Effects Of E-Cigarette Warning Labels About Mental Health Consequences Of Nicotine Addiction Among Young Adults In The Us: Results From A Randomized Controlled Experiment.

Introduction: Since 2016, the U.S. Food and Drug Administration (FDA) has required e-cigarette packaging and advertising to bear the warning: "WARNING: THIS PRODUCT CONTAINS NICOTINE. NICOTINE IS AN ADDICTIVE CHEMICAL." Nicotine has numerous adverse consequences besides addiction, including increased anxiety and depression symptoms that arise from nicotine withdrawal. We tested the effects of exposure to text-only e-cigarette package labels about the psychological consequences of nicotine withdrawal.

Methods: We randomized 1919 U.S. young adults aged 18-24 years to view one of four warning label conditions: a no-message control, the current FDA warning, a message that "nicotine addiction can worsen depression and anxiety symptoms," and a message that "nicotine addiction is a source of stress." We explored associations between condition and intentions to use or quit e-cigarettes and perceived message effectiveness.

Results: Label condition was not associated with intentions to use or quit e-cigarettes. Intentions were equivalent among those who viewed the FDA label and those who viewed the no-message control. Compared with the FDA label, the depression/anxiety label and the stress label produced greater agreement among participants that the message "makes me concerned about nicotine addiction" after adjustment for sociodemographic characteristics; those who viewed the depression/anxiety label had greater agreement that the message "discourages me from wanting to use nicotine."

Conclusions: While brief exposure to the warnings tested may not impact young adults' intentions to use or quit vaping, messages about stress, depression, and anxiety arising from nicotine addiction had higher perceived effectiveness among young adults than the FDA's current message about addictiveness.

Implications: Findings from this randomized controlled experiment among U.S. young adults suggest that warnings about the mental health consequences of nicotine addiction might be one type of message to consider including in a suite of required e-cigarette warnings and as part of a comprehensive effort to educate the public about the risks of commercial tobacco products.