Máirtín S McDermott1, Grace Li2, Ann McNeill1,3, David Hammond4, James F Thrasher5,6, Richard J O'Connor7, K Michael Cummings8,9, Ron Borland10,11, Geoffrey T Fong2,4,12, Sara C Hitchman1,3. 1. Addictions Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. 2. Department of Psychology, University of Waterloo, Waterloo, ON, Canada. 3. UK Centre for Tobacco and Alcohol Studies, UK. 4. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. 5. Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA. 6. Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. 7. Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. 8. Department of Psychiatry and Behavioural Sciences, Medical University of South Carolina, Charleston, SC, USA. 9. Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA. 10. Cancer Council Victoria, Melbourne, VIC, Australia. 11. School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia. 12. Ontario Institute for Cancer Research, Toronto, ON, Canada.
Abstract
BACKGROUND AND AIMS: The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country. DESIGN: Cross-sectional survey. SETTING: Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN. PARTICIPANTS: A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re-contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US. MEASUREMENTS: Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content. FINDINGS: Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs [odds ratio (OR) = 1.58, P = 0.02], whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non-daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P < 0.001). There were no significant differences in reports of noticing HWLs when comparing concurrent smokers and vapers with daily (OR = 1.62, P = 0.91) or non-daily (OR = 1.15, P = 1.00) vapers. There were no significant differences by country in reporting that HWLs made them concerned about using NVPs. Daily vapers were less likely to report feeling concerned than concurrent users (OR = 0.11, P = 0.017). Among those who reported reading HWLs (n = 688), there was little evidence of differences in recall of the HWL content. CONCLUSIONS: Respondents in England, where health warning labels on nicotine vaping products are mandatory, were not significantly more likely to report having noticed such warnings than those in Australia, Canada and the United States where warnings are not mandatory.
BACKGROUND AND AIMS: The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country. DESIGN: Cross-sectional survey. SETTING: Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN. PARTICIPANTS: A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re-contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US. MEASUREMENTS: Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content. FINDINGS: Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs [odds ratio (OR) = 1.58, P = 0.02], whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non-daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P < 0.001). There were no significant differences in reports of noticing HWLs when comparing concurrent smokers and vapers with daily (OR = 1.62, P = 0.91) or non-daily (OR = 1.15, P = 1.00) vapers. There were no significant differences by country in reporting that HWLs made them concerned about using NVPs. Daily vapers were less likely to report feeling concerned than concurrent users (OR = 0.11, P = 0.017). Among those who reported reading HWLs (n = 688), there was little evidence of differences in recall of the HWL content. CONCLUSIONS: Respondents in England, where health warning labels on nicotine vaping products are mandatory, were not significantly more likely to report having noticed such warnings than those in Australia, Canada and the United States where warnings are not mandatory.
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