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Objectives: In this paper, we test variations of e-cigarette warning labels on high school youth, alone, and alongside modified risk statements (MRS) and/or flavors, to determine how perceptions of and intentions toward use of e-cigarettes are influenced by these package elements. Methods: An experiment (N = 715 high school youth) varied the warning label participants viewed (FDA warning label/ MarkTen warning label/ abstract warning label) and whether they viewed the label alone or alongside MRS and/or flavors. Results: Drawing upon the Heuristic Systematic Model, we found that youth who view an MRS with any of the warning labels are more likely to engage in counterarguing (compared to the FDA warning label alone), which increases risk perceptions. Additionally, the greater youth perceive the risks associated with ecigarettes, the lower their intentions of using them, even if they have tried an e-cigarette in the past. Conclusions: Tobacco education and public health messages should encourage youth to evaluate the tobacco industry messages they receive, as counterarguing is associated with higher risk perceptions. Furthermore, fostering increased awareness of the risks associated with e-cigarette use by youth can reduce intentions to use them. [ABSTRACT FROM AUTHOR]

This paper tests how certainty conveyed through language can be harnessed to enhance the effectiveness of health risk messages. We conducted experiments with low-income, adult smokers (n = 317) and middle schoolers (n = 321) on pictorial cigarette warning labels. We manipulated hypotheticality of risk through verb modality: present tense, may, can, and will. For adult smokers, present tense led to greater health risk beliefs, compared to hypothetical, among adult males but not females. For youth, contrary to what might seem intuitive, the hypothetical may verb was more effective than the present tense language in promoting health risk beliefs, which was associated with reduced susceptibility to use cigarettes. We discuss the findings in relation applications of construal level theory to health communication. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we consider how best to prevent recreational uptake of e-cigarettes among tobacco nonusers; it is important to investigate the underlying beliefs that young adults have about e-cigarettes and package elements. Methods: Using the focus group method of belief elicitation, we explore underlying belief structures that undergraduate students at a large Midwestern public university have about e-cigarettes. Beliefs are analyzed using the constantcomparative approach and categorized using the theory of planned behavior. Results: Participants describe a dual view, wherein e-cigarettes are a cool and causal item to use at a party, while holding a negative stigma toward everyday use. They acknowledged confusion over nicotine and focused on the flavors and smoke tricks as attractions to the product. In response to package elements, participants describe the flavors and modified risk statement as undermining the health warning. Conclusions: Findings suggest it may be useful to supplement the required warning labels with a public education campaign that improves understanding of nicotine and to regulate the amount of nicotine permissible in e-cigarettes in order to prevent addiction in recreational users, while at the same time supporting use of the product for smoking cessation. [ABSTRACT FROM AUTHOR]

Objectives: We tested how variations of the warning message on e-cigarette packages influenced risk and ambiguity perceptions, and whether including a modified risk statement on the package influenced how the warning label was perceived. Method: A 4 (warning text) x 2 (modified risk statement), plus control, experiment (N = 451) was conducted. Results: Smoking status, sex, and the language used in the warning statements interacted to influence risk perceptions. For example, non-smoking women perceived e-cigarettes with the FDA text at 30% of the package as riskier than the FDA text at 12-point type. Additionally, including a modified risk statement on the package increased ambiguity among non-smokers, as did an abstract warning label. Conclusions: When evaluating the effectiveness of warning label text, it is important to consider smoking status and sex. Additionally, including modified risk statements on the package with the warning label could potentially increase ambiguity among non-smokers. [ABSTRACT FROM AUTHOR]