TMU
Owner
Tarbiat Modares University (TMU) is the owner of HEHP.
0.8
Cite Score
Volume 13, Issue 3 (2025)
Health Educ Health Promot 2025, 13(3): 521-528 |
Back to browse issues page
Article Type:
History
Received: 2025/07/15 | Accepted: 2025/08/26 | Published: 2025/08/30
Received: 2025/07/15 | Accepted: 2025/08/26 | Published: 2025/08/30
How to cite this article
Salawati T, Noh C, Ahmad M. Adolescents' Perception of Message Appeals in E-Cigarette Prevention. Health Educ Health Promot 2025; 13 (3) :521-528
URL: http://hehp.modares.ac.ir/article-4-82705-en.html
URL: http://hehp.modares.ac.ir/article-4-82705-en.html
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Rights and permissions
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
1- Center for Fundamental and Continuing Education, University of Malaysia Terengganu, Terengganu, Malaysia
2- School of Multimedia Technology & Communication, University of Northern Malaysia, Sintok, Malaysia
2- School of Multimedia Technology & Communication, University of Northern Malaysia, Sintok, Malaysia
Keywords:
| Abstract (HTML) (536 Views)
Full-Text: (58 Views)
Introduction
An electronic cigarette, or e-cigarette, is a device that uses a lithium battery to produce aerosols (or vapors) through heating. Unlike combustible cigarettes, these devices do not produce smoke because they do not involve combustion [1]. This difference often leads to e-cigarettes being considered healthier and safer compared to regular cigarettes [2, 3].
As awareness of safer alternatives increases, e-cigarettes are becoming increasingly popular among young people, particularly due to aggressive promotion on social media and peer influence [4-7]. Their popularity is evident in the rise of e-cigarette users in Indonesia, which jumped from 0.3% in 2011 to 3% in 2021 [8]. Among adolescents, e-cigarette use is also relatively high. A study of high school and college students showed that 36.2% had smoked, and 65.2% had tried e-cigarettes [9].
Although e-cigarettes are gaining popularity as an alternative considered safer and healthier than traditional cigarettes, several studies indicate that their use can actually increase the risk of adolescents experiencing nicotine addiction and potentially becoming smokers in the future [10, 11]. It is also possible for e-cigarette users to become dual users of combustible cigarettes and to engage in drug use [12]. Additionally, e-cigarettes have been shown to harm adolescent health. Some studies indicate that their use can cause respiratory problems and negatively affect mental health and sleep quality [13, 14]. E-cigarette use can also increase impulsive and aggressive behavior and cause disturbances in adolescents’ memory and attention [15].
E-cigarette use among adolescents is one of the serious global public health problems [16, 17]. Despite the associated risks, adolescents continue to choose to use them. In Indonesia, the lack of strict regulations regarding e-cigarettes is one of the contributing factors [4, 18]. Additionally, predisposing factors related to e-cigarettes also play a role [19, 20]. Recent research in Indonesia shows that adolescents tend to perceive e-cigarettes as less harmful products than combustible cigarettes and believe that these devices can help them quit smoking, despite scientific evidence to the contrary [9]. These findings align with previous research indicating that many adolescents are unaware of the potential risks, including addiction and other health problems [7]. Therefore, education for adolescents is a crucial step in preventing the use of e-cigarettes.
Communicating health issues to adolescents poses a challenge. They are in a developmental phase toward adulthood, exhibit high curiosity, tend to try new things and take risks, and are heavily influenced by their peers [21, 22]. This characteristic makes adolescents the primary target for campaigns aimed at preventing e-cigarette use [3].
Much research has been conducted on adolescents’ perceptions of e-cigarette prevention messages in Western countries. However, most studies have employed quantitative and mixed methods, with samples drawn from those countries [23-26]. Several studies in different countries have also explored the various appeals of messages related to combustible cigarettes and e-cigarettes [17, 27, 28].
Although various messaging approaches, such as emotional, rational, humorous, and fear-based, have been widely applied in health campaigns, understanding how adolescents respond to different health messages aimed at preventing e-cigarette use remains limited. This is especially true from the perspective of adolescents’ personal experiences, both as users and non-users of e-cigarettes in Indonesia. There are only a few qualitative studies that focus on Indonesian adolescents and explore their perceptions of e-cigarette prevention messages. Research in Indonesia has primarily highlighted the appeal of messages related to combustible cigarettes [29].
This research is important because communicating health issues to adolescents is challenging. In the developmental phase toward adulthood, adolescents tend to exhibit high curiosity, have the potential to try new things and take risks, and are heavily influenced by their peers, making them a prime target for campaigns aimed at preventing e-cigarette use. This research sought to provide a new perspective on more effective communication strategies to reach adolescents. The study aimed to explore the perceptions of adolescent e-cigarette users and non-users regarding different types of message appeals in e-cigarette prevention campaigns. With the increasing prevalence of e-cigarette use among adolescents, a deep understanding of their perceptions of health messages has become crucial. Therefore, this research is expected to provide valuable insights that can be used to design more effective and relevant prevention campaigns, ultimately reducing the risk of addiction and adverse health impacts among the younger generation.
Participants and Methods
This qualitative study is part of a broader qualitative study on adolescents’ perceptions of message appeals regarding e-cigarette use prevention conducted in 2024. A qualitative approach was employed to explore participants’ views in depth.
Data were collected through focus group discussions (FGDs) with high school students in Semarang, Indonesia. Fifty-one male students were recruited from four high schools (two public and two private) located in two sub-districts with the highest number of vape stores. Teachers and school staff identified and invited students based on the inclusion criteria: adolescent males aged 16-18, enrolled in the selected schools, and identified as e-cigarette users or non-users. FGD participants were grouped by vaping status to ensure homogeneity and encourage open discussion. A total of 10 FGDs were conducted, consisting of five FGDs with e-cigarette users (vape group) and five FGDs with non-users (non-vape Group). Homogeneous grouping is recommended to reduce discomfort, minimize bias, and allow participants to share their experiences more freely [30]. Each FGD consisted of 4-6 participants, an optimal size to encourage group interaction while allowing all members to contribute [28]. The sample size was determined through data saturation, defined as the point at which no new themes emerge from the data [31]. Saturation was observed after the eighth FGD. Additional FGDs were conducted with one group each from the Vape and Non-Vape groups to ensure no new themes emerged. This approach is consistent with previous methodological recommendations, indicating that 4-8 FGDs per subgroup are generally sufficient to reach the saturation point in relatively homogeneous samples [31].
Every FGD was audio recorded and transcribed verbatim in Indonesian. The first author used a deductive thematic approach to code the transcripts. NVIVO software version 11 was employed to support the deductive thematic analysis of the data, guided by Braun & Clarke [32]. The second and third authors served as academic advisors with experience in qualitative research and health communication. All authors regularly reviewed and discussed the coding framework and interpretations during supervision meetings to ensure rigor and reflexivity.
Findings
Fifty-one male students aged 16–18 years from Semarang, Indonesia were studied (Table 1).
Table 1. Characteristics of the participants
![src=./files/hehp/images/HTML_Publish/82705/1.png]()
Sixteen main codes were generated from the FGDs, with eight for each group. These codes were organized into sixteen categories (eight for each group). Each code represents a meaningful statement related to adolescents’ perceptions of message appeal. As a result, a single code was treated as a single category because participants’ responses reflected different and non-overlapping meanings to preserve the uniqueness and richness of each response. Next, all categories were identical to the main codes. Finally, all categories were organized into ten common themes (five for each group; Table 2).
Table 2. Themes, categories, and codes among the non-vape group
![src=./files/hehp/images/HTML_Publish/82705/2.png]()
Five themes were also obtained for the vape group (Table 3).
Table 3. Themes, categories, and codes among the vape group
![src=./files/hehp/images/HTML_Publish/82705/3.png]()
Emotional appeal with the most resonance
Within the theme of emotional appeal, two categories emerged in both the vape and non-vape groups. In the vape group, the identified categories were the message evokes emotion and the message does not evoke emotion. Furthermore, the non-vape group revealed two categories, including the message evokes emotion and displays personal experience.
An electronic cigarette, or e-cigarette, is a device that uses a lithium battery to produce aerosols (or vapors) through heating. Unlike combustible cigarettes, these devices do not produce smoke because they do not involve combustion [1]. This difference often leads to e-cigarettes being considered healthier and safer compared to regular cigarettes [2, 3].
As awareness of safer alternatives increases, e-cigarettes are becoming increasingly popular among young people, particularly due to aggressive promotion on social media and peer influence [4-7]. Their popularity is evident in the rise of e-cigarette users in Indonesia, which jumped from 0.3% in 2011 to 3% in 2021 [8]. Among adolescents, e-cigarette use is also relatively high. A study of high school and college students showed that 36.2% had smoked, and 65.2% had tried e-cigarettes [9].
Although e-cigarettes are gaining popularity as an alternative considered safer and healthier than traditional cigarettes, several studies indicate that their use can actually increase the risk of adolescents experiencing nicotine addiction and potentially becoming smokers in the future [10, 11]. It is also possible for e-cigarette users to become dual users of combustible cigarettes and to engage in drug use [12]. Additionally, e-cigarettes have been shown to harm adolescent health. Some studies indicate that their use can cause respiratory problems and negatively affect mental health and sleep quality [13, 14]. E-cigarette use can also increase impulsive and aggressive behavior and cause disturbances in adolescents’ memory and attention [15].
E-cigarette use among adolescents is one of the serious global public health problems [16, 17]. Despite the associated risks, adolescents continue to choose to use them. In Indonesia, the lack of strict regulations regarding e-cigarettes is one of the contributing factors [4, 18]. Additionally, predisposing factors related to e-cigarettes also play a role [19, 20]. Recent research in Indonesia shows that adolescents tend to perceive e-cigarettes as less harmful products than combustible cigarettes and believe that these devices can help them quit smoking, despite scientific evidence to the contrary [9]. These findings align with previous research indicating that many adolescents are unaware of the potential risks, including addiction and other health problems [7]. Therefore, education for adolescents is a crucial step in preventing the use of e-cigarettes.
Communicating health issues to adolescents poses a challenge. They are in a developmental phase toward adulthood, exhibit high curiosity, tend to try new things and take risks, and are heavily influenced by their peers [21, 22]. This characteristic makes adolescents the primary target for campaigns aimed at preventing e-cigarette use [3].
Much research has been conducted on adolescents’ perceptions of e-cigarette prevention messages in Western countries. However, most studies have employed quantitative and mixed methods, with samples drawn from those countries [23-26]. Several studies in different countries have also explored the various appeals of messages related to combustible cigarettes and e-cigarettes [17, 27, 28].
Although various messaging approaches, such as emotional, rational, humorous, and fear-based, have been widely applied in health campaigns, understanding how adolescents respond to different health messages aimed at preventing e-cigarette use remains limited. This is especially true from the perspective of adolescents’ personal experiences, both as users and non-users of e-cigarettes in Indonesia. There are only a few qualitative studies that focus on Indonesian adolescents and explore their perceptions of e-cigarette prevention messages. Research in Indonesia has primarily highlighted the appeal of messages related to combustible cigarettes [29].
This research is important because communicating health issues to adolescents is challenging. In the developmental phase toward adulthood, adolescents tend to exhibit high curiosity, have the potential to try new things and take risks, and are heavily influenced by their peers, making them a prime target for campaigns aimed at preventing e-cigarette use. This research sought to provide a new perspective on more effective communication strategies to reach adolescents. The study aimed to explore the perceptions of adolescent e-cigarette users and non-users regarding different types of message appeals in e-cigarette prevention campaigns. With the increasing prevalence of e-cigarette use among adolescents, a deep understanding of their perceptions of health messages has become crucial. Therefore, this research is expected to provide valuable insights that can be used to design more effective and relevant prevention campaigns, ultimately reducing the risk of addiction and adverse health impacts among the younger generation.
Participants and Methods
This qualitative study is part of a broader qualitative study on adolescents’ perceptions of message appeals regarding e-cigarette use prevention conducted in 2024. A qualitative approach was employed to explore participants’ views in depth.
Data were collected through focus group discussions (FGDs) with high school students in Semarang, Indonesia. Fifty-one male students were recruited from four high schools (two public and two private) located in two sub-districts with the highest number of vape stores. Teachers and school staff identified and invited students based on the inclusion criteria: adolescent males aged 16-18, enrolled in the selected schools, and identified as e-cigarette users or non-users. FGD participants were grouped by vaping status to ensure homogeneity and encourage open discussion. A total of 10 FGDs were conducted, consisting of five FGDs with e-cigarette users (vape group) and five FGDs with non-users (non-vape Group). Homogeneous grouping is recommended to reduce discomfort, minimize bias, and allow participants to share their experiences more freely [30]. Each FGD consisted of 4-6 participants, an optimal size to encourage group interaction while allowing all members to contribute [28]. The sample size was determined through data saturation, defined as the point at which no new themes emerge from the data [31]. Saturation was observed after the eighth FGD. Additional FGDs were conducted with one group each from the Vape and Non-Vape groups to ensure no new themes emerged. This approach is consistent with previous methodological recommendations, indicating that 4-8 FGDs per subgroup are generally sufficient to reach the saturation point in relatively homogeneous samples [31].
Every FGD was audio recorded and transcribed verbatim in Indonesian. The first author used a deductive thematic approach to code the transcripts. NVIVO software version 11 was employed to support the deductive thematic analysis of the data, guided by Braun & Clarke [32]. The second and third authors served as academic advisors with experience in qualitative research and health communication. All authors regularly reviewed and discussed the coding framework and interpretations during supervision meetings to ensure rigor and reflexivity.
Findings
Fifty-one male students aged 16–18 years from Semarang, Indonesia were studied (Table 1).
Table 1. Characteristics of the participants
Sixteen main codes were generated from the FGDs, with eight for each group. These codes were organized into sixteen categories (eight for each group). Each code represents a meaningful statement related to adolescents’ perceptions of message appeal. As a result, a single code was treated as a single category because participants’ responses reflected different and non-overlapping meanings to preserve the uniqueness and richness of each response. Next, all categories were identical to the main codes. Finally, all categories were organized into ten common themes (five for each group; Table 2).
Table 2. Themes, categories, and codes among the non-vape group
Five themes were also obtained for the vape group (Table 3).
Table 3. Themes, categories, and codes among the vape group
Emotional appeal with the most resonance
Within the theme of emotional appeal, two categories emerged in both the vape and non-vape groups. In the vape group, the identified categories were the message evokes emotion and the message does not evoke emotion. Furthermore, the non-vape group revealed two categories, including the message evokes emotion and displays personal experience.
- The message evokes emotion
Participants in the FGDs from both groups, vape and non-vape, expressed a preference for messages with emotional appeal for similar reasons. According to them, messages with emotional appeals have the potential to evoke feelings more effectively than those with rational appeals. Below are excerpts from participants’ statements in both groups:
Emotional messages, mum, because emotions are heart-to-heart, touching feelings. FGD SG2 vape group
Messages that touch on emotions, such as smoking can cause others to get cancer, might make young people think about their future; If they smoke, it can jeopardize their health and family in the future. FGD SG2 non-vape group
Emotional messages, mum, because emotions are heart-to-heart, touching feelings. FGD SG2 vape group
Messages that touch on emotions, such as smoking can cause others to get cancer, might make young people think about their future; If they smoke, it can jeopardize their health and family in the future. FGD SG2 non-vape group
- The message displays personal experience
Participants from the non-vape group indicated that emotional messages would have a greater impact if they included testimonials from former smokers or vape users. These testimonials were particularly evocative, as they conveyed the pain and struggle associated with past smoking behaviors. This demonstrates that emotional appeals can be a powerful tool in promoting cessation and raising awareness about the risks associated with vaping and smoking. Through the experiences of others who have suffered from the consequences of their past behaviors, adolescents receiving these messages may reconsider their decision to try using e-cigarettes, in order to avoid burdening their future. Below are excerpts from participants’ statements in both groups:
“Messages from someone who is really sick, dying, about to die.” FGD SG1 non-vape group
The experience of the sick can impact others. FGD SG2 non-vape group
“Messages from someone who is really sick, dying, about to die.” FGD SG1 non-vape group
The experience of the sick can impact others. FGD SG2 non-vape group
- The message does not evoke emotion
Although most participants preferred messages with emotional appeal, one participant in the FGD of the vape group did not share this sentiment. He expressed a preference for messages in the form of interactive chats, such as podcasts. The following is an excerpt from the participant’s statement:
I prefer podcasts; They are more fun. The conversation is more interesting, and I want to listen. I do not like messages that arouse emotions because they make me sleepy. FGD SA vape group
Rational appeal: Trusted but uninspiring
Within the theme of rational appeal, two categories emerged in both the vape and non-vape groups. In the vape group, the identified categories were: 1) informative but not influential, and 2) less interesting message. In the non-vape group, the categories were: 1) less interesting message, and 2) a rational message must be combined with evidence.
I prefer podcasts; They are more fun. The conversation is more interesting, and I want to listen. I do not like messages that arouse emotions because they make me sleepy. FGD SA vape group
Rational appeal: Trusted but uninspiring
Within the theme of rational appeal, two categories emerged in both the vape and non-vape groups. In the vape group, the identified categories were: 1) informative but not influential, and 2) less interesting message. In the non-vape group, the categories were: 1) less interesting message, and 2) a rational message must be combined with evidence.
- Less interesting message
The majority of participants from both the vape and non-vape groups expressed a dislike for rational messages. According to them, messages that only present data from research results tend to be boring and make one feel sleepy. Below are excerpts from participants’ statements in both groups:
“Information that contains research data will be ignored. Sometimes when there is health education, I do not want to listen to it; It is boring.” FGD SN non-vape group
“A rational message makes me sleepy, mum.” FGD SN vape group
“Information that contains research data will be ignored. Sometimes when there is health education, I do not want to listen to it; It is boring.” FGD SN non-vape group
“A rational message makes me sleepy, mum.” FGD SN vape group
- Informative but not influenced
A participant from the vape group noted that although the data presented was important, the information could not influence behavior change. The following is the participant’s statement:
“My parents sent me a message from Facebook about the ban on using vapes. However, the message contained data. I looked at it for a while. Did it affect me? Yes, it did, but maybe in the future, I will change when I am 30 years old. I do not want to change now.” FGD SA vape group
“My parents sent me a message from Facebook about the ban on using vapes. However, the message contained data. I looked at it for a while. Did it affect me? Yes, it did, but maybe in the future, I will change when I am 30 years old. I do not want to change now.” FGD SA vape group
- A rational message must be combined with evidence
Participants from the non-vape group stated that even though they do not support smoking, messages about the dangers of smoking that only present research data are not interesting to them. They believe that the presentation of this data needs to be combined with objective evidence, such as testimonials from former smokers who have become ill. The following are excerpts from participants’ statements:
Not only is data needed, but we must also have evidence from the person (user testimony). FGD SN non-vape group
Humor appeals: A double-edged sword
In the theme of humor appeal, the same two categories emerged in both the vape and non-vape groups. These categories were messages that are not taken seriously and Doctor Tirta’s messages.
Both the vape and non-vape groups had a variety of responses to health education messages presented through humor. Some participants from both groups enjoyed humorous messages, while others did not.
Not only is data needed, but we must also have evidence from the person (user testimony). FGD SN non-vape group
Humor appeals: A double-edged sword
In the theme of humor appeal, the same two categories emerged in both the vape and non-vape groups. These categories were messages that are not taken seriously and Doctor Tirta’s messages.
Both the vape and non-vape groups had a variety of responses to health education messages presented through humor. Some participants from both groups enjoyed humorous messages, while others did not.
- Messages that are not taken seriously
Participants from the vape group expressed a dislike for humor-themed health education messages, as they were concerned that the message might not be properly understood by the target audience and could be perceived merely as a joke. The following is an excerpt from a participant’s statement:
It is better if the doctor explains it. I am afraid the humorous message is just a joke. FGD SA vape group
Humorous messages are not taken seriously; They are just jokes. FGD SG2 vape group
In the non-vape group, a few participants mentioned that not everyone can receive health education messages with humor, as they consider the message to be less serious. According to these participants, messages with humorous themes must be well-designed to be effectively understood, especially in terms of word choice.
Humorous messages may not be taken seriously, so word choice needs to be considered to be accepted. FGD SG1 non-vape group
It is better if the doctor explains it. I am afraid the humorous message is just a joke. FGD SA vape group
Humorous messages are not taken seriously; They are just jokes. FGD SG2 vape group
In the non-vape group, a few participants mentioned that not everyone can receive health education messages with humor, as they consider the message to be less serious. According to these participants, messages with humorous themes must be well-designed to be effectively understood, especially in terms of word choice.
Humorous messages may not be taken seriously, so word choice needs to be considered to be accepted. FGD SG1 non-vape group
- Doctor Tirta’s message
Participants from the vape group who received humorous health education messages perceived these messages as being delivered in a light-hearted, less serious, and ‘tongue-in-cheek’ manner. They understood the term “humor” not as a message containing jokes or comedy. The following are excerpts from participants’ statements:
We see it not in the comedy, but he funnily delivers the message, so we do not expect that there will be education. FGD SA vape group
The participants provided an example of education delivered by Dr. Tirta, a doctor in Indonesia who is an influencer on social media. Dr. Tirta’s delivery is light-hearted and sometimes incorporates humorous, rude, and sarcastic terms typical of young people, while still conveying meaningful content to the target audience who watches it. The following is an excerpt from a participant’s statement:
We see it not in the comedy, but he funnily delivers the message, so we do not expect that there will be education. FGD SA vape group
The participants provided an example of education delivered by Dr. Tirta, a doctor in Indonesia who is an influencer on social media. Dr. Tirta’s delivery is light-hearted and sometimes incorporates humorous, rude, and sarcastic terms typical of young people, while still conveying meaningful content to the target audience who watches it. The following is an excerpt from a participant’s statement: