Health warnings on vapes changed people's choices, but there was a catch

When nearly 3,000 Canadians faced hypothetical choices between vape pods, heated tobacco, and cigarettes, researchers tested whether warnings, nicotine strength, packaging, or price had the greatest influence on their decisions.

Study: E-cigarette, heated tobacco, and cigarette preferences among Canadian e-cigarette users and nonusers: A discrete choice experiment. Image Credit: Yta23 / Shutterstock

A Health Canada report published in 2024 reported that, in 2023, 28% of Canadians aged 15 to 24 had used vapes in the previous 30 days. In a recent study published in the Canadian Journal of Public Health, a team of researchers explored the impact of policies, such as on-product warnings and nicotine concentrations, on young nonusers and current e-cigarette users.

E-cigarette use

E-cigarettes or vapes, which heat a liquid to produce an aerosol, are widely considered less harmful than tobacco cigarettes, but their long-term health risks are still debated. Heated tobacco products instead warm processed tobacco without burning it. While these products may help some smokers quit cigarette smoking, they also create a new route to nicotine addiction, particularly for young people. Governments have implemented policies such as advertising bans, nicotine limits, taxes, and plain packaging to limit nicotine product use.

While evidence that higher taxes have decreased tobacco use is strong, evidence for e-cigarettes and heated tobacco is more mixed. Because rules around e-cigarettes change quickly, researchers struggle to measure their effects on risk perceptions, buying choices, and intentions to use. Warnings placed directly on vapes and heated tobacco have not been adopted in Canada, so their effects remain untested. Canada already requires warnings on individual cigarettes.

The current study

In this study, the researchers ran a discrete choice experiment in which people repeatedly chose one option from a set of products with varying features. A commercial online panel, LeoOpinion, run by the market research company Léger, was used to recruit participants. In total, 1,839 e-cigarette nonusers aged 16 to 29 years and 1,122 current e-cigarette users completed the online survey. Nonusers took part in November and December 2021, and users in April and May 2022. The study included residents of Alberta, Ontario, and Québec. Nonusers averaged 24 years of age, compared with 36 among users, 51% of whom also smoked cigarettes. Nonusers had not vaped in the preceding 30 days, though some had used e-cigarettes previously or currently smoked cigarettes.

The questionnaires drew on a scoping review of earlier stated preference studies. Draft versions were piloted with 28 students and staff at McMaster University and then translated into French.

Each question showed two or three products and a "none" option. Users chose the product they would most likely buy, while nonusers chose the product most likely to encourage someone in their position to try vaping or smoking. Both groups also selected the option they believed posed the least health risk. The products were JUUL vape pods, IQOS heated tobacco sticks, and du Maurier cigarettes, selected as the most popular brands at the time.

Across the products, the researchers varied four features: a health warning printed on the product or none; plain or branded vape pod packaging; high (5%) or low (1.5%) nicotine concentration in vape pods; and prices at current levels or raised by 20% or 40%.

The design produced 48 choice sets split into four blocks of 12 to limit the burden on respondents. The researchers then used statistical methods to estimate how each feature affected choices and converted the estimates into predicted probabilities. Subgroup comparisons were then performed by sex, income, province, age, and dual use of cigarettes and e-cigarettes.

Key findings

The study found that health warnings printed directly on products generally reduced predicted preferences for nicotine products, while lower nicotine strength made vape pods more appealing. Under the least restrictive experimental scenario, nonusers had a predicted probability of 0.50 of choosing none of the products. Warnings on every product raised it to 0.65. Among users, the figure was 0.10 at baseline and reached 0.18 with the same warnings.

Warnings had their largest combined effect when displayed across all three product categories. For vaping devices alone, a warning reduced the predicted probability of choosing vape pods by seven percentage points among nonusers and three among users. Warnings on all products reduced it by 12 and five points, respectively. Contrary to manufacturers' claims that tighter vaping rules would increase smoking, the warnings did not increase predicted cigarette preferences. Warnings also changed risk perceptions. The predicted probability of nonusers naming vapes as the least risky option fell from 0.44 to 0.35, and among users from 0.48 to 0.41. Respondents increasingly selected the survey's "other" option rather than identifying cigarettes as less risky. The authors cautioned that this might distort perceptions of vaping's relative harm compared with smoking.

Price effects on choices were smaller. A 40% increase in vape pod prices lowered users' predicted preference for vape pods from 0.55 to 0.48, but increased preferences for heated tobacco and cigarettes. Higher cigarette prices did not change preferences for vape pods, even among dual users who also smoke. Plain vape pod packaging had little effect on preferences. Nonusers and users who did not smoke preferred lower nicotine strength in vape pods, which suggests the 2021 federal limit of 20 mg/mL may not have changed vaping preferences. Dual users did not show the same preference for lower nicotine strength.

The authors noted that online panel respondents' stated intentions may differ from their actual behavior. Selecting "none" did not necessarily indicate lasting cessation, and the nonuser question asked about someone similar to the respondent rather than the respondent directly. Only about 31% of current e-cigarette users named JUUL as their usual brand, which may have inflated the "none" responses.

Conclusion

Overall, health warnings printed directly on nicotine products such as vapes appear to reduce the appeal of vape pods in hypothetical choices and indicate an increased likelihood of people choosing none of the products. Warnings appearing on every product produced the largest increase in the predicted probability of selecting none of the nicotine products.

Higher vape prices increased preferences for cigarettes and heated tobacco, while higher cigarette prices did not increase preferences for vaping. Lower nicotine strength increased the appeal of vape pods for most respondents, and plain packaging had little effect.

The authors suggested that warnings and higher prices, with information campaigns explaining relative health risks, could work together to reduce e-cigarette experimentation and use in Canada.

Source:

Journal reference:

- Guindon, G. E., Mentzakis, E., Buckley, N. J., Atri, A., & Montreuil, A. (2026). E-cigarette, heated tobacco, and cigarette preferences among Canadian e-cigarette users and nonusers: A discrete choice experiment. Canadian Journal of Public Health. DOI:10.17269/s41997-026-01270-2, https://link.springer.com/article/10.17269/s41997-026-01270-2