The Impact of Exposure to Food and Drug Administration E-cigarette Authorization Messages on Product Perceptions and Interest-An Experiment With Adults Who Smoke and Youth.

Introduction: In the United States, e-cigarettes have entered a new regulatory era, needing authorizations from the Food and Drug Administration (FDA) to remain on or enter the marketplace. This study explored the impact of e-cigarette authorization messages on product perceptions and interests.

Aims and methods: We conducted an online experiment in June 2022 with nationally representative samples of adults (≥21) who smoke cigarettes (n = 866) and youth ages 15-20 (n = 859). They were randomized to one of five conditions: Viewing an ad for a fictional e-cigarette brand with no reference to the FDA (control), an ad with an "authorized for sale by FDA" claim in varying presentation styles (plain text, FDA "approved" stamp, FDA logo), or reading a fictional news excerpt about the product's authorization plus control ad. We compared group differences in product interest, susceptibility, harm perceptions, and message perceptions.

Results: Among adults who smoke, there were no effects on product interest nor susceptibility, but ratings of the product's harmfulness compared to cigarettes were lower among those in the news versus control condition (β = -0.25, p = .04). Among youth, odds of susceptibility were higher among ever e-cigarette users who viewed the ad with the FDA logo authorization message relative to the control ad (OR = 6.3, 95% CI:1.67 to 23.9, p < .01). About 40% of all participants agreed the authorization claim makes them think the product is safe to use, but fewer (14%-19%) agreed it makes them more interested in trying it.

Conclusions: FDA e-cigarette authorization messages may impact some product harm beliefs. More research is needed to track potential impacts on product use and on ways to promote accurate message understanding.

Implications: This study provides new data about the potential impact of messages about FDA authorization of e-cigarette products (presented as ad claims or a news story) on authorized product perceptions, interest, and susceptibility among adults who smoke cigarettes and youth. Our results suggest that FDA e-cigarette authorization messages may impact harm-related beliefs among adults who smoke and product susceptibility among youth who have ever used e-cigarettes before, though real-world effects are likely to be impacted by message type and format, and perceived message source and credibility. Authorization messages are likely to be misinterpreted as "FDA approval" by some; therefore, providing clarifications about authorization meaning and standards are relevant where possible.