Testing the influence of harm reduction messages on health risk attitudes, injunctive norms and perceived behavioral control

(2023) 20:113 Katz et al. Harm Reduction Journal https://doi.org/10.1186/s12954-023-00846-2 Harm Reduction Journal Open Access RESEARCH Testing the influence of harm reduction messages on health risk attitudes, injunctive norms and perceived behavioral control Sherri Jean Katz1*, Elisia Cohen1 and Dorothy Hatsukami2 Abstract Background E-cigarettes can potentially be a harm reduction pathway for adults who smoke and who are seeking to make the complete switch from cigarettes. However, often people who smoke believe that e-cigarettes are just as damaging as cigarettes to their health. From a harm reduction perspective, the key question is whether providing information about the reduced toxicant intake of e-cigarettes, compared to cigarettes, could influence their perceptions and whether there are certain message features that might further support this transition. Methods In this experiment (n = 305), we test whether a harm reduction (reduced toxicant intake, complete switch) message will influence the health risk attitudes, injunctive norms and perceived behavioral control of people who smoke, compared to those who do not view a message and whether including a “smoking cue” within the message influences their response. Results Results indicate that those who viewed the harm reduction message with a smoking cue had lower health risk attitudes than those who did not view a message (p = 0.025) and higher injunctive norms than those who viewed the message without a smoking cue (p = 0.006). Conclusions These findings demonstrate that a harm reduction message with a smoking cue can influence the perceptions of adults who smoke, lowering health risk attitudes and increasing injunctive norms. Keywords E-cigarettes, Harm reduction messages, Smoking cues Introduction E-cigarettes have been called a reduced harm product that can potentially ease the public health burden of tobacco if people who smoke transition completely [1, 2]. One challenge to complete transition is that prior research has highlighted that many adults who smoke believe e-cigarettes are as harmful as combustible *Correspondence: Sherri Jean Katz 1 Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, USA 2 Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA cigarettes [3]. For example, in a study of 1843 US adults who smoke, 53% of those who were not using e-cigarettes, highlighted a concern over the safety of the product as a reason not to use them, while 52% of them noted they were skeptical that e-cigarettes could help them completely quit smoking [4]. This sentiment was also relevant in a focus group study distinguishing perceptions of nicotine and addiction among US adults, conducted in Spring 2020 that included people who smoked, who smoked and vaped, who used to smoke, and who did not smoke or vape [5]. Participants perceived that it was nicotine, rather than smoking, that led to disease, with perceptions influenced by how individuals viewed the concept of addiction and whether they smoked or vaped [5]. Interestingly, addiction was viewed by participants © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Katz et al. Harm Reduction Journal (2023) 20:113 who smoked cigarettes as not only about a chemical response to nicotine, but rather about the behavioral aspects of smoking, which is noteworthy because e-cigarette use mimics many of these behavioral factors [5]. The key question in this current study is whether informing people who smoke cigarettes about the reduced toxicant intake of e-cigarettes, compared to cigarettes, within a testimonial message about a person who has made the complete switch to vaping, could influence these perceptions. In other words, can a message designed to address both the safety concerns and the efficacy skepticism change how adults who smoke perceive e-cigarettes and what message features might further support this transition. E‑cigarettes and smoking cessation A recent network meta-analysis has highlighted the potential of e-cigarettes as a reduced harm product in support of smoking cessation, noting that participants assigned to use nicotine e-cigarettes had greater rates of smoking abstinence than those assigned to use a licensed nicotine replacement therapy (NRT) or those assigned to a non-nicotine control condition [6]. Indeed, of the many reduced harm product options, e-cigarettes provide a behavioral experience that most closely mimics cigarette smoking, and prior research mentioned above has shown that people who smoke view the behavioral aspects of smoking as a part of the addiction [5]. One concern is that there are high rates of people who both smoke and vape among those who begin using them [7], and research has highlighted that these individuals are a multifaceted group with specific factors predicting whether or not a person makes the complete switch away from smoking cigarettes and therein whether or not e-cigarettes are actually harm reducing for that individual [8]. However, in recognition that there is at least the potential for e-cigarettes to be used as a harm reduction pathway for some adults who smoke cigarettes [9], it is important to identify what are the characteristics of a health message that best facilitates persuading people who smoke cigarettes to make a complete switch from cigarettes. Smoking cues When considering how best to inform adults who smoke that using e-cigarettes leads to lower exposure of harmful chemicals compared to cigarettes, it is important to consider both the arguments in the message (what they are told) and the format of the message (how it looks). Indeed, research on the heuristic–systematic model has highlighted that the arguments in the message are processed logically (systematically) with a focus on the strength of the message, while key imagery, can be processed simultaneously through a heuristic pathway, and Page (...truncated)