Asfar Taghrid, Schmidt Michael, Oluwole Olusanya Joshua, Casas Alejandra, Friedman Lily, Ferdous Tarana, Noar Seth M, Eissenberg Thomas, Maziak Wasim
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
Tob Control. 2024 Feb 12. doi: 10.1136/tc-2023-058384.
This study reports on the development of pictorial health warning labels for electronic nicotine delivery system (ENDS) using the Delphi approach with a panel of tobacco control experts. Twenty-four evidence-based ENDS-specific warnings corresponding to three themes (toxicity, health risks and specific harm) were developed and used in the Delphi study.
We conducted a three-round online Delphi study among 60 experts (55% female) between June 2022 and April 2023. We balanced the panel in areas of expertise and positions relevant to ENDS (risks, benefits). In round 1, participants rated the warnings on attention, relevance to evidence and perceived effectiveness (harm perception, motivation to quit) and provided suggestions for improvement. In rounds 2 and 3, participants ranked the revised warnings based on importance in each theme. We assessed levels of agreement between participants using interquartile deviations and medians.
Warnings in theme 1, toxicity, received the highest ratings for perceived effectiveness on harm perception and encouraging quitting ENDS (p<0.05). Experts recommended using clear and affirmative text paired with emotion-provoking pictures and avoiding the rare side effects of ENDS. Most of the top-ranked warnings were from theme 3, ENDS-specific harm, pertained to lung damage, dual use of ENDS and cigarettes, nicotine addiction among youth, anti-ENDS industry sentiment and toxicity.
This study developed 24 evidence-based ENDS health warning labels using a systematic process that included several rounds of expert panel feedback. These warnings can be used to advance ENDS prevention and tobacco control policies and further target different populations.
本研究报告了使用德尔菲法与一组烟草控制专家共同开发电子尼古丁传送系统（ENDS）图片健康警示标签的情况。针对三个主题（毒性、健康风险和特定危害）制定了24条基于证据的ENDS特定警示，并在德尔菲研究中使用。
2022年6月至2023年4月期间，我们对60名专家（55%为女性）进行了三轮在线德尔菲研究。我们在与ENDS相关的专业领域和立场（风险、益处）方面平衡了专家小组。在第一轮中，参与者对警示的关注度、与证据的相关性以及感知有效性（危害感知、戒烟动机）进行评分，并提供改进建议。在第二轮和第三轮中，参与者根据每个主题的重要性对修订后的警示进行排序。我们使用四分位数间距和中位数评估参与者之间的一致程度。
主题1（毒性）中的警示在危害感知和鼓励戒烟的感知有效性方面获得了最高评分（p<0.05）。专家建议使用清晰肯定的文字搭配引发情感的图片，并避免提及ENDS罕见的副作用。排名靠前的警示大多来自主题3（ENDS特定危害），涉及肺部损伤、ENDS与香烟的双重使用、青少年尼古丁成瘾、反ENDS行业情绪和毒性。
本研究通过一个包括多轮专家小组反馈的系统过程，开发了24条基于证据的ENDS健康警示标签。这些警示可用于推进ENDS预防和烟草控制政策，并进一步针对不同人群。
