The Effect of Conflicting Public Health Guidance on Smokers' and Vapers' E-cigarette Harm Perceptions.

BACKGROUND: E-cigarettes are increasingly being viewed, incorrectly, as more harmful than cigarettes. This may discourage smokers from switching to e-cigarettes. One potential explanation for these increasingly harmful attitudes is conflicting information presented in the media and online, and from public health bodies. AIMS AND METHODS: In this prospectively registered online study, we aimed to examine the impact of conflicting public health information on smokers' and vapers' e-cigarette harm perceptions. Daily UK smokers who do not vape (n = 334) and daily UK vapers (n = 368) were randomized to receive either: (1) a consistent harm reduction statement from two different public health bodies (Harm Reduction), (2) a consistent negative statement about e-cigarette harms from two different public health bodies (Negative), (3) a harm reduction statement from one public health body and a negative statement from another (Conflict), and (4) a statement of the risks of smoking followed by a harm reduction statement from one public health body and a negative statement from another (Smoking Risk + Conflict). Participants then answered questions regarding their perceptions of e-cigarette harm. RESULTS: The Negative condition had the highest e-cigarette harm perceptions, significantly higher than the Smoking Risk + Conflict condition (MD = 5.4, SE = 1.8, p < .016, d = 0.3 [CI 0.73 to 10.04]), which did not differ from the Conflict condition (MD = 1.5, SE = 1.8, p = .836, d = 0.1 [CI -3.14 to 6.17]). The Conflict condition differed from the Harm Reduction condition, where harm perceptions were lowest (MD = 5.4, SE = 1.8, p = .016, d = 0.3 [CI 0.74 to 10.07]). CONCLUSIONS: These findings are the first to demonstrate that, compared to harm reduction information, conflicting information increases e-cigarette harm perceptions amongst vapers, and smokers who do not vape. IMPLICATIONS: This research provides the first empirical evidence that conflicting information increases smokers' and vapers' e-cigarette harm perceptions, compared to harm reduction information. This may have a meaningful impact on public health as e-cigarette harm perceptions can influence subsequent smoking and vaping behavior. Conflicting information may dissuade smokers, who have the most to gain from accurate e-cigarette harm perceptions, from switching to e-cigarettes. These findings indicate that public health communications that are consensus-based can lower harm perceptions of e-cigarettes, and have the potential to reduce morbidity and mortality attributable to tobacco smoking.

Tackling Smoker Misperceptions About E-cigarettes Using Expert Videos.

BACKGROUND: The pervasive misperception that e-cigarettes are equally or more harmful than combustible cigarettes is a barrier to current smokers switching to e-cigarettes. To tackle misperceptions, public health bodies are using informational videos, although their efficacy is unknown. METHODS: In our online study, current UK smokers who do not vape (n = 382) were randomized to view either: (1) a Cancer Research UK (CRUK) text-only video; (2) a video featuring leading e-cigarette experts (expert); or (3) a no video control condition, and then completed questions regarding e-cigarette harm perceptions. RESULTS: Compared to the control condition, participants in the CRUK condition, and especially those in the expert condition had more accurate harm perceptions of e-cigarettes and had more accurate knowledge of e-cigarette constituents. In the expert condition, 67% of individuals reported they would try an e-cigarette in a future quit attempt, compared with 51% in the CRUK condition and 35% in the control condition. CONCLUSIONS: Our findings are encouraging in the face of mounting evidence that e-cigarette misperceptions are increasing. Whilst misperceptions are often characterized as resistant to correction, we find that carefully designed public health information videos have the potential to promote a more accurate, informed view of e-cigarettes, and encourage intended e-cigarette use among UK smokers. Importantly, we find this among current smokers who do not vape, a group often reported as having the highest levels of misperceptions and as having the most to gain from accurate e-cigarette perceptions. IMPLICATIONS: There is mounting evidence that e-cigarette misperceptions are increasing, particularly among smokers who do not vape, a group who have most to gain from accurate information about e-cigarettes. Misperceptions are often characterized as difficult to change and there is relatively little research on how to correct e-cigarette misperceptions. Our research in the UK shows that, compared to controls, e-cigarette misperceptions can be corrected among those smokers who are shown carefully constructed expert videos. This work has important implications for the development and dissemination of these important messages.