Does warning language impact perceptions? Results from an exploratory experiment comparing English, Spanish, and Dual language E-Cigarette warnings among Spanish speakers in the US

Tobacco warnings written in English may not be as effective among Spanish speakers. We explored whether warning perceptions differ based on exposure to English, Spanish, or dual language warnings. From November 2, 2020 - December 29, 2020, we conducted an online experiment with a convenience sample of 776 Spanish-speaking adults in the US, randomizing each to one of three warning conditions: English only, Spanish only, or dual (both English and Spanish). Multivariable linear and logistic regressions examined associations between warning exposure and perceptions. Of 776 participants, 291 preferred to read in Spanish, 55.5% were male, 62.5% were Hispanic, and 48.1% reported past 30-day e-cigarette use. Negative affect (beta = 1.79, beta = 0.007), perceived message effectiveness (beta = 0.84, beta = 0.007), and psychological reactance (beta = 1.55, p < 0.001) were greater among participants exposed to the dual language warnings compared to those exposed to the English warnings. Results of this exploratory study suggest that e-cigarette warning statements presented in both English and Spanish may result in stronger reactions among Spanish speakers. With increasing prevalence of Spanish speakers in the US, future work should continue to examine this topic.