Development and testing of relative risk-based health messages for electronic cigarette products

Abstract Background Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative smokers. This research aimed (1) develop and test selection of relative products; (2) compare these the two current EU Tobacco Products Directive (TPD) messages; (3) explore differences between smokers, non-smokers dual users. Method Twenty-six focusing either harm-reduction cessation were developed rated by multidisciplinary experts accuracy, persuasiveness clarity. The eight highest ranking compared alongside TPD in sample 983 European residents (316 327 non-smokers, 340 users) understandability, believability convincingness. Results On all three constructs combined, highest, closely followed four “Completely switching lowers your smoking related diseases”, “Use this product is much less harmful than smoking”, healthier “This presents substantially lower risks health cigarettes” did differ statistically from messages. Non-smokers TPD1 significantly higher overall Dual users safer smoking” non-smokers. Messages understandability. Conclusions provide useful resource future policy makers considering updating labelling.