As controversy swirls around the vaping industry, a team of Cornell researchers has set out to help regulators identify the most effective health warnings to include in advertisements for electronic cigarettes.

Backed by a three-year, $1.4 million grant from the National Institutes of Health, National Cancer Institute, and U.S. Food and Drug Administration, the scholars aim to address a paradox presented by the required warnings.

Health officials want to discourage adolescents, among whom vaping has reached epidemic levels, from developing nicotine addictions through e-cigarettes. But they don’t want to scare off adult smokers for whom e-cigarettes might represent a healthier alternative to combustible cigarettes.

“You have this potential therapeutic use for one population and a harmful use for another,” said Jeff Niederdeppe, associate professor of communication in the College of Agriculture and Life Sciences. “The trick is, how do you deter young people from starting but not prevent smokers from trying to quit through using e-cigarettes?”

Niederdeppe and Sahara Byrne, professor of communication in CALS, are the study’s principal investigators. Co-investigators are Michael Dorf, the Robert S. Stevens Professor of Law at Cornell Law School; Rosemary Avery and Alan Mathios, professors of policy analysis and management in the College of Human Ecology; and Amelia Greiner Safi, M.S. ’06, lecturer in the College of Veterinary Medicine’s Department of Population Medicine and Diagnostic Sciences.

Their work is unfolding during a period of fast-moving legal and medical developments concerning vaping that have made headlines in recent months.

On Jan. 2, the Trump administration announced a ban on the sale of most flavored e-cigarette cartridges, excluding menthol and tobacco flavors.

Numerous state and local governments have cracked down on e-cigarettes with flavors such as mint, candy, fruit and chocolate – the most popular among young people now using the products at “alarming levels,” according to the FDA and Centers for Disease Control.

The agencies’ 2019 National Youth Tobacco Survey found that more than 5 million students – 27% of high school students and 10% of middle school students – report being regular e-cigarette users. Youth e-cigarette use has “increased dramatically,” undermining progress in reducing overall tobacco use, the agencies said.

Meanwhile, the CDC reported in December that an “explosive outbreak” of vaping-related lung injuries had resulted in more than 50 deaths and 2,500 hospitalizations, attributed to products containing THC and vitamin E acetate.

“We applied for funding the moment this issue became most critical,” Byrne said of the grant, which was awarded last September.

Cornell’s study, “The E-Cigarette Population Paradox: Testing Effects of Youth-Targeted Population Warnings for E-Cigarettes Among Two Key Populations,” includes three phases.

First, focus groups will help hone potential warning messages for different types of advertisements. Combinations of warnings and ad imagery then will be tested with adolescents, gauging their reactions, their intentions to vape or smoke combustible cigarettes, and their understanding of health risks. A final experiment will test how adult smokers perceive the warnings that proved most effective with teens.

The researchers will again take advantage of a mobile communications lab to reach hundreds of test participants in multiple states. Eye-tracking stations will help show which ad content attracts viewers’ attention, revealing how often and for how long they focus on text and images in different areas.

The same lab supported the team’s recent study assessing the value of graphic warnings on ads for combustible cigarettes, work the FDA cited while proposing revisions to decades-old text warnings.

Potential e-cigarette warning strategies could focus more on youth, Niederdeppe and Byrne said, highlighting, for example, evidence that nicotine can harm developing brains or increase anxiety and depression. Or they could target adults, perhaps stating that e-cigarettes should only be used by adults who are trying to quit smoking.

Cornell’s experiments also will analyze nonverbal messages, such as when ads feature attractive young people or bright, airy nature scenes to imply that e-cigarettes are part of healthy, active lifestyles.

“The advertisements for these products are using a lot of tactics that early tobacco products would use,” said Byrne. “So we are also looking at implicit advertising, and one question is: Does the federal government have the ability to restrict implicit messages in the ads?”

Adding to the challenge of crafting effective warnings is that, unlike combustible cigarettes, the long-term health risks of e-cigarettes are not yet known. The FDA also has not approved them as an aid for smoking cessation.

Said Niederdeppe: “We’re closely monitoring what public health agencies are saying about the science.”