Evaluating the Influence of Warning Labels on E-cigarette Products and Their Efficacy in Shaping User Perceptions Toward Smoking Cessation

Dear Editor, We read with great interest the article “Evaluating the Influence of Warning Labels on E-cigarette Products and Their Efficacy in Shaping User Perceptions Toward Smoking Cessation” by Muattqin et al.1 The study enlightens how different warning labels on e-cigarettes affect users’ consumption and cause them to quit smoking due to the high chances of developing life-threatening diseases. These results highlight the value of targeted labelling approaches to tobacco control policy and indicate that appropriately crafted warnings may be relevant for shaping consumer behavior in a fluid nicotine product landscape; however, we would like to respectfully highlight a few observations to enhance the accuracy and interpretation of the findings. First, we would like to rectify the categorization used in this paper for visual warning labels. The authors state that visual warnings represent a “new” form of e-cigarette labelling, although this is a misstatement. The World Health Organization (WHO) has acknowledged pictorial warning labels as an evidence-based policy intervention efficiently used in tobacco control for over two decades. Three categories can be used to classify tobacco product warnings: plain packaging with visual warnings, text-only warnings, and combined text-and-image warnings. Rather than consisting just of an image without any text, these labels were classified as text-and-image mixed.2 The literature search strategy employed in this study also seems insufficient and, therefore, might be subject to bias. First, the authors used only one term, “pictorial warning label,” without exploring its synonyms like “graphic health warning,” “text-plus-image warning,” or even regional terms, resulting in a potential for missing other articles using different wording. In addition, the absence of a controlled vocabulary, like MeSH terms in PubMed (e.g., Tobacco Products, Electronic Nicotine Delivery Systems, or Health Warnings), drastically reduces the scope and comprehensiveness of the searches.3 Data availability statement Nil. Authors contribution SZ and DR contribute in conceptualization, manuscript writing, editing. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.