Getting tobacco vaping warning labels right for both adults and teens has proven complex, as regulators confront two public health challenges: How to promote e-cigarette use as an alternative for adults who smoke cigarettes, while warning teens who use e-cigarettes of the potential long-term consequences, which include nicotine addiction and exposure to toxic chemicals.

In a recent study published in Social Science and Medicine, a multidisciplinary team led by Jeff Niederdeppe, senior associate dean in the Jeb E. Brooks School of Public Policy and professor of communication in the College of Agriculture and Life Sciences (CALS), sought to deepen regulators’ understanding of how both adults and teens respond to the warning labels.

“This is really a nuanced challenge for regulators,” Niederdeppe said. “Can we get the labels to do two things at once so they are helping more adults to quit smoking while getting more teens to realize e-cigarettes are still bad for them?”

Co-authors include Sahara Byrne, senior associate dean and professor of communication in CALS; Rosemary Avery, professor in the Brooks School; Amelia Greiner Safi, professor of social and behavioral sciences and public health practice in the Department of Public and Ecosystem Health, in the College of Veterinary Medicine; Michael Dorf, the Robert S. Stevens Professor of Law at Cornell Law School; Alan Mathios, professor in the Brooks School; and Motasem Kalaji, assistant professor of communication studies at California State University, Northridge.

The team’s paper, “Managing a Policy Paradox? Responses to Textual Warning Labels on E-cigarette Advertisements Among U.S. National Samples of Youth Overall and Adults Who Smoke or Vape,” assessed responses to five e-cigarette warning message themes, placed in the context of ads for vaping products.

“The warning manipulations in our experiment were based on statements that U.S. federal agencies have made on the potential harms of e-cigarette use, which include nicotine addiction, harm to the developing brain among youth, and the potential for exposure to toxic chemicals like lead and formaldehyde,” Byrne said.

More than 12% of high school students and 5% of middle school students reported using e-cigarettes in the past 30 days. More than 28 million U.S. adults (11.5%) still smoke tobacco cigarettes daily.

While the FDA has not approved e-cigarettes as an evidence-based solution for smoking cessation, the CDC has acknowledged that they are less harmful than regular tobacco cigarettes and that they can be effective in helping adults to quit smoking.

In the study, respondents were randomly assigned to view one of five message theme conditions, each of which featured three different warning label messages placed on an ad for an e-cigarette product.

The responses showed that relative to the current FDA warning – “This product contains nicotine. Nicotine is an addictive chemical”– alternative warning label messages were largely ineffective at reducing youth willingness to vape in the future, or at changing risk beliefs about vaping products relative to cigarettes among adults who smoke or vape.

The research did reveal one potential opportunity for regulators and health communicators: Messages that describe the chemical constituents of vaping products, and articulate the potential health harms of those chemicals, may have potential to promote interest in quitting tobacco products among adults who smoke and vape.

The Cornell-led multidisciplinary team, which published a related paper last June, continues to build a body of research that can help guide regulators in the future.

“We’ve got 50 to 60 years’ worth of research on the effects on the body of smoking tobacco, but vaping products are relatively new,” Avery said. “Though the general consensus is that the risks of their use are lower than cigarettes’, there’s still a lot we don’t know about them. So how do you develop statements that are true and can stand up in court, when the science is still evolving?”

Giles Morris is assistant dean of communications in the Cornell Jeb E. Brooks School of Public Policy.