Public health messaging and e-cigarette risk perception during EVALI - Foundation for a Smoke-Free World

Public health messaging and e-cigarette risk perception during EVALI

An increasing number of economic studies show that how smokers perceive e-cigarette harm can influence their behavior when they consider quitting or switching from combustible cigarettes to e-cigarettes. Risk perception can also foreshadow young smokers’ behavior when choosing between combustible cigarettes or e-cigarettes, neither, or both. The link between risk perception and smoking behavior is an important topic for future study, and it may be particularly useful in designing public health messaging strategies.

In their working paper, Dhaval Dave and his colleagues examine the evolution of e-cigarette risk perception in US adults and youth during the 2019 e-cigarette, or vaping, use-associated lung injury (EVALI) outbreak. (To learn more about EVALI facts and figures, read Michael Paskow’s blog post here.) Their study traces the transformation of risk perception across different age groups as public health messaging campaigns changed. Early in the EVALI outbreak, smokers faced an ‘information shock’ as the Centers for Disease Control (CDC) issued warnings against all e-cigarette use. As the outbreak subsided, however, these warnings were refined to advise more specifically against e-cigarettes that contained tetrahydrocannabinol (THC) and were purchased from unauthorized sellers.

The authors argue that risk perceptions of new products like e-cigarettes will exhibit variability, uncertainty, and sensitivity as individuals change their beliefs in response to new information from both government and media sources. Their analysis determined that smokers with an initially low level of e-cigarette risk perception were more influenced by the initial flood of information than smokers who started out with higher levels of risk perception. After the CDC refined its warnings to vaping products with THC, all smokers exhibited decreased levels of risk perception. However, risk perception did not revert to pre-EVALI levels for either gender. And after the outbreak, there were almost 14% more smokers who believed that nicotine-containing e-cigarettes were more harmful than combustible cigarettes.

Dave and his colleagues maintain that the CDC’s initial recommendations were consistent with the precautionary principal of protecting public health against any unforeseen consequences of the outbreak. But if the CDC had provided more targeted advice about the risks of THC-containing e-cigarettes early in the outbreak, it could have more effectively limited the use of these products — and potentially curtailed the EVALI outbreak more efficiently. As we continue to examine the US EVALI outbreak, tools like the Signal Analytics platform for early detection of EVALI may also prove useful in future outbreak response.

Future research will reveal any unintended consequences of implementing the precautionary principal in CDC warnings. It will explain further whether this messaging increased rates of combustible cigarette consumption among the youth. By enhancing the focus and specificity of their messaging campaigns, US government agencies can work to enhance long-term, positive impacts on public health, and on smoking behaviors across the globe.

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