The batteries in e-cigarettes and other vape products can explode if charged or handled improperly, and there have been multiple reports of battery explosions, burns, and shocks. The U.S. Food and Drug Administration hosted a public workshop on Battery Safety Concerns in Electronic Nicotine Delivery Systems (ENDS) in April 2017, and during the workshop, RTI International’s Center for Communication Science showcased best practices for educating consumers about ENDS battery safety and strategies for promoting safe battery behaviors.

1. www.rti.orgRTI International is a registered trademark and a trade name of Research Triangle Institute.
Translating Best Practices in Risk
Communication and Product Labeling to
ENDS Battery Safety
Sima Razi, MPH; Jon Poehlman, PhD; Doug Rupert, MPH
Center for Communication Science, RTI International
1

2. Safe Practices for ENDS Batteries
 Vape within the amp limit
 Store batteries in protective
cases
 Don’t store batteries in cars or
pockets, near flammable items
 Avoid excessive temperatures
(hot or cold)
 Use correct charger
 Replace batteries every 3-6
months
2

3. Challenges to Promoting Safe Battery Behavior
 Scope of unsafe behaviors is unknown
 Consumer awareness of battery risks not fully examined
 Limited understanding of why users adopt unsafe behaviors
 No testing of warning labels
3

4. Applying Best Practices
Part 1: Product Labeling
Best practices in product labeling and risk communication
from prescription drug literature
Part 2: Consumer Education
Best practices in risk communication and behavior change
more broadly
4

5. 5
Product Labeling

6. Methods
6
Literature Review
Date Range 1997 – Present (20 years)
Language English only
Location U.S. only
Keywords (1st tier) Drug n Prescription n Prescription drug n Medication
Keywords (2nd tier) Risks n Risk information n Side effects n Adverse events
n Label n Error
Keywords (3rd tier) Comprehension n Understanding n Perception n
Communication n Education
Publications Found 120
Abstracts Reviewed 25
Final Pubs Reviewed 21

7. Best Practice #1 – Plain Language
Plain language labels boost consumer comprehension
Plain language elements:
 Active voice (not passive)
 Simple sentences
 Concise / No excess words
 Direct language (“you” and other pronouns)
 Bulleted lists or checklists
 Conversational tone (like you speak)
 Examples
7
Source: CommunicateHealth
http://communicatehealth.com

8. Best Practice #1 – Plain Language
Before
Your initial evaluation may take up to one hour. During the evaluation,
your therapist will provide appropriate testing and discuss various
treatment strategies designed to help you reach your optimal state of
health and function. It is advised that you wear comfortable and
loose clothing for this initial evaluation. If your legs or feet are being
examined, gym shorts are recommended.
After
Your first appointment will take about one hour. We will do some
tests and talk about your treatment options. Please wear
comfortable, loose clothes. If we are looking at your legs or feet,
please wear shorts.
8

9. Best Practice #2 – Explicit Instructions
Explicit Instructions
 Tell consumers what to do (rather than what not to do)
 Avoid ambiguity and complexity
Before
Take two pills twice a day prior to meals. Avoid taking on an empty
stomach.
After
Take two pills before breakfast and two pills before dinner. Be sure to
eat soon after taking the pills.
9
7-9 AM 12-2 PM 4-6 PM 9-11 PM
2 pills -- 2 pills --

10. Best Practice #2 – Explicit Instructions
Before
VapeMist XXL is not compatible with other batteries, chargers, or
accessories. Batteries may become unstable after 3-6 months of
continued use.
After
Use the charger that came in the VapeMist XXL box to re-charge your
batteries. Replace the batteries every 3 months. Use only 50 Amp,
2600 mah batteries: Other batteries won’t work.
10
Amp mah
50 2600

11. Best Practice #3 – Low Literacy Structure and Formatting
Low-literacy structure reduces cognitive burden, improves
comprehension
Features of low-literacy structure:
 Headings / Distinct sections
 Ample white space
 Easy to scan
 Large font size
 Bulleted lists or checklists
11

12. Best Practice #3 – Low Literacy Structure and Formatting
12
Version A Version B

13. Best Practice #4 – Icons and Visuals
Icons and visuals can improve comprehension under right
conditions:
 Recognizable / Intuitive
 Compatible with text
 Tested with audience
 Culturally appropriate
13

14. Best Practice #5 – Numeric Risk Information
 Numeric information improves consumer understanding of risks
 Visual depictions of risk are helpful
 No format or type of visual performs best
14
Risk of Explosion
Unsafe Battery
Storage
Risk of Explosion
Safe Battery
Storage

15. Best Practice #6 – Negative Framing
Consumers more attuned to risks when they are framed negatively
 Positive frame = Focus on potential gain
 Negative frame = Focus on potential loss
Positive Frame
If you store your batteries safely, your vape pen will almost always
work when you need it.
Negative Frame
If you don’t store your batteries safely, your vape pen can explode or
catch fire.
15

16. 16
Consumer Education

17. Ideal Consumer Behavior (Deficit Model)
17
Risk
Information
Awareness
Heightened
Risk
Perception
Protective
Behavior

18. Real-Life Consumer Behavior
18
Consumer
Behavior
Self-efficacy
Behavioral
Beliefs
Risk
Perceptions
Perceived
Severity
Perceived
Susceptibility
Benefits
vs. Costs
Cues to
Action
Behavioral
Intentions
Subjective
Norms
Motivation
to Comply
Outcome
Expectations
Previous
Experience
Self
Motivation
Environmental
Factors
Interpersonal
Relationships
Incentives
Perceived
Barriers
Perceived
Facilitators
Stage of
Change
Communication
Channels
Relative
Advantage
Complexity
Trialability
Compatibility
Knowledge
Response Efficacy

19. Risk communication is a necessary but insufficient step for
behavior change
“Although people may need to have more information or to have
information presented more clearly, a focus on knowledge alone
often is insufficient for achieving communication goals.”
- Communicating Science Effectively: A Research Agenda (National Academies
Press, 2017)
19

20. Best Practice #1 – Listen to Your Audience
Campaigns that leverage stakeholder input are more authentic
and believable
 Understand audience needs, perceptions, and behavior
 Involve audience in planning process
 Push audience to develop solutions
20

21. Best Practice #2 – Reframe Messages
What messages will resonate
with your audience?
 Focus on underlying
motivations for behavior
 Safety may not be important
to them
 Be disruptive
21

22. Best Practice #3 – Audience Segmentation
 Divide audience into segments with similar beliefs, behaviors,
motivations, and information needs
 Customize messages for each segment
22
Safety
Convenience
Cost

23. Best Practice #4 – Multiple Channels
Disseminate messages through multiple communication channels
 Identify trusted and credible sources
 Leverage mix of channels:
 Interpersonal
 Broadcast
 Digital
 Point-of-action
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24. Next Steps
 Formative Research. Investigate consumer battery behavior,
including motivations and barriers to change.
 Warning Labels. Create warning labels based on best practices
from other fields and test labels with consumers.
 Consumer Education. Identify audience segments, develop
customized messages, and disseminate through trusted channels.
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25. References
Bailey, S.C., Navaratam, P., Black, H. et al. (2015). Advancing best practices for prescription drug labeling. Annals of Pharmacotherapy, 49(11),
1222-1236.
Blalock, S.J., & Dixon, M. (2016). Effect of quantitative information concerning medication side-effects on risk perception. Presented at the
American College of Rheumatology, Washington, D.C.
Davis, T.C., Federman, A.D., Bass, P.F., et al. (2009). Improving patient understanding of prescription drug label instructions. Journal of
General Internal Medicine, 24(1), 57-62.
Davis, T.C., Wolf, M.S., Bass, P.F., et all. (2006). Low literacy impairs comprehension of prescription drug warning labels, Journal of General
Internal Medicine, 21(8), 847-851.
Katz, M.G., Kripalani, S., & Weiss, B.D. (2006). Use of pictorial aids in medication instructions: A review of the literature. American Journal of
Health Systems Pharmacy, 62(23), 2391-97.
Kebodeaux, C., Peters, G., Kindermann, H. et al. (2016). Patient-perceived content and formatting expectations for prescription container
labeling. Journal of the American Pharmacists Association, 56(3), 242-247.
King, J.P., Davis, T.C., Bailey, S.C., et al. (2011). Developing consumer-centered, nonprescription drug labeling a study in acetaminophen.
American Journal of Preventive Medicine, 40(6), 593-598.
Law, A.V., & Zargarzadeh, A.H. (2010). How do patients read, understand and use prescription labels? An exploratory study examining patient
and pharmacist perspectives. International Journal of Pharmacy Practice, 18(5): 282-289.
Locke, M.R., & Shiyanbola, O.O., & Gripentrog, E. (2014). Improving prescription auxiliary labels to increase patient understanding. Journal of
the American Pharmacists Association, 54(3), 267-274.
Masland, M.C., Kang, S.H., & Ma, Y. (2011). Association between limited English proficiency and understanding prescription labels among five
ethnic groups in California. Ethnicity & Health, 16(2), 125-144.
McCormack, L., Lefebvre, R.C., Bann, C., et al. (2016). Consumer understanding, preferences, and responses to different versions of drug
safety messages in the United States: A randomized controlled trial. Drug Safety, 39(2), 171-184.
Murty, S., & Sansgiry, S.S. (2007). Consumer comprehension of OTC medication labels and the scope for improvement in font size. Journal of
Pharmacy Technology, 23, 207-213.
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26. References
Peters, E., Hart, P.S., & Fraenkel, L. (2011). Informing patients: The influence of numeracy, framing, and format of side effect information on risk
perceptions. Medical Decision Making, 31(3), 432-436.
Shiffman, S., Gerlach, K.K., Sembower, M.A., Rohay, J.M. (2011). Consumer understanding of prescription drug information: An illustration
using an antidepressant medication. Annals of Pharmacotherapy, 45(4), 452-458.
Shrank, W., Avorn, J., Rolon, C., & Shekelle, P. (2007). Effect of content and format of prescription drug labels on readability, understanding,
and medication use: A systematic review. Annals of Pharmacotherapy, 41(5), 783-801.
Vigilante, W.J., & Wogalter, M.S. (1998). Older adults' perceptions of OTC drug labels: Print size, white space and design type. In Kumar, S.,
Advances in Occupational Ergonomics and Safety.
West, S.L., Squiers, L.B., McCormack, L., et al. (2013). Communicating quantitative risks and benefits in promotional prescription drug labeling
or print advertising. Pharmacoepidemiology and Drug Safety, 22(5), 447-458.
Wolf, M.S., Davis, T.C., Bass, P.F., et al., (2010). Improving prescription drug warnings to promote patient comprehension. Archives of Internal
Medicine, 170(1), 50-56.
Wolf, M.S., Davis, T.C., Curtis, L.M., et al. (2011). Effect of standardized, patient-centered label instructions to improve comprehension of
prescription drug use. Medical Care, 49(1), 96-100.
Wolf, M.S., Davis, T.C., Shrank, W., et al. (2007). To err is human: Patient misinterpretations of prescription drug label instructions. Patient
Education and Counseling, 67(3), 293-300.
Wolf, M.S., Davis, T.C., Tilson, H.H., et al. (2006). Misunderstanding of prescription drug warning labels among patients with low literacy.
American Journal of Health System Pharmacy, 63(11), 1048-1055.
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27. Contact Information
27
Doug Rupert, MPH
Center for Communication Science
RTI International
PHONE: (919) 541-6495
EMAIL: drupert@rti.org
TWITTER: @DougRupertMPH