E-cigarette health warnings and use among U.S. adolescents: Deterrence and cognitive elaboration in a national longitudinal study

Objectives Limited research has investigated the association between e-cigarette health warnings and e-cigarette use behaviors among adolescents. This study examines the relationships between e-cigarette health warnings (deterrence and cognitive elaboration) and e-cigarette use among U.S. adolescents. Study design Longitudinal study. Methods Data were drawn from the Population Assessment of Tobacco and Health Study (Waves 5–7), a nationally representative longitudinal cohort of U.S. adolescents aged 12–17 years. Associations between warning-related deterrence (frequency of dissuasion) and cognitive elaboration (extent of thinking about health risks), and past 30-day e-cigarette use (binary) and use frequency (days used in the past 30 days) were estimated using generalized estimating equations with logistic and negative binomial regression models, respectively. Results Among adolescents who had ever used e-cigarettes, 46.1% were current users. Approximately 24.3% reported frequent deterrence from e-cigarette health warnings, while 28.8% reported high levels of cognitive elaboration. Frequent deterrence was associated with substantially lower odds of current e-cigarette use (OR = 0.34, 95% CI: 0.26–0.43) and lower use frequency (IRR = 0.25, 95% CI: 0.19–0.33). Higher cognitive elaboration was also associated with lower odds (OR = 0.34, 95% CI: 0.24–0.47) and frequency (IRR = 0.36, 95% CI: 0.28–0.48) of e-cigarette use, with evidence of graded associations across levels of cognitive elaboration. Conclusion Deterrence and cognitive elaboration in response to e-cigarette health warnings were inversely associated with e-cigarette use and use frequency. These findings suggest that adolescents’ perceptions and cognitive responses to health warnings co-occur with patterns of e-cigarette use.