Meghan E Morean1, Olivia A Wackowski2, Thomas Eissenberg3, Cristine D Delnevo2, Suchitra Krishnan-Sarin4. 1. Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA. Electronic address: meghan.morean@yale.edu. 2. Rutgers Center for Tobacco Studies, 303 George Street, New Brunswick, NJ 08901, USA. 3. Virginia Commonwealth University, Department of Psychology, 100 West Franklin Street, Richmond, VA 23220, USA. 4. Yale School of Medicine, Department of Psychiatry, 34 Park Street, New Haven, CT 06519, USA.
Abstract
INTRODUCTION: Nicotine in e-cigarettes typically is labeled as mg/ml or percent nicotine, but these metrics may be difficult to understand. We examined whether adults who use e-cigarettes accurately can compare nicotine concentrations presented as mg/ml and percent and/or can identify the strength of concentrations presented using these metrics. METHODS: 310 adults completed an online survey in 2020. Participants viewed nicotine concentration pairs (e.g., 24 mg/ml vs 3%) and indicated which concentration was stronger or if they were equal. Participants also categorized nicotine concentrations presented as mg/ml (0-60 mg/ml) and percent (0-6%) into strength categories (no nicotine, very low, low, medium, high, very high). "Correct" answers for the strength of each concentration (e.g., 30 mg/ml is "high" nicotine) were based on the subjective opinion of e-cigarette researchers. RESULTS: When making direct comparisons, adults correctly identified that one concentration was stronger or that both were equivalent about half of the time (8.30 [5.08] of 19). Adults answered correctly more often when the stronger concentration was presented in mg/ml (4.75 [2.74] of 8) than percent (2.54 [2.60] of 8), p < .001). Adults "correctly" identified the strengths of 8.90 (3.22) of 18 nicotine concentrations, with more "correct" responses for mg/ml (5.27 [2.15]) than percent (3.63 [1.71], p < .001). Adults classified concentrations presented as percent as weaker than equivalent concentrations presented as mg/ml. CONCLUSIONS: Adults had difficulty understanding nicotine concentrations labeled using the most common metrics, especially percent nicotine. A singular, easy-to-understand labeling system may increase public knowledge about the nicotine concentration/strength of vaping products.
INTRODUCTION: Nicotine in e-cigarettes typically is labeled as mg/ml or percent nicotine, but these metrics may be difficult to understand. We examined whether adults who use e-cigarettes accurately can compare nicotine concentrations presented as mg/ml and percent and/or can identify the strength of concentrations presented using these metrics. METHODS: 310 adults completed an online survey in 2020. Participants viewed nicotine concentration pairs (e.g., 24 mg/ml vs 3%) and indicated which concentration was stronger or if they were equal. Participants also categorized nicotine concentrations presented as mg/ml (0-60 mg/ml) and percent (0-6%) into strength categories (no nicotine, very low, low, medium, high, very high). "Correct" answers for the strength of each concentration (e.g., 30 mg/ml is "high" nicotine) were based on the subjective opinion of e-cigarette researchers. RESULTS: When making direct comparisons, adults correctly identified that one concentration was stronger or that both were equivalent about half of the time (8.30 [5.08] of 19). Adults answered correctly more often when the stronger concentration was presented in mg/ml (4.75 [2.74] of 8) than percent (2.54 [2.60] of 8), p < .001). Adults "correctly" identified the strengths of 8.90 (3.22) of 18 nicotine concentrations, with more "correct" responses for mg/ml (5.27 [2.15]) than percent (3.63 [1.71], p < .001). Adults classified concentrations presented as percent as weaker than equivalent concentrations presented as mg/ml. CONCLUSIONS: Adults had difficulty understanding nicotine concentrations labeled using the most common metrics, especially percent nicotine. A singular, easy-to-understand labeling system may increase public knowledge about the nicotine concentration/strength of vaping products.
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