Developing Targeted Health Messages about E-Cigarettes

Introduction:  Health communication strategies are needed to counter the proliferation of e-cigarette ads that target young adults. This project relies on principles of consumer insight-driven advertising development and describes the conception and creation of three message strategies to communicate e-cigarette risks. This case study informs how future health promotion and education campaigns could be designed.

Methods: Semi-structured interviews were used to collect qualitative data from 30 undergraduate students enrolled at a large Southwestern university. The interviews assessed undergraduates’ knowledge, attitudes, normative beliefs, and efficacy beliefs about e-cigarettes, among others. Results from the qualitative interviews informed the development of the three different health messages, along with a control condition (no message). The impact of each different message on participants’ knowledge was assessed through the use of a randomized control design.

Results: From the qualitative interviews prominent themes emerged: college students had numerous misconceptions about the contents of e-cigarettes including that they produce water vapor and uncertainty regarding whether e-cigarettes contain nicotine. Many participants also indicated that e-cigarettes were less harmful than conventional cigarettes and did not contain chemicals that are found in conventional cigarettes. Three health messages were created to target these misconceptions. The first health message (group A) included the phrase “vapor isn’t water” underneath a wordcloud of e-cigarette vapor composed of the word “chemicals.” The second health message (group B) depicted a scroll menu with different names for e-cigarettes and the tagline, “Call it what you want, most still have nicotine.” The third health message (group C) depicted foods filled with unappetizing combinations (for example, chocolate filled with mustard) and the tagline, “Don’t let yourself be surprised. E-cigarettes are unregulated. There could be anything inside.” 294 undergraduates were randomized to one of the message conditions (or control) and asked a range of questions regarding knowledge of e-cigarettes. Overall, results indicated that college students in groups A and B had significantly higher knowledge scores than the control group. When examining differences in knowledge scores by e-cigarette group (ever users vs. never users), ever users in group A had significantly higher knowledge scores than the control group. For non-users, those in group B had significantly higher scores than those in the control group.

Conclusions: These findings have significant implications for public health promotion and education efforts in show casing the need for empirically based health messages in health campaign materials.