Does media channel matter? exploring the disparities of online and offline anti-tobacco messages and their impacts on e-cigarette harm perception and use

Abstract Background Prior studies emphasize the impact of anti-tobacco campaigns on tobacco prevention; there needs to be more understanding of the variations across different media channels. This study examines the associations between cigarette use, harm perception of e-cigarettes, and e-cigarette use, and explores how exposure to offline and online anti-tobacco messages is related to these associations. Methods Utilizing data from the HINTS 6 (N = 5,268), this study employs mediation analysis to explore two primary mediating mechanisms: [1] the mediating role of offline and online anti-tobacco message exposure and [2] the sequential mediating effect involving offline and online anti-tobacco messages and harm perception of e-cigarettes. Results Our findings revealed that cigarette use was positively associated with e-cigarette use (B=0.260, β = 0.256, p<.001). While offline anti-tobacco messages exposure showed no significant mediating effect (B=0.002, β = 0.002, [-0.001, 0.005]) between cigarette use and e-cigarette use, and it became a substantial and negative mediator when introducing harm perception of e-cigarettes (B=-0.001, β=-0.001, [-0.002, − 0.001]). Conversely, online anti-tobacco messages exposure positively mediated the link between cigarette use and e-cigarette use (B=0.004, β = 0.004, [0.001, 0.007]), but was not significantly associated with harm perception of e-cigarettes (B=-0.022, β=-0.007, p>.05). Conclusions This study reaffirms the prevalence of dual use and reveals the disparities between online and offline anti-tobacco messages exposure. The distinctive roles played by online and offline media channels and the pivotal influence of harm perception of e-cigarettes on e-cigarette use carry significant implications for public health and tobacco control.