Morean Meghan Elizabeth, Gueorguieva Ralitza, O'Malley Stephanie, Krishnan-Sarin Suchitra
Psychiatry, Yale School of Medicine, New Haven, New york, USA
Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA.
Tob Control. 2025 Apr 1;34(2):212-219. doi: 10.1136/tc-2023-058133.
The US Food and Drug Administration (FDA) requires a warning label on nicotine e-cigarettes and pouches: 'This product contains nicotine. Nicotine is an addictive chemical'. Some brands marketing synthetic nicotine products have modified the warning ('This product contains tobacco-free nicotine (TFN)…'). The public health impact of altering the warning is unknown, so we examined its impact on risk perceptions and use intentions.
1000 participants completed an anonymous online survey. Participants viewed the black-and-white FDA and TFN-modified warning labels in isolation, in a randomised order and reported on perceived addictiveness and, secondarily, use intentions. Participants then selected which label conveyed the most harm overall. Generalised estimating equations (GEEs) were used to evaluate the impact of label type and participant characteristics on perceived addictiveness and, secondarily, use intentions. Multivariable logistic regression was used to evaluate relationships between participant characteristics and choosing which label conveyed the most harm.
Overall, the TFN-modified label was associated with lower addictiveness ratings but not increased use intentions. Where significant interactions between label type and participant characteristics emerged, TFN-modified labelling was associated with disproportionately reduced risk perceptions or increased use intentions among vulnerable populations (eg, underage individuals, racially minoritised groups). 25.5% of participants selected the TFN-modified label as conveying the most harm, with younger individuals (<21 years) significantly less likely to choose the TFN-modified label.
Modifying the FDA-mandated nicotine warning label to include 'tobacco-free nicotine' may negatively impact public health, so the FDA should enforce inclusion of its original required warning label.
美国食品药品监督管理局（FDA）要求在尼古丁电子烟和烟弹上贴上警示标签：“本产品含有尼古丁。尼古丁是一种成瘾性化学物质”。一些销售合成尼古丁产品的品牌修改了警示内容（“本产品含有无烟草尼古丁（TFN）……”）。改变警示内容对公众健康的影响尚不清楚，因此我们研究了其对风险认知和使用意愿的影响。
1000名参与者完成了一项匿名在线调查。参与者以随机顺序单独查看了黑白的FDA和TFN修改后的警示标签，并报告了感知到的成瘾性，其次是使用意愿。然后，参与者选择哪个标签总体上传达的危害最大。使用广义估计方程（GEEs）来评估标签类型和参与者特征对感知到的成瘾性以及其次对使用意愿的影响。使用多变量逻辑回归来评估参与者特征与选择传达最大危害的标签之间的关系。
总体而言，TFN修改后的标签与较低的成瘾性评级相关，但与使用意愿增加无关。当标签类型与参与者特征之间出现显著交互作用时，TFN修改后的标签与弱势群体（如未成年人、少数族裔群体）中风险认知的不成比例降低或使用意愿增加相关。25.5%的参与者选择TFN修改后的标签为传达最大危害的标签，年龄较小的个体（<21岁）选择TFN修改后标签的可能性显著较低。
将FDA规定的尼古丁警示标签修改为包含“无烟草尼古丁”可能会对公众健康产生负面影响，因此FDA应强制使用其原来要求的警示标签。
