Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
Nicotine Tob Res. 2020 Jun 12;22(7):1131-1138. doi: 10.1093/ntr/ntz194.
Evidence for the health harms of e-cigarettes is growing, yet little is known about which harms may be most impactful in health messaging. Our study sought to identify which harms tobacco product users were aware of and which most discouraged them from wanting to vape.
Participants were a convenience sample of 1,872 U.S. adult e-cigarette-only users, cigarette-only smokers, and dual users recruited in August 2018. In an online survey, participants evaluated 40 e-cigarette harms from seven categories: chemical exposures, device explosions, addiction, cardiovascular harm, respiratory harm, e-liquid toxicity, and other harms. Outcomes were awareness of the harms ("check all that apply") and the extent to which the harms discouraged vaping (5-point scale; (1) "not at all" to (5) "very much").
Awareness of most e-cigarette harms was modest, being highest for harms in the device explosions category of harms (44%) and lowest for the e-liquid toxicity category (16%). The harms with the highest mean discouragement from wanting to vape were the respiratory harm (M = 3.82) and exposure to chemicals (M = 3.68) categories. Harms in the addiction category were the least discouraging (M = 2.83) compared with other harms (all p < .001). Findings were similar for e-cigarette-only users, cigarette-only smokers, and dual users.
Addiction was the least motivating e-cigarette harm, a notable finding given that the current FDA e-cigarette health warning communicates only about nicotine addiction. The next generation of e-cigarette health warnings and communication campaigns should highlight other harms, especially respiratory harms and the chemical exposures that may lead to health consequences.
E-cigarette health harms related to respiratory effects, chemical exposures, and other health areas most discouraged vaping among tobacco users. In contrast, health harms about addiction least discouraged use. Several countries have begun implementing e-cigarette health warnings, including the United States, and many others are considering adopting similar policies. To increase impact, future warnings and other health communication efforts should communicate about health harms beyond addiction, such as the effects of e-cigarette use on respiratory health. Such efforts should communicate that e-cigarette use is risky and may pose less overall risk to human health than smoking, according to current evidence.
电子烟对健康造成危害的证据越来越多，但人们对哪些危害可能对健康信息传递最具影响力知之甚少。我们的研究旨在确定烟草制品使用者意识到哪些危害，以及哪些危害最能阻止他们想要吸食电子烟。
参与者是 2018 年 8 月招募的美国成年电子烟使用者、香烟使用者和双重使用者的便利样本。在一项在线调查中，参与者评估了来自七个类别的 40 种电子烟危害：化学暴露、设备爆炸、成瘾、心血管危害、呼吸道危害、电子烟液毒性和其他危害。结果是对危害的认识（“检查所有适用的内容”）以及危害阻止吸食电子烟的程度（5 分制；（1）“一点也不”到（5）“非常”）。
大多数电子烟危害的认识程度适中，最高的是设备爆炸类别的危害（44%），最低的是电子烟液毒性类别的危害（16%）。最能阻止人们想要吸食电子烟的危害是呼吸道危害（M=3.82）和接触化学物质（M=3.68）。与其他危害相比，成瘾类别的危害最不具有劝阻性（M=2.83）（所有 P<0.001）。电子烟使用者、香烟使用者和双重使用者的调查结果相似。
成瘾是最不具有激励作用的电子烟危害，这是一个值得注意的发现，因为目前 FDA 的电子烟健康警告只传达了尼古丁成瘾的信息。下一代电子烟健康警告和宣传活动应该强调其他危害，特别是呼吸道危害和可能导致健康后果的化学暴露。
与呼吸效应、化学暴露和其他健康领域相关的电子烟健康危害最能阻止烟草使用者吸食电子烟。相比之下，健康危害对成瘾的影响最小。几个国家已经开始实施电子烟健康警告，包括美国，还有许多其他国家正在考虑采取类似的政策。为了提高影响，未来的警告和其他健康宣传工作应该传达除成瘾以外的健康危害，例如电子烟使用对呼吸健康的影响。根据目前的证据，此类工作应该传达电子烟使用是有风险的，并且可能比吸烟对人类健康的总体风险更小。
