Developing tobacco risk communications for young adults susceptible to dual use of cigarettes and e-cigarettes (Preprint)

BACKGROUND Dual use of combustible cigarettes and electronic cigarettes is disproportionately high among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young adults (YA). Mass-reach health communications may be effective at curbing dual use behavior. Current research is exploring whether comparative risk messaging, which poses e-cigarettes as less harmful than cigarettes, may be an effective way to stop dual use behavior. OBJECTIVE This formative evaluation focused on communicating the health risks of cigarette smoking and e-cigarette use to young adults susceptible to dual use of these products, including LGBTQ+ YA. METHODS Online focus groups were conducted with YA to develop candidate messages (N=12). Interviews (N=13) qualitatively explored thematic content, and an online rating survey (N=326) quantitatively assessed perceived message effectiveness (PME) of and reactance to candidate messages applying standard and comparative risk message framing. RESULTS In the online survey, most messages scored above the midpoint for PME specific to cigarette smoking while reactance scores were generally low. Qualitatively, LGBTQ+ YA found comparative messages valuable for harm minimization but were concerned about unintentionally promoting vaping among non-users. Interview and focus group participants found messages featuring novel information, including that on toxic constituents and physical health, most effective, especially those deemed “shocking” by LGBTQ+ YA. Addiction messaging was best received when paired with novel harms (e.g. social or occasional use). Participants preferred gain-framed, behavioral efficacy messages that encouraged rather than demanded behavior change. YA susceptible to dual use perceived standard and comparative messages as effective. CONCLUSIONS Comparative messages may encourage switching to lower-risk nicotine products when paired with efficacy statements encouraging harm minimization.