Associations between Beliefs about E-cigarettes and Public Support for Regulating E-cigarettes Chul-joo Lee, Andy Tan, Cabral Bigman, & Kyungbo Kim

Public Attitudes towards E-cigarette Policies  Securing and maintaining public support for health policies is very important  Public support or perceived legitimacy  people’s willingness to comply with public policies  the success of the policies (the extent to which the policies achieve their objectives)  The increasing uptake of e-cigarettes  various e-cigarette regulations in recent years  It is thus important to examine what the key factors that influence public support for policies intended to regulate e-cigarettes

Cognitive Predictors of Policy Support  Beliefs about consequences of using e-cigarettes  Based on cognitively-oriented attitude- and persuasion theories  Beliefs about benefits of e-cigarettes – Support for e-cigarette regulating policies  Beliefs about harms of e-cigarettes + Support for e-cigarette regulating policies

Affective Predictors of Policy Support  The Role of Cognitive Shortcut or Affective Factor in Affecting Public Opinion  Attitude and Public Opinion Theories  In the context of high uncertainty and the new topic where public knowledge is not high (consequently people do not form beliefs about the topic)  Emotions and Trust

Trust in Government Regulating Agencies  In the context of government policies  e.g., government spending on distributive (Social Security, Medicare, environmental protection, national defense) and redistributive policies (Medicaid, aid to mothers with dependent children, health insurance for those who cannot afford it)  In the context of health policies…  e.g., compulsory governmental health policies such as quarantine or vaccine; public health legal interventions that address noncommunicable, or chronic, diseases; government policies to ban smoking by minors and increase taxes on tobacco  Trust in government regulating agencies (e.g., FDA) + Support for e-cigarette regulating policies

Interplay between Beliefs and Trust  “ Synergistic model,” which emphasizes that affect and cognition operate “jointly produce effects that are more attributable to their combination than to either one alone” (Eagly & Chaiken, 1993, p. 423)  Beliefs about e-cigarettes may have an enhanced effect for those with low levels of trust. Those with high trust may have already agree with regulating e-cigarettes.

Data  KnowledgePanel (maintained by GfK), a nationally representative online research panel; random-digit dial (RDD) and address-based sampling methods  The first round of the survey (January 2014), the completion rate = 58% (n=795). Of these participants, 784 were re-invited for the second survey (April 2014) and 626 completed this survey (a completion rate=80%). For the third round, 748 participants from the first round were re-invited in June 2014 and 571 completed this third round (completion rate=76%).  A final analyzed sample of 527 respondents (July 2014)

Measures  Public support for regulating e-cigarettes 1) Vaping or using e-cigarettes should not be allowed in places where smoking cigarettes is not allowed, 2) Youth under 18 years should not be allowed to buy e-cigarettes, 3) E- cigarette packages and advertisements should be required to carry an addiction warning, 4) The use of flavors in e-cigarettes should not be allowed, 5) E-cigarette packages should be required to label the amount of nicotine and other harmful ingredients, and 6) Marketing and advertising e-cigarettes to youth under 18 years should not be allowed.

Measures (cont.)  Beliefs about harms of e-cigarettes 1) Breathing vapors from other people’s e-cigarettes is harmful to my health, 2) If I vape or use e- cigarettes every day, I will become addicted, and 3) E-cigarettes tempt non-smoking youth to start smoking regular cigarettes  Beliefs about benefits of e-cigarettes 1) If I vape, or use e-cigarettes, it will be less harmful to me than if I smoke regular cigarettes, 2) Vaping or using e-cigarettes can help people quit smoking regular cigarettes completely, and 3) Breathing vapors from other people’s e-cigarettes is less harmful to my health than breathing from other people’s regular cigarettes

Measures (cont.)  Trust in government regulatory agencies Respondents were asked how much they trust U.S. government regulatory agencies (e.g., the Food and Drug Administration (FDA)) on a 4-point scale (1 = not at all, 2 = a little, 3 = some, 4 = a lot)

Results  Beliefs about e-cigarette benefits were NOT associated with support for e-cigarette regulations (b = -.073, SE =.048, p >.05).  Beliefs about e-cigarette harms (b =.487, SE =.044, p <.001) and trust in government regulatory agencies (b =.147, SE =.033, p <.001) were associated with higher support for e-cigarette regulations.  The positive association between beliefs about harms and support for regulations was stronger among respondents who had lower levels of trust in government regulatory agencies (b = -.105, SE =.035, p <.01).

Results (cont.)

Limitations  Cross-sectional survey design  Other lexicons for e-cigarette were NOT used  E-cigarette belief items NOT exhaustive  Self-reported e-cigarette use item  Social desirability bias  Trust in government regulatory agencies is a single-item measure; limited in content validity & susceptible to a measurement error  Banning flavor measure  which flavor?

Discussion  No statistically significant association between beliefs about benefits of e-cigarettes and support for e- cigarette policies  Bivariate correlation (p <.001); After controlling for beliefs about harms of e-cigarettes, the association became non-significant.  Correlation between harm beliefs and benefit beliefs was.244 (p <.001)  Negativity dominance = Salience of “negative” beliefs in human judgment & decision making

Discussion (cont.)  Little room for beliefs about harms of e-cigarettes to increase policy support  Respondents with HIGH levels of trust (> Mean + 1SD) - policy support mean 4.25  Respondents with MEDIUM levels of trust – policy support mean 4.04  Respondents with LOW levels of trust (< Mean - 1SD) – policy support mean 3.68  Interventions targeting those with low levels of trust

Discussion (cont.)  Importance of Beliefs about Harms of E-cigarettes to Mobilize Support for Regulating E-cigarettes  But which beliefs among the four?  “Breathing vapors from other people’s e-cigarettes is harmful to my health” shows the strongest correlation with the policy support & its mean is the lowest (M = 3.34)