Text-Only, Health-Harm E-Cigarette Warnings Increase Beliefs in Addictiveness

THURSDAY, June 5, 2025 (HealthDay News) — Text-only, health-harm warnings on electronic cigarettes are associated with increased beliefs about the harm and addictiveness of e-cigarettes, according to a review published online June 2 in JAMA Internal Medicine.

Youjin Jang, Ph.D., from the University of North Carolina at Chapel Hill, and colleagues conducted a systematic literature search to examine whether health-harm warnings are more effective than the required nicotine addiction warning on e-cigarettes.

Based on 24 studies (22,549 participants), the researchers found that e-cigarette text-only warnings were associated with improvement for most examined outcomes. E-cigarette warnings were associated with greater attention, negative affect, and effects perceptions, as well as increased addiction beliefs and risk beliefs compared with controls. However, relative risk beliefs were not impacted by e-cigarette warnings. Relatedly, e-cigarette warnings were also associated with reduced intentions to vape and increased intentions to quit vaping. Nicotine addiction warnings outperformed health-harm warnings on many outcomes. Health-harm warnings were associated with more negative affect, attention, and effects perceptions, as well as increased risk beliefs and intentions to quit vaping compared with addiction warnings.

“Part of the novelty of our findings is that we found that warnings that use only text can serve an important role in informing about tobacco product risk for e-cigarettes,” Jang said in a statement. “Expanding text-only warnings on packages and advertisements to include potential health hazards and harms of using e-cigarettes — such as exposure to harmful chemicals — is a next important step for e-cigarette warning policies.”

One author disclosed personal fees as an expert witness in litigation against tobacco and e-cigarette companies.

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