Challenges in communicating the benefits of switching from cigarettes to e-cigarettes: Responses from eight adult focus groups with varying smoking experience

This study explored the effectiveness of nuanced messages, described in our study as warnings, that seek to convey the potential benefits of switching from cigarettes to e-cigarettes for adults. The messages were designed to convey the potentially complex idea that e-cigarettes are likely less harmful than combustible cigarettes but that e-cigarettes still present a risk. Eight adult focus groups (N = 37) with varying smoking profiles responded to a set of messages that are used by government agencies and non-government organizations to convey the benefits of switching and ongoing risk associated with e-cigarette use. Results indicate that a suggestion of health benefits from exclusive use of e-cigarettes was met with skepticism from users of e-cigarettes and combustible cigarettes, and generated confusion about what these benefits were. Messages suggesting that individuals who have switched to e-cigarettes should not switch back to combustible cigarettes elicited the strongest statements of doubt and mistrust among focus group participants, regardless of smoking status. Participants representing all smoking profiles agreed with the message suggesting that switching from combustible cigarettes to e-cigarettes still exposes the user to ongoing health risks. Our focus group discussions suggest that adult smokers may not interpret nuanced messages about harm reduction in a way that will encourage switching behavior.