The Impact of Health Warnings in e-Cigarette Content on Instagram on Adults’ e-Cigarette Cognitions: Online Between-Subjects Experiment Study
Abstract
Background e-Cigarette use is a growing public health concern, with e-cigarettes being marketed by social media influencers on Instagram. Influencers promote e-cigarettes using misleading relative harm claims, portraying them as safer than regular cigarettes while overstating benefits and selectively omitting information on the harms. To counter this, the US Federal Drug Administration requires influencers to include a nicotine warning label in their sponsored posts, similar to the ones used on e-cigarette packages. However, research on their effectiveness remains limited, leaving questions about when, how, and for whom these warnings work. Objective This study examined how (1) relative harm claims and (2) health warnings in influencers’ sponsored e-cigarette content influence health outcome expectations and intentions to use e-cigarettes. In addition, we investigated whether user status (ie, smoking cigarettes or vaping e-cigarettes vs nonuse) moderates these effects. Methods Participants (n=597 age: mean 40.84, SD 11.93 years) were recruited through a survey company using a quote-based sample of German adults aged between 18 and 60 years, stratified by age, gender, and education. We conducted a preregistered 2 (relative harm claim: absent or present) × 2 (health warning: absent or present) between-subjects experiment. Participants viewed Instagram profiles of 2 influencers and separate posts including sponsored e-cigarette content. Relative harm claims in sponsored…
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