticipated social interactions, and cognitive elaboration compared with control, while pictorial warnings led to somewhat higher scores than text warnings on these variables.
* Text warnings led to lower interest in e-cigarette use compared with control among e-cigarette users, but pictorial and text warnings did not differ.
* Text warnings led to higher affective risk and perceived harm for vaping compared with control, and pictorial warnings led to higher levels on these variables compared with text.
* Text warnings elicited greater anticipated message avoidance and message reactance compared with control, with slightly larger effects among pictorial than text warnings.

Main message:
The study found that text warnings motivated adult e-cigarette users to want to quit vaping, with a small added benefit from including photographic images. Both text and pictorial warnings made smokers less interested in smoking compared with the control, suggesting that e-cigarette warnings could discourage both vaping and smoking. Warnings about nicotine addiction also discouraged vaping, providing evidence that the warning currently required on e-cigarette packages and advertisements in the USA may be effective. However, warnings with specific information about other hazards of vaping were even more discouraging of e-cigarette use than the nicotine addiction warnings. These findings support initial use of text-only e-cigarette warnings and the use of multiple messages and rotating them to maximize the public health benefit of warnings.

Brewer NT, Jeong M, Hall MG, et al. Impact of e-cigarette health warnings on motivation to vape and smoke. Tobacco Control: An International Journal. 2019;28(1):e64-e70. doi:10.1136/tobaccocontrol-2018-054878