INTRODUCTION: t is unclear whether FDA's required warnings on e-cigarette advertisements will apply to social media. Given the key role of social media in marketing e-cigarettes, we seek to inform FDA decision-making by exploring how warnings on various tweet content influence perceived healthiness, nicotine harm, likelihood to try ecigarettes and warning recall.
METHODS: n this 2x4 between-subjects experiment participants viewed a tweet from a fictitious e-cigarette brand. Four tweet content versions (ecigarette product, ecigarette use, ecigarette in social context, unrelated content) were crossed with 2 warning versions (absent, present). Adult ecigarette users (n= 994) were recruited via social media ads to complete a survey and randomized to view one of 8 tweets. Multivariable regressions explored effects of tweet content and warning on perceived healthiness, perceived harm, and likelihood to try e-cigarettes and tweet content on warning recall. Covariates were tobacco and social media use and demographics.
RESULTS: Tweets with warnings elicited more negative health perceptions of the e-cigarette brand than tweets without warnings (p< 0.05). Tweets featuring ecigarette products (p< 0.05) or use (p< 0.001) elicited higher warning recall than tweets featuring unrelated content.
CONCLUSIONS: his is the first study to examine warning effects on perceptions of e-cigarette social media marketing. Warnings led to more negative e-cigarette health perceptions, but no effect on perceived nicotine harm or likelihood to try e-cigarettes. There were differences in warning recall by tweet content. Research should explore how varying warning content (text, size, placement) on tweets from e-cigarette brands influences health risk perceptions.
IMPLICATIONS: FDA's 2016 ruling requires warnings on advertisements for nicotine-containing e-cigarettes, but does not specify whether this applies to social media. This study is the first to examine how e-cigarette warnings in tweets influence perceived healthiness and harm of e-cigarettes, which is important because e-cigarette brands are voluntarily including warnings on Twitter and Instagram. Warnings influenced perceived healthiness of the e-cigarette brand, but not perceived nicotine harm or likelihood to try e-cigarettes. We also saw higher recall of warning statements for tweets featuring e-cigarettes. Findings suggest that expanding warning requirements to e-cigarette social media marketing warrants further exploration and FDA consideration.