Effects of a Modified Exposure Claim for an e-Cigarette on Claim Comprehension, Behavioral Intentions, and Risk Perceptions Among US Adult Tobacco Users and Nonusers: Randomized Experimental Study

Clinical Snapshot

Key Findings

• P Value: P<0.001 for smokers with quit intentions; P=0.07 for smokers without quit intentions

• Effect Size: Increased intention to use among smokers with quit intentions: 42.5% (control) vs 55.5% (test), difference of 13 percentage points

• Primary Outcome: Claim comprehension was high: 94.4% understood lower harmful chemical levels, 95.1% understood reduced exposure from complete switching

• Nnt Or Sensitivity: Number needed to treat: approximately 8 smokers with quit intentions exposed to claim for one additional person to express positive use intention

• Confidence Interval: Not reported

Clinical Application

Marketing claims easily implementable but require regulatory approval; online survey methodology may not reflect real-world decision-making Relevant to Australian tobacco harm reduction policy; TGA would need to evaluate modified exposure claims; aligns with RACGP position on e-cigarettes as cessation aids for motivated quitters Adult smokers considering cessation, particularly those with existing quit intentions; limited applicability to tobacco never-users

Abstract

BACKGROUND: Effective communication about the relative risks of cigarettes and e-cigarettes can help increase switching away from cigarettes while minimizing unintended use. OBJECTIVE: This study examined comprehension of a proposed modified exposure claim (MEC) about an e-cigarette (IQOS VEEV, the study product [SP]) and the effects of claim exposure on SP use intentions and risk perceptions among adult tobacco users and nonusers. METHODS: Adult smokers with no intention to quit smoking (S-NIQ, n=606), adult smokers with an intention to quit smoking (S-IQ, n=600), adult e-cigarette users (ECU, n=630), adult former smokers (FS, n=619), adult tobacco and nicotine products (TNP) never-users aged 18-24 years (n=648), and adult TNP never-users aged 25 years and older (n=749; total N=3852) participated in a randomized between-groups online experimental study. Participants viewed a marketing brochure for the SP with (test condition) or without (control condition) an embedded MEC. Outcome measures included claim comprehension, intention to use the SP regularly, and perceived health risk to self from using the SP or smoking cigarettes. RESULTS: Most participants were female (n=2110, 54.8%), had a mean age of 40.2 (SD 14.93) years, and were equally split across the 4 US regions. S-IQ and S-NIQ were long-term, frequent cigarette smokers, while 91.4% (566/619) of FS were long-term quitters. ECU on average used e-cigarettes ≥15.2 times per day, and the majority of them (552/630, 87.6%) had started using e-cigarettes more than 12 months before. Most participants correctly understood the key elements of the claim: the SP produces lower levels of harmful chemicals compared to cigarettes (1818/1926, 94.4%), and switching completely from cigarettes to the SP reduces exposure to harmful chemicals (1832/1926, 95.1%). In both conditions, positive intention to use the SP was high among ECU (control: 238/314, 75.8% vs test: 249/315, 79%; P=.33), moderate among S-IQ (control: 127/299, 42.5%; test: 166/299, 55.5%; P<.001) and S-NIQ (control: 140/299, 46.8%; test: 166/307, 54.1%; P=.07), low among FS (control: 28/306, 9.2%; test: 33/312, 10.6%; P=.55), and very low among adult TNP never-users aged 18-24 years (control: 3/330, 0.9%; test: 8/318, 2.5%; P=.11), and adult TNP never-users aged 25 years and older (control: 5/373, 1.3% vs test: 12/375, 3.2%; P=.09). All groups understood that the SP posed a lower health risk compared to cigarettes. In all groups, claim exposure was associated with significantly lower risk perception of the SP relative to cigarettes (all comparisons, P<.001). CONCLUSIONS: The tested MEC has the potential to benefit public health by simultaneously increasing already high levels of SP use intention and reducing SP risk perceptions relative to cigarettes among adult tobacco users while generating low levels of use intention among tobacco nonusers.

References

1. 1.Magnani, P., Ehtesham, M., Soulan, A., Kallischnigg, G., Russell, C., & Roulet, S. (2026). Effects of a Modified Exposure Claim for an e-Cigarette on Claim Comprehension, Behavioral Intentions, and Risk Perceptions Among US Adult Tobacco Users and Nonusers: Randomized Experimental Study. *JMIR Formative Research*. https://doi.org/10.2196/85802