Noticing Voluntary E-Cigarette Warning Labels and Associations With Harm Perceptions and Use Intentions: A Baseline Cross-Sectional Analysis of Wave 4 of the Population Assessment of Tobacco and Health Study Prior to the Food and Drug Administration Mandate

Christina N. Wysota, Zongshuan Duan, Yan Wang, Raymond S. Niaura, Lorien C. Abroms

Research output: Contribution to journalArticlepeer-review


Purpose: To examine the effect of e-cigarette warning labels (EWLs) prior to the August 2018 FDA-warning label mandate to establish a baseline for future research. Design: Cross-sectional survey. Setting: United States. Participants: A cohort of adult participants in the Population Assessment of Tobacco and Health (PATH) study (n = 30,004) at Wave 4 (Dec 2016-Jan 2018). Measures: Correlates (e.g., sociodemographics, substance use, social influence, cigarette warnings, and mental health) of noticing EWLs in the past 30-days (noticed vs did not notice), perceived harm of e-cigarettes/nicotine (from 1 = not at all harmful to 5 = extremely harmful), relative harm of e-cigarettes (from 1 = less harmful to 3 = more harmful than cigarettes), intention to quit (yes/no) and intention to try e-cigarettes (from 1 = definitely not to 4 = definitely yes). Results: The prevalence of noticing EWLs was 22.1%. Those who currently use electronic nicotine products, established and experimentally, were more likely to notice EWLs relative to never users (aOR = 3.55; 95% CI: 2.96-4.25; P <.001 and aOR = 2.42; 95% CI: 1.88-3.10; P <.001, respectively). Those with past 30-day alcohol and cigarette use were less likely to notice EWLs (aOR =.27; 95% CI:.24-.31 and aOR =.91; 95% CI:.83-.99; respectively). Those who noticed cigarette warnings were more likely to notice EWLs (aOR = 12.00; 95% CI: 10.46-13.77; P <.001). Among those who noticed EWLs, there were higher odds of perceiving e-cigarettes to be equally or more harmful than cigarettes (aOR = 1.15; 95% CI: 1.02-1.30), but no association was found between noticing EWLs and perceived harm of e-cigarettes/nicotine or use intentions. Conclusion: Noticing voluntary EWLs was not associated with increased perceived harm of e-cigarettes and nicotine harm, or e-cigarette use intentions. Future research is warranted to examine the effect of the FDA mandated EWLs.

Original languageEnglish (US)
JournalAmerican Journal of Health Promotion
StateAccepted/In press - 2024


  • awareness
  • education/communications
  • health policy
  • population health
  • tobacco control

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health

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