Why Conflicting Recommendations About E-Cigarettes May Influence Smokers’ Healthy Behaviors
Since 2007, sales of electronic cigarettes (e-cigarettes) have grown immensely; their use is particularly common among youth and young adults. These devices could potentially be an alternative to combustible cigarettes, but there have been conflicting recommendations (CRs) regarding e-cigarettes because of insufficient scientific evidence. In a new article published in NCA’s Communication Monographs, Qinghua Yang, Natalie Herbert, Sijia Yang, Julia Alber, Yotam Ophir, and Joseph N. Cappella surveyed 717 former and current smokers to determine how CRs about e-cigarettes relate to confusion about health effects and intention to adhere to less controversial healthy lifestyle recommendations.
Some statements from credible scientific organizations about e-cigarettes have emphasized their potentially positive benefits, such as their reduced harm compared to combustible cigarettes and use as a tool for smoking cessation. However, some credible organizations have noted that there may be long-term negative effects associated with e-cigarette use or second-hand vaping inhalation. The Communication Monographs article authors note that this conflicting information may result in public confusion. In addition, they argue that confusion about e-cigarette CRs could “spill over to other health behaviors where recommendations are clear and certain,” such as regular exercise or eating fruits and vegetables. To address the effects of CRs on confusion and this spill over, the authors examine the interaction between CRs and information avoidance tendency (IAT).
Recent studies have suggested that uncertainty may be positive or negative, depending on how it is managed. For example, if uncertainty is a source of anxiety, people may attempt to reduce their uncertainty by seeking new information. Conversely, individuals may cope with uncertainty that fosters optimism or hope by avoiding new, distressing information. Because people with high IAT may be more likely to avoid information, they may be less susceptible to the confusion that CRs generate and, subsequently, may avoid the spill-over effect.
Yang, Herbert, Yang, Alber, Ophir, and Cappella recruited U.S. adults who had smoked at least 100 cigarettes in their lifetime. Approximately 55 percent of respondents were women and nearly 88 percent were white. About half had tried vaping. Participants were surveyed about smoking, vaping, IAT, and intentions to adhere to healthy lifestyle recommendations. To measure “information avoidance to maintain uncertainty,” participants were asked to report the extent to which they agreed to the following statement: “I tend to AVOID health information because,” which was followed by four endings: “It can be depressing,” “I get anxious when I think about my health,” “Being constantly reminded of it makes me nervous about my own health condition,” and “It can be scary to think about.” Avoidance of low quality information to reduce uncertainty was similarly measured using the same statement as above with three different endings: “There’s a lot of misinformation out there, so it’s difficult to know which is truthful,” “The recommendations are always changing,” and “The amount of information out there can be overwhelming.”
Participants were then “randomly assigned to one of five conditions.” The test group was exposed to a treatment message about using e-cigarettes to quit smoking that contained information both in favor of and against using e-cigarettes. There were four control conditions. One group was exposed to messages in favor of using e-cigarettes to quit smoking, and another saw messages that argued against using e-cigarettes to quit smoking. The third control group saw a general message about e-cigarettes, and the last received no message at all.
After randomization, participants responded to questions measuring their confusion about e-cigarettes and their intention to adhere to healthy lifestyle recommendations.
The authors found that there was more confusion about the health implications of using e-cigarettes when participants had low levels of IAT to maintain uncertainty. Confusion was also associated with lowered intentions to engage in healthy behaviors, including eating fruits and vegetables, exercising, and lowering alcohol intake. Thus, participants who avoided information to maintain uncertainty actually benefited from that avoidance, by experiencing less confusion and a higher likelihood to adhere to healthy lifestyle recommendations.
First, the authors recommend that in situations where scientific consensus is still developing (e.g., e-cigarettes and COVID-19), people should avoid attempting to reach early conclusions by consuming excessive information. Second, because CRs may be harmful for some individuals, they recommend that “future [health communication] campaigns or interventions educate the public by (a) clearing the misunderstanding that more information is always favorable, (b) informing the [public about the] potential benefits of information avoidance, and (c) giving suggestions of not processing – or at least cautiously processing – CRs while the scientific evidence is insufficient,” particularly when competing claims exist, as in the case of conflicting claims about e-cigarettes’ use as a tool to quit smoking. Qinghua Yang, who led the research, said, “Our research offers a caution about the possible inadvertent consequences of legitimate, conflicting claims from credible scientific groups that could undermine other guidance about healthy behavior that has been previously well-established.”