A recent Cornell study suggests that warning labels that describe health harms of chemicals may encourage quitting for adult e-cigarette users but not necessarily for young users. The study contributes to ongoing investigations by Cornell researchers on issues surrounding e-cigarettes, public health and policy.
Electronic cigarettes — also known as e-cigs or vapes — differ from traditional cigarettes in that they do not burn tobacco. E-cigs deliver aerosol through the heating of a liquid that contains nicotine and other chemicals.
While e-cigarettes were the most commonly used tobacco product for middle and high schoolers in 2023, the National Youth Tobacco Survey identified a decrease in the use of e-cigarettes among young people. This decrease followed a peak of e-cigarette use in 2019 that correlated with an outbreak of E-cigarette, or Vaping, Associated Lung Injuries.
According to a previous Cornell study authored by Prof. Alan Mathios, economics, on vaping and e-cigarettes, the 2019 EVALI outbreak led to an increase of perceptions of risk for vaping.
During the EVALI outbreak, the media reported a series of hospitalizations related to electronic cigarettes. The media coverage was unintentionally misleading, according to Mathios. Although named for all e-cigs, EVALI hospitalizations were attributed to illegally manufactured vapes containing Tetrahydrocannabinol, which is a compound found in marijuana.
Mathios identified a decline in e-cigarette demand following the outbreak, indicating a potential increase in hesitancy. Though people may consider this decline in e-cigarettes positive, Mathios noted that many adults could use e-cigarettes as an alternative to smoking.
“For adults, the real cost of this misinformation was higher risk perceptions of e-cigarettes that led to fewer people trying to quit [combustible cigarettes],” Mathios said.
The consequence of higher risk perceptions for adults reveals an ultimatum between deterring young folks from using e-cigs and encouraging adult smokers to switch from combustible cigarettes to e-cigs as a way to quit smoking entirely.
Various sources disagree on which population should be the priority, according to Prof. Jeff Niederdeppe, communication. While the U.S. has tended toward a preventative approach, the U.K. has focused on encouraging the adult population to switch.
For Niederdeppe, “There is no right answer.”
“If it’s 25 to 30 percent of young people using [e-cigs], that’s a really high proportion,” Niederdeppe said. “If it’s 10 percent, does that change [how we weigh the different populations against one another]?”
Niederdeppe co-authored a new collaborative study on e-cigarette warning labels that offers understanding of how people may respond to different warning messages. The study provides insight for policymakers who want to influence different groups’ e-cigarette use.
Respondents of the study were given one of five warning messages in text. One was based on the current FDA warning, which read “this product contains nicotine. Nicotine is an addictive chemical.” The four others included condition-specific warnings in addition to the FDA warning. Condition-specific warnings ranged from statements on youth brain development to information about the chemical constituents, health harms and chemical equivalence of e-cigs to cigarettes.
The team found that relative to the current FDA warning, the other warning messages were not more effective at deterring use or changing risk perceptions of e-cigarettes among youth. However, the study also found that messages including the chemical constituents and corresponding health harms may increase interest in quitting for adult smokers and vapers.
Although these results provided some potential, Niederdeppe cautioned against drawing conclusions too quickly.
“I don’t want to suggest that one study should drive the policy [on warning labels],” Niederdeppe said. “I do think [the recent study] provides valuable information for the FDA in thinking about these issues.”
Niederdeppe and Mathios agree that navigating the paradox for e-cigs in the youth and adult population is complex, especially in light of the EVALI outbreak. Both researchers are continuing to investigate the competing objectives. Niederdeppe is expanding on the warning message research with further analyses of different subgroups among the youth. Mathios, on the other hand, is part of the Cornell Research on Tobacco Regulation research team, where he continues research on the future policies that may emerge regarding e-cigarettes.
Brenda Kim can be reached at [email protected].