This study is the first to examine the influence of e-cigarette emission phrasing on perceived harm of secondhand exposure, and whether harm perception was associated with support for a tobacco-free campus policy. 

Participants: In the fall 2018 and spring 2019 semesters, 52 sections of a college English course (N = 791 students) were cluster randomized to one of three conditions (“vapor,” “aerosol,” or “chemicals”) assessing harm of secondhand exposure to e-cigarette emissions. Methods: Regression models adjusted for demographic characteristics, tobacco use, and other potential confounders. Results: Compared to the “vapor” condition, “chemicals” and “aerosol” conditions were associated with increased odds of perceiving secondhand exposure to e-cigarettes to be harmful/very harmful (AOR = 2.0, p < 0.01). Greater perceived harm of secondhand e-cigarette exposure was associated with increased odds of supporting a tobacco-free campus policy (AOR = 2.22, p < 0.001). Conclusions: Health campaigns should use accurate terminology to describe e-cigarette emissions, rather than jargon that conveys lower risk.

Introduction

Health communication is more than simply providing health-related information. The manner in which such information is framed and presented often has important consequences for audience understanding, risk perception, individual behavior, and public policy making. 1–4 Some health topics represent particularly contentious issue domains because vested interests are motivated to promote particular frames to attempt to influence public discourse. Tobacco is one such domain where there is currently a continuously shifting landscape of emerging products, coupled with powerful industry marketing that present frames to compete with public health interest groups and vie for public attention and acceptance. There are many framing devices in tobacco marketing and risk communication, ranging from glamorous or grotesque imagery, to narratives about manipulation, to simple words used to describe tobacco products and consumer behavior. 5–8

Shaping the ways people think about and describe secondhand smoke has been an industry tactic dating back to at least the early 1970s. 9 For example, tobacco industry representatives have referred to secondhand smoke as “environmental tobacco smoke” to make it sound more natural, with weaker direct linkages to their products, and thereby less harmful. 10 Similarly, industry representatives have used the term “passive smoking,” which carries the connotation of indifference, and may be used to downplay the annoyance often felt by nonsmokers who are unable to avoid exposure. 9

There has long been interest in the harms and consequences of secondhand exposure to cigarette smoke. Secondhand exposure to cigarette smoke, ie, smoke inhaled involuntarily from cigarettes being smoked by others, can cause asthma attacks, coronary heart disease, strokes, lung cancer, and lower respiratory illness, among other harms. 11 Furthermore, each year secondhand smoke causes an estimated 42,000 deaths in the United States (U.S.) 12 and 603,000 deaths worldwide. 13 Smoke-free laws and policies are important because they not only protect nonsmokers from secondhand smoke exposure, but also may reduce smoking among the general population. 14

Smoke-free college campus policies—which prohibit smoking on campus—are critical in eliminating exposure to secondhand smoke, as well as preventing smoking initiation and promoting cessation. 15 As a result, there is a major nationwide movement to implement smoke-free campus policies. Since 2012, the number of 100% smoke-free campuses in the U.S. has more than tripled from 774 to 2,487. 16 However, approximately 1-in-6 of these smoke-free campus policies do not address e-cigarettes. 16

The exclusion of e-cigarettes from clean air policies is problematic because there is a high prevalence of use among young people 17 and growing evidence that these products are harmful. 18 , 19 In 2019, 27.5% of high school students and 10.5% of middle school students reported current e-cigarette use. 17 E-cigarettes are now the most prevalent form of tobacco use among youth and young adults. One of the reasons e-cigarette use is so pervasive is the commonly held opinion that e-cigarettes pose less harm than cigarettes 20–27 —even though research has shown that the former products are not harmless. Indeed, there is growing evidence that e-cigarette emissions are harmful to human health. 28–46 Research demonstrates that e-cigarette generated aerosol includes harmful chemicals including formaldehyde, acetaldehyde, acrolein, furans, chloropropanols, and TSNAs. 36 , 47–49 Furthermore, research has documented that e-cigarette use in natural settings (ie, locations where e-cigarette use is common such as in homes, vaping conventions, or vape shops) results in secondhand exposures 35 , 50 and thirdhand exposures 51–53 (ie, chemical residue that collects on surfaces). Thus, there is a need for public policy designed to protect non-users of e-cigarettes from the products’ emissions.

Despite their U.S. retail availability for approximately 15 years, 54 there is inconsistent language surrounding e-cigarette products and use, 55 as well as the emissions of e-cigarettes. 56 Some people seem to associate the commonly used word “vape” with harmless water vapor. 57 , 58 However, “aerosol,” ie, solid and liquid particles suspended in gas, and “chemicals” (the composition of aerosol) are more accurate terms that may differentially communicate risk associated with exposure. The public health community more often refers to e-cigarette emissions as an “aerosol” 59–61 that is made up of “chemicals”. 19 , 57 , 62 Previous research suggests that the use of “chemicals” might be associated with greater perceived harm. 57 One of the reasons people in the U.S. might associate “chemicals” with greater harm perceptions may be the historic influence of the landmark works of Rachel Carson, who in the 1960s exposed the corrupt practices of the chemical industry in spreading misinformation about the harmful effects of chemical exposures on environmental and human health. 63

There is reason to believe that the different descriptors will matter in audience emission perceptions and related cognitions. As framing devices, specific words can activate different networks of related concepts and perspectives, which will then lead to different “problem definition[s],” “causal interpretation[s],” and “treatment recommendation[s]”. 1 Moreover, initial evidence suggests that terminology related to e-cigarettes might be associated with how people view them. One study found that news articles published in the U.S. that include “vape” in the headlines tend to portray e-cigarette use more positively compared to the use of “e-cigarette” or “e-cig”. 64 However, research has yet to examine whether different word uses for e-cigarette emissions influence perceptions of harmfulness.

We expect the contrast to be particularly sharp between “vape” and “aerosol/chemicals” because of the strong link between “vape” and innocuous water vapor on one hand, and the connection between “aerosol/chemicals” and environmental/physical risk on the other. Thus, the current study had two primary aims: (1) we investigated whether the terminology used to describe the secondhand output of e-cigarettes (aerosol, vapor, or chemicals) influenced undergraduates’ perceptions of its harmfulness; and (2) we examined whether perceived harmfulness of secondhand exposure to e-cigarettes was associated with support for a tobacco-free campus, adjusting for support for a smoke-free campus and other important factors.

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Matthew E. Rossheim , Xiaoquan Zhao , Eric K. Soule , Dennis L. Thombs ,
Sumihiro Suzuki , Asra Ahmad & Tracey E. Barnett – Journal of American College Health – September 15, 2020.

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