Assessing the impact of a standardised appearance and health warnings on e-cigarette appeal

Abstract

Branding, colours, and shapes are key to the appeal of e-cigarettes, particularly among adolescents and young adults (AYAs). In the Netherlands, where only tobacco flavours are allowed, product design remains the main attractive feature. Since youth e-cigarette use threatens the government’s goal of a smoke-free generation by 2040, this project investigates whether standardising e-cigarette appearance and adding health warnings can reduce their appeal. Three studies were conducted among 1239 participants: 221 AYA e-cigarette users (12-25 years), 710 AYA non-users (12-25 years), and 308 adult e-cigarette users (26+ years). They 1) indicated their preferred e-cigarette type, 2) evaluated the attractiveness, perceived harm, and expected taste of e-cigarettes in their preferred colour, in white, and in drab-brown (Pantone 448c) colour; all with and without a printed health warning, and 3) rated the severity and likelihood of four potential e-cigarette warning messages related to addiction, short term physical health, long term physical health, and mental health effects. Study 1 showed that AYAs were more likely to use disposable (71% vs. 46%), large cylindrical (53% vs. 35%) and brightly coloured e-cigarettes (90% vs. 71%) than adults. Study 2 showed that drab-brown e-cigarettes were rated as least attractive and tasty, followed by white, then colourful. Health warnings further reduced attractiveness and tastiness, most strongly in colourful e-cigarettes. Both drab-brown colouring and health warnings independently increased perceived harm compared to colourful or unlabelled e-cigarettes. Study 3 showed that individuals perceive short-term and long-term physical consequences as more severe, but less likely to occur than addiction. To reduce e-cigarette appeal among young and prospective users, governments may consider implementing a standardised e-cigarette design using drab-brown colour and a printed health warning about physical health consequences.