Table 1.

Select example quotes of participants' perceptions of proposed reduced risk statements,^a, ^b by theme.

A.Perceptions that proposed reduced risk statements would make e-cigarettes seem appealing and likely encourage their use
•“It makes it sound a whole lot better…like ‘okay yeah, all right, if it's that much less harmful I might as well check it out.’” (female non-e-cigarette user, age 49) •“…I think a lot of younger people would see this and be like ‘oh well, I don't really smoke but it's not as bad as cigarettes so why not start this?’…And that's why warning labels that commend the product aren't really you know, present…” (male exclusive e-cigarette user, age 19)
B.Perceptions that proposed reduced risk statements don't seem like a warning or are not appropriate as a warning
•“It just seems like a sales pitch for electronic cigarettes to me…” (male non-e-cigarette user, age 29) •“Yeah, it's not um – it doesn't seem like a warning…This is more advisory than warning…” (male non-e-cigarette user, age 39) •“This is like saying, ‘Hey buy me, take me home,’…as a warning I would say, it's looking pretty positive for somebody that wants to move on to an e-cigarette.” (female non-e-cigarette user, age 58) •“I think it's good marketing, but not for a warning label.” (male exclusive e-cigarette user, age 31) •“I don't think they should be legally allowed to put this until you can tell me the health risks.” (female exclusive e-cigarette user, age 33) •“I feel like that's what the companies want to put on their label.” (male dual e-cigarette/cigarette user, age 23) •“…that's like an advertisement kind of…” (male dual e-cigarette/cigarette user, age 20)
C.Perceptions that proposed reduced risk statements were too general, did not warn about any specific risks
•“Yeah well this is just uh like a broad warning I guess, so they're not going in depth about what's in the product…It's more like ‘hey we made this, it's not safe but you can trust us that it's better than cigarettes.’” (male exclusive e-cigarette user, age 23), •“You're gonna tell me it's bad for my health. Why? Am I gonna turn it over and see the woman going [holds hand up to throat in suggestion of a stoma]. You know so like what am I talking about here?” (female exclusive e-cigarette user, age 33) •“…Cause I wanna know what is it gonna do, you know? How is it gonna be harmful to me? …Because we know what cigarettes can do to people, you know, we see the commercials with the lady with the hole in her throat… is e-cigs gonna do this to me or is it just…I donno, you know?” (female dual e-cigarette/cigarette user, age 26) •“Yeah well I mean, no tobacco product is safe…That's like… everybody knows that.” (female non-e-cigarette user, age 49) •“It's too simple, it's saying ‘okay it's harmful but less harmful.’ It’s telling me something but not enough…I mean we kinda knew that.” (female non-e-cigarette user, age 49)
D.Skepticism about use of term “substantially lower risks”
•“My first thought with that was ‘prove it.’ Because we don't know. We don't know exactly how much healthier it is….with the words ‘substantially less harmful,’ it could give certain people the thought ‘oh well this one can't give me cancer so… game on.’ Um, when that's not necessarily accurate….” (female exclusive e-cigarette user, age 33) •“We haven't studied it yet. We don't know if it's substantially lower. I mean I could almost probably guarantee that it's lower but substantially is a very vague term… You can't say that. The FDA's not gonna let you put that on a label because they don't…[know that]…” (male dual e-cigarette/cigarette, age 20) •“And yes, there is like lower risk than cigarettes. But the whole ‘substantially,’ I'm like ‘ehhhhhhh’. It's a little iffy.” (male dual e-cigarette/cigarette, age 19) •“I feel like if you put this on a label then I could sue you in 10 years. Cause you said I can't get lung cancer cause it's substantially lower. Guess what, I got lung cancer.” (female exclusive e-cigarette user, age 33) •“…we don't know…So they can't say that it is [substantially less harmful]…but what happens 15 years from now?” (male exclusive e-cigarette user, age 31) •“There has to be some research behind the… to be able to put substantially down.” (male exclusive e-cigarette user, age 53) •“…that ‘substantially’ could be anybody's level. I mean how are they measuring that? People want to know more, they are going to investigate that because that can mean just about anything.” (male non-e-cigarette user, age 32)

Note: within each section of table, quotes presented are from unique individuals.

^a“WARNING: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes”.

^b“WARNING: This product may be harmful to health, but is substantially less harmful than cigarettes”.