Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
Nicotine Tob Res. 2024 Jan 22;26(2):151-160. doi: 10.1093/ntr/ntad175.
Youth represent a high-priority group for e-cigarette health communication. This study examined youth exposure to the Food and Drug Administration (FDA) e-cigarette warning label over 4 years and its association with change in youth harm perception and intention.
We pooled data from the 2018-2021 National Youth Tobacco Survey (age 10-17; n = 67 159). Participants were divided into four groups: never users (58.5%), susceptible nonusers (16.3%), former users (12.7%), and current users (12.5%). We examined the prevalence, time-trend, correlates, and association of youth exposure to the warning with addictiveness and harm perception, intention to use e-cigarettes, and intention to quit all tobacco products.
Only 24.5% of youth were exposed to the warning. Exposure increased from 14.9% in 2018 to 30.8% in 2019, then declined to 25.2% in 2021. Hispanic (adjusted odds ratio (aOR) = 0.76 [95% CI = 0.641 to 0.89]) and non-Hispanic black current users (0.53 [0.40 to 0.69]) were less likely to be exposed to the warning than white current users. Youth exposure was positively associated with a higher perception of e-cigarette addictiveness (1.12 [1.04 to 1.19]) and intention to quit all tobacco products (1.28 [1.13 to 1.46]). However, exposure was negatively associated with harm perception (0.91 [0.85 to 0.96]) and the intention to use e-cigarettes among e-cigarette nonusers (2.38 [1.99 to 2.84]).
The decline in youth exposure to the warning indicates wear-out effects. Strengthening the label by using compelling designs, adding themes on e-cigarette harm to youth, periodically rotating warning content, and using culturally tailored messaging may improve its impact on youth and address racial/ethnic disparities.
The FDA e-cigarette label reached only 24.5% of youth, and exposure to the warning declined to indicate wear-out effects. Exposure was significantly lower among minorities. Exposure was associated with a higher perception of e-cigarette addictiveness and intention to quit all tobacco products. Still, it did not increase harm perception or reduce intention to use e-cigarettes among nonusers. Strengthening the label by using more compelling designs, including diverse themes focusing on e-cigarette harm relevant to youth, and periodically rotating warning content may improve its impact on youth. Continued surveillance of the implementation of e-cigarette policies is needed to ensure that they equally affect youth across racial/ethnic subpopulations.
青年是电子烟健康传播的重点人群。本研究考察了在 4 年内青少年接触食品和药物管理局（FDA）电子烟警告标签的情况，以及其与青少年对电子烟危害感知和使用意图变化的关系。
我们汇总了 2018-2021 年全国青少年烟草调查（年龄 10-17 岁；n=67159）的数据。参与者分为四组：从未使用者（58.5%）、易感染的非使用者（16.3%）、曾经使用者（12.7%）和当前使用者（12.5%）。我们考察了警告对成瘾性和危害感知、使用电子烟的意图以及戒掉所有烟草制品的意图的影响。
只有 24.5%的青少年接触过该警告。接触率从 2018 年的 14.9%上升到 2019 年的 30.8%，然后在 2021 年下降到 25.2%。西班牙裔（调整后的优势比（aOR）=0.76[95%CI=0.641 至 0.89]）和非西班牙裔黑人当前使用者（0.53[0.40 至 0.69]）比白人当前使用者更不容易接触到该警告。青少年接触警告与更高的电子烟成瘾感知（1.12[1.04 至 1.19]）和戒掉所有烟草制品的意图（1.28[1.13 至 1.46]）呈正相关。然而，接触警告与电子烟危害感知（0.91[0.85 至 0.96]）和电子烟非使用者使用电子烟的意图（2.38[1.99 至 2.84]）呈负相关。
青少年接触警告的比例下降表明出现了疲劳效应。通过使用更具吸引力的设计、增加针对青少年电子烟危害的主题、定期轮换警告内容以及使用文化适应性的信息传递方式，来加强该标签，可以提高其对青少年的影响，并解决种族/民族差异。
FDA 电子烟标签仅覆盖了 24.5%的青少年，且青少年接触警告的比例下降表明出现了疲劳效应。少数族裔的接触率明显较低。接触警告与更高的电子烟成瘾感知和戒掉所有烟草制品的意图呈正相关。然而，它并没有增加非使用者对电子烟危害的感知或减少使用电子烟的意图。通过使用更具吸引力的设计、纳入针对青少年电子烟危害的各种主题、以及定期轮换警告内容，来加强该标签，可以提高其对青少年的影响。需要继续监测电子烟政策的实施情况，以确保它们在种族/民族亚群体中平等地影响青少年。
