Risk Perceptions of E-Cigarettes and the Evaluation of EVALI Messaging

With the growth of sales of e-cigarettes and other alternative nicotine products, governments face the new challenge of crafting public health messages that provide information to consumers about these less risky but not risk-free products. Bayesian learning serves as the theoretical framework for our analysis of how smokers form their perceptions of the risks of e-cigarettes based on the risks of smoking. This paper consists of two parts. First, we conduct a cross-country descriptive analysis of government messaging and smokers’ perceptions of e-cigarette risks. We study a diverse group of eight countries: Australia, China, Indonesia, Japan, Malaysia, Sweden, the U.K. and the U.S. We find that public health messages range widely across the countries. In online cross-country surveys of adult smokers, on average perceptions of e-cigarette risks are associated with their perceptions of the risk of smoking and with their countries’ messaging. Notably, in all eight countries many smokers incorrectly believe that e-cigarettes are relatively more harmful than smoking and over-estimate the absolute risks of e-cigarettes. In the second part of our study, we report the results of online randomized experiments that compare the effects of different e-cigarette risk messaging about an outbreak of lung injuries (given the acronym EVALI). The U.K. public health message about the low risk of e-cigarettes relative to smoking reduced smokers’ incorrect risk perceptions, while the U.S. public health message increased incorrect risk perceptions.