The Effect of Graphic Health Warning Labels Placed on the ENDS Device on Young Adult Users’ Experience, Exposure and Intention to Use: A Pilot Study

ABSTRACT

This proof-of-concept study aims to evaluate the effect of placing graphic health warning labels (GHWLs) on the ENDS device on users’ experience, puffing patterns, harm perception, nicotine exposure, and intention to quit or use in the future. JUUL users (n = 26, age 18–24 years; 69% male; 85% Hispanic) were recruited to complete two 60 minutes ad libitum sessions that differed by GHWL on the device (GHWL vs. no-GHWL control) in an experimental clinical lab study. Compared to the control session, using JUUL with GHWL on the device was significantly associated with reduced positive experiences such as pleasure, product liking, and user satisfaction (p-value < 0.05 for all). Also, after exposure to GHWL, participants were less interested in using the same product again (p-value = 0.007), even if it was the only product available on the market compared to control (p-value = 0.03). Trends toward reduced puffing behavior and nicotine boost were also noted during the GHWL, compared to control sessions. This pilot study shows that placing GHWL on the ENDS device may be an effective and promising strategy to reduce ENDS use among young people.

Authors contribution

WM, TA and MVR contributed to the conception and design of the study, supervised data collection, contributed to interpretation of the data and critically revised the manuscript for important intellectual content. WL, MVR and MEK collected the data, performed the initial analyses, and drafted the initial manuscript. ZBT, OO and SN contributed to interpretation of the data and critically revised the manuscript for important intellectual content. All authors reviewed and approved the final draft. This manuscript was written by WL with input from all co-authors who read and approved the final version.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the views of the NIH and ORED.

Disclosure of potential conflict of interest

The authors declare that they have no competing interests or conflicts.

Additional information

Funding

WM, TA, and MVR are supported by the Fogarty International Center at the U.S. National Institutes of Health (NIH) (R01TW010654). OO is supported by NIDA T32DA043449 grant. This project was funded by Florida International University (FIU) Office of Research and Economic Development RCMI Pilot Study Program. This study was approved by the FIU Institutional Review Board.