JMIR Publications

ABSTRACT

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.