Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
Oberlin College, Department of Psychology, Oberlin, OH, USA.
Nicotine Tob Res. 2022 Jun 15;24(7):1110-1119. doi: 10.1093/ntr/ntac024.
E-cigarette liquid nicotine concentrations typically are labeled as mg/mL or percent, which poorly convey nicotine strength to users. We evaluated whether four novel nicotine concentration labels better convey information about nicotine strength and addictiveness.
Adolescents and young adults (N = 826) completed an online survey in 2020. Participants rated nicotine concentrations (3, 6, 18, 30, 40, and 50 mg/mL) from "no nicotine" to "very high nicotine" communicated using current market labels (mg/mL, percent) and four new labels (text-based, caution sign-shaped, horizonal stoplight, vertical thermometer) which used color, symbols, and verbal strength descriptors. Participants reported on perceived addictiveness for all labels viewed and rank-ordered labels on perceived ability to convey information accurately.
Participants ranked the vertical (77%) and horizontal (70%) labels in first or second place and mg/mL (59.1%) and percent (47.2%) in last or second-to-last place. All new labels conveyed nicotine strength more accurately than did market labels (M[SD] correct of 6: percent = 1.50[1.08]; mg/mL = 2.14[1.52]; caution = 5.23[1.37]; vertical thermometer = 5.28[1.51]; text = 5.33[1.36]; horizontal stoplight = 5.47[1.14]), with the horizontal label also outperforming the thermometer and caution labels. Underestimating nicotine strength was uncommon among all new labels (4.7-6.8%). The new labels also were associated with increased perceived addictiveness at higher concentrations (30, 40, and 50 mg/mL), although the thermometer label underperformed the others. When considering perceived nicotine strength, rates of strength underestimates, perceived addictiveness, and rank ordering, the horizontal stoplight label performed best.
Novel labeling could improve understanding of nicotine strength and e-cigarette-related risk.
Extending prior research showing that adolescents and young adults who use Electronic Nicotine Delivery Systems (ENDS) have difficulty understanding nicotine concentrations labeled using mg/mL and percent nicotine, the current study demonstrates that novel nicotine concentration labels can improve understanding of nicotine strength and influence perceptions of addictiveness among young ENDS users. While four novel labels were tested, each outperforming current market labeling, the novel label that resembles a horizontal stoplight performed best. The study provides proof-of-concept that creating an easy-to-understand nicotine concentration label is possible and that new labeling better conveys information about nicotine strength and addictiveness.
电子烟液尼古丁浓度通常以毫克/毫升或百分比表示，这使得用户难以了解尼古丁的强度。我们评估了四种新的尼古丁浓度标签是否能更好地传达尼古丁强度和成瘾性的信息。
2020 年，青少年和年轻人（N=826）完成了一项在线调查。参与者使用当前市场标签（毫克/毫升、百分比）和四种新标签（基于文本、警告标志形状、水平交通信号灯、垂直温度计）对 3、6、18、30、40 和 50 毫克/毫升的尼古丁浓度进行了从“无尼古丁”到“高尼古丁”的评估。参与者报告了他们对所有看到的标签的成瘾性感知，并对他们认为能够准确传达信息的标签进行了排名。
参与者将垂直（77%）和水平（70%）标签排在第一或第二位，而毫克/毫升（59.1%）和百分比（47.2%）则排在最后或倒数第二位。所有新标签都比市场标签更准确地传达了尼古丁强度（正确的 6：百分比=1.50[1.08]；毫克/毫升=2.14[1.52]；警告=5.23[1.37]；垂直温度计=5.28[1.51]；文本=5.33[1.36]；水平交通信号灯=5.47[1.14]），水平标签也优于温度计和警告标签。在所有新标签中，低估尼古丁强度的情况都很少见（4.7-6.8%）。新标签也与更高浓度（30、40 和 50 毫克/毫升）的感知成瘾性增加有关，尽管温度计标签的表现不如其他标签。当考虑到感知尼古丁强度、强度低估率、感知成瘾性和排名顺序时，水平交通信号灯标签表现最佳。
新颖的标签可以提高对尼古丁强度和电子烟相关风险的认识。
扩展了先前的研究，表明使用电子尼古丁输送系统（ENDS）的青少年和年轻人难以理解以毫克/毫升和百分比尼古丁表示的尼古丁浓度，本研究表明，新颖的尼古丁浓度标签可以提高对尼古丁强度的理解，并影响年轻的 ENDS 用户对成瘾性的认知。虽然测试了四种新颖的标签，但每个标签都优于当前的市场标签，而类似于水平交通信号灯的新颖标签表现最好。该研究提供了一个概念验证，即创建一个易于理解的尼古丁浓度标签是可能的，并且新标签更好地传达了尼古丁强度和成瘾性的信息。
