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UNC Lineberger’s Seth Noar, PhD, and Jacob Rohde surveyed teens to understand their knowledge and beliefs about e-cigarettes.

A University of North Carolina Lineberger Comprehensive Cancer Center study could inform public health researchers about ways to communicate more effectively with teenagers about the health risks of e-cigarettes.

In the International Journal of Environmental Research and Public Health, researchers reported that the majority of teenagers they surveyed knew about many of the health risks of e-cigarettes, but that had no influence on whether they had used e-cigarettes.

However, a question related to use – their belief as to whether or not using e-cigarettes would put them at risk of addiction – identified an approach to educate teenagers about e-cigarette health risks.

“Knowing that e-cigarettes contain addictive nicotine made no difference in whether teens used e-cigarettes or not, but believing that using e-cigarettes would get them addicted did make a difference. In fact, adolescents who believed that using e-cigarettes could get them addicted were much less likely to use them,” said UNC Lineberger’s Seth Noar, PhD, a professor in the UNC School of Media and Journalism. “This means that simply informing adolescents about the risks of e-cigarettes – such as addiction – is unlikely to change their behavior.”

The findings are from a survey of 69 adolescents completed in 2017 about their knowledge and use of e-cigarettes, as well as their beliefs about health risks. Nearly half of the study group had used e-cigarettes.

The majority of teens knew many of the health risks: 83 percent knew e-cigarettes usually contain addictive nicotine, 74 percent knew e-cigarettes have unknown long-term health effects, and 67 percent knew e-cigarette liquid contains harmful chemicals. However, knowing this information was not linked to whether the teens had used e-cigarettes.

Although they found that knowledge of health risks wasn’t linked to e-cigarette use, they did find that beliefs about addiction were a key discriminating factor among those who had and had not used e-cigarettes. Teens who had used e-cigarettes were more likely to discount the risks of addiction than teens who had never used them.

“Our study highlights the important distinction between knowledge and beliefs about e-cigarette risks,” said Jacob Rohde, a doctoral student in the UNC School of Media and Journalism. “In the context of addiction, efforts to reduce e-cigarette use shouldn’t solely focus on informing adolescents about nicotine in e-cigarettes – that much is already known. Instead, the key is to convey the health risks of nicotine exposure in a way that helps adolescents understand what addiction is and what its real consequences are.”

Noar said the findings are important to future efforts to communicate with adolescents about e-cigarette health risks. He said researchers are starting to test different types of messages to better communicate about e-cigarette health risks to prevent and deter their use.

“We are testing a platform that adolescents know and love – text messaging,” Noar said. “This is an important line of research given that e-cigarettes have become the tobacco product of choice among youth. We need to change that.”

In addition to Noar and Rohde, other authors include Casey Horvitz, Allison J. Lazard, Jennifer Cornacchione Ross, and Erin Sutfin.

The study was supported by the National Cancer Institute and the U.S. Food and Drug Administration Center for Tobacco Products.