Impact of e-liquid packaging on vaping product perceptions among youth in England, Canada, and the US

Studies have found that advertising of some vaping products might appeal to youth (15- to 24-year-old) and could promote vaping among young people. For instance, a recent study found that youth perceive vaping product marketing as appealing and more than half think that vaping advertising targets non vapers (1). Given that young people notice advertisements of vaping products more often than adults (2), their perceptions of these advertisements is an important factor concerning initiation and use of vaping products among youth. One of the most prominent channels for advertising vaping products is packaging of vaping devices and their refills—cartridges, pods and e-liquids. Packaging for vaping e-liquids often contain elements that may be appealing specifically to youth. For example, a study in the US found that vaping companies used cartoons on one-fifth of e-liquid products to market their products online (3), and packaging of some e-liquids in the US resembled packaging for food and drink products that are often marketed to young people, such as candy or soda (4). Furthermore, vaping products’ packaging more often emphasises fruit or sweet flavours (via visually pleasing designs) which are more appealing to young people rather than alternatives to smoking that are more relevant to adult smokers (5). Similar to studies on tobacco products (6, 7), the evidence to date therefore suggests that product packaging may play an important role in increasing the appeal of vaping products, particularly among young people. To mitigate this form of promotion, standardised (i.e., plain) packaging of vaping products has been adopted in some countries including Israel and the Netherlands (7). Studies have yet to assess the impact of standardised packaging measures in naturalistic settings, but experimental data already suggest that standardised packaging might be effective in changing the appeal of vaping products among youth. Recent work has found that standardised packaging reduced the appeal of e-cigarettes and refills among youth aged 11 to 18 in England but not among adults (8). Similarly, data from the 2020 ITC Youth Tobacco and Vaping Survey found that standardised packaging reduced appeal of vaping products among youth aged 16 to 19 in England, the US and Canada (9). However, none of these studies assessed how standardised packs and their characteristics affect the appeal of e-liquid products specifically. The recent studies explored how youth perceive vaping products in olive-coloured standardised packs—the distinctive colour of plain standardised tobacco cigarette packs in certain countries (7). However, lighter-coloured packs might be perceived as less harmful than darker coloured ones (10), and lighter coloured plain packs might help discern vaping products from tobacco products in standardised olive packs. This may lead to more accurate harm perceptions, considering that vaping is less harmful than smoking (11). To assess whether colour of standardised e-liquid packs has any effect on youth interest in trying and harm perceptions of these products, our study will compare branded, standardised white and standardised olive packs of e-liquids. In addition, many smokers and vapers inaccurately perceive most of the health risks of smoking and vaping to be caused by nicotine (12), but little is known about whether nicotine concentration of e-liquids has any effect on youth interest in trying and harm perceptions of these products. This study will also examine how low versus high nicotine concentration labelling on the e-liquid packs affects youth interest in trying and harm perceptions of the e-liquids. This study will examine how branded and plain e-liquid packaging as well as colour of the plain packs and information on nicotine concentration affect youth interest in trying and harm perceptions of these products.

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