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Boynton MH, Agans RP, Michael Bowling J, Brewer NT, Sutfin EL, Goldstein AO, Noar SM, Ribisl KM. Erratum to: understanding how perceptions of tobacco constituents and the FDA relate to effective and credible tobacco risk messaging: a national phone survey of U.S. adults, 2014-2015. BMC Public Health 2017; 17:726. [PMID: 28931386 PMCID: PMC5607607 DOI: 10.1186/s12889-017-4760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022] Open
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Viera AJ, Tuttle L, Olsson E, Gras-Najjar J, Gizlice Z, Hales D, Linnan L, Lin FC, Noar SM, Ammerman A. Effects of physical activity calorie expenditure (PACE) labeling: study design and baseline sample characteristics. BMC Public Health 2017; 17:702. [PMID: 28899366 PMCID: PMC5596490 DOI: 10.1186/s12889-017-4710-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
Background Obesity and physical inactivity are responsible for more than 365,000 deaths per year and contribute substantially to rising healthcare costs in the US, making clear the need for effective public health interventions. Calorie labeling on menus has been implemented to guide consumer ordering behaviors, but effects on calories purchased has been minimal. Methods In this project, we tested the effect of physical activity calorie expenditure (PACE) food labels on actual point-of-decision food purchasing behavior as well as physical activity. Using a two-group interrupted time series cohort study design in three worksite cafeterias, one cafeteria was assigned to the intervention condition, and the other two served as controls. Calories from food purchased in the cafeteria were assessed by photographs of meals (accompanied by notes made on-site) using a standardized calorie database and portion size-estimation protocol. Primary outcomes will be average calories purchased and minutes of moderate to vigorous physical activity (MVPA) by individuals in the cohorts. We will compare pre-post changes in study outcomes between study groups using piecewise generalized linear mixed model regressions (segmented regressions) with a single change point in our interrupted time-series study. The results of this project will provide evidence of the effectiveness of worksite cafeteria menu labeling, which could potentially inform policy intervention approaches. Discussion Labels that convey information in a more readily understandable manner may be more effective at motivating behavior change. Strengths of this study include its cohort design and its robust data capture methods using food photographs and accelerometry.
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Francis DB, Noar SM, Kowitt SD, Jarman KL, Goldstein AO. Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults. Prev Med 2017; 99:94-98. [PMID: 28189803 PMCID: PMC5687516 DOI: 10.1016/j.ypmed.2017.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/03/2017] [Accepted: 01/31/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact? METHODS Data were collected through a nationally representative phone survey of US adults (N=5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability. RESULTS About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source. CONCLUSION Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns.
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Noar SM, Francis DB, Bridges C, Sontag JM, Brewer NT, Ribisl KM. Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review. JOURNALISM & MASS COMMUNICATION QUARTERLY 2017; 94:416-442. [PMID: 29975497 PMCID: PMC5483339 DOI: 10.1177/1077699016674188] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.
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Sontag JM, Noar SM. Assessing the Potential Effectiveness of Pictorial Messages to Deter Young Women from Indoor Tanning: An Experimental Study. JOURNAL OF HEALTH COMMUNICATION 2017; 22:294-303. [PMID: 28266905 DOI: 10.1080/10810730.2017.1281361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The recent Surgeon General's call-to-action to prevent skin cancer indicates an urgent need for research on messages to deter young women from tanning indoors. Answering this call, the current study assessed differences in the potential effectiveness of pictorial indoor tanning messages. We randomly assigned undergraduate female participants (N = 568) to one of three message conditions visually depicting health effects, appearance damage, or immediate risks, or to a text-only control. All participants viewed three messages within their condition and answered questions after message exposure. Factorial ANOVAs indicated that compared to the text-only condition, pictorial messages produced greater negative emotional reactions and were perceived as more effective than text-only messages. Text-only messages, however, were significantly more believable than pictorial messages. We observed several differences among the pictorial conditions and among the messages within the pictorial conditions. We conclude that messages discouraging indoor tanning should use pictorial messages illustrating the negative health and appearance damaging effects of indoor tanning, focusing on particular health and appearance consequences. Additional research is needed to guide the selection of images that are believable and will most discourage indoor tanning behavior.
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Kowitt SD, Noar SM, Ranney LM, Goldstein AO. Public attitudes toward larger cigarette pack warnings: Results from a nationally representative U.S. sample. PLoS One 2017; 12:e0171496. [PMID: 28253257 PMCID: PMC5333827 DOI: 10.1371/journal.pone.0171496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/20/2017] [Indexed: 11/18/2022] Open
Abstract
A large body of evidence supports the effectiveness of larger health warnings on cigarette packages. However, there is limited research examining attitudes toward such warning labels, which has potential implications for implementation of larger warning labels. The purpose of the current study was to examine attitudes toward larger warning sizes on cigarette packages and examine variables associated with more favorable attitudes. In a nationally representative survey of U.S. adults (N = 5,014), participants were randomized to different warning size conditions, assessing attitude toward "a health warning that covered (25, 50, 75) % of a cigarette pack." SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Across experimental groups, nearly three-quarters (72%) of adults had attitudes supportive of larger warning labels on cigarette packs. Among the full sample and smokers only (N = 1,511), most adults had favorable attitudes toward labels that covered 25% (78.2% and 75.2%, respectively), 50% (70% and 58.4%, respectively), and 75% (67.9% and 61%, respectively) of a cigarette pack. Young adults, females, racial/ethnic minorities, and non-smokers were more likely to have favorable attitudes toward larger warning sizes. Among smokers only, females and those with higher quit intentions held more favorable attitudes toward larger warning sizes. Widespread support exists for larger warning labels on cigarette packages among U.S. adults, including among smokers. Our findings support the implementation of larger health warnings on cigarette packs in the U.S. as required by the 2009 Tobacco Control Act.
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Luecking CT, Noar SM, Dooley RM, Gizlice Z, Ammerman AS. Impact of Weight of the Nation Community Screenings on Obesity-Related Beliefs. Am J Prev Med 2017; 52:S315-S321. [PMID: 28215388 PMCID: PMC5505775 DOI: 10.1016/j.amepre.2016.08.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 08/18/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION HBO's Weight of the Nation was a collaborative effort among several national organizations to raise awareness about the complexity of the obesity epidemic and promote action through media and community forums. The primary aim of this study was to assess the short-term effects of Weight of the Nation community screenings on obesity-related beliefs, intentions, and policy support. METHODS Five Prevention Research Centers across the U.S. administered surveys at nine Weight of the Nation community screenings between September 2012 and May 2013. Adults aged ≥18 years who completed pre-post surveys were included. The survey assessed demographic information, perceptions of the documentary, efficacy to take action and influence policies that affect obesity, intentions to take actions to support a healthy weight, and positions on policy changes that impact food systems. Data were analyzed in 2015. RESULTS A convenience sample of 442 individuals completed surveys. The sample was mostly health workers, female, college educated, aged 25-44 years, and racially and ethnically diverse. Significant increases (p<0.001) were observed for perceived self- and collective efficacy that individuals and communities can influence policies and environmental factors that affect obesity, intentions to take actions that contribute to a healthy weight, and support for policies that change the food system. CONCLUSIONS A broad, nationwide effort, such as Weight of the Nation, that combines media with opportunities to bring community members together for discussion, may play a role in influencing beliefs, intentions, and policy support regarding obesity prevention.
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Hall MG, Sheeran P, Noar SM, Ribisl KM, Boynton MH, Brewer NT. A brief measure of reactance to health warnings. J Behav Med 2017; 40:520-529. [PMID: 28120228 DOI: 10.1007/s10865-016-9821-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/26/2016] [Indexed: 11/25/2022]
Abstract
Reactance to persuasive messages involves perceived threat to freedom, anger, and counterarguing that may undermine the impact of health warnings. To understand reactance's effects, reliable and valid assessment is critical. We sought to develop and validate a brief Reactance to Health Warnings Scale (RHWS). Two independent samples of US adults completed the brief RHWS in studies that presented warnings on cigarette packs that smokers carried with them for 4 weeks (Study 1; n = 2149) or as digital images of cigarette packs that participants viewed briefly (Study 2; n = 1413). The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance and exposure to pictorial warnings, supporting its convergent validity. With respect to predictive validity, the Brief RHWS predicted perceived message effectiveness, quit intentions, avoidance of the warnings, and number of cigarettes smoked per day. The Brief RHWS can serve as an efficient adjunct to the development of persuasive messages.
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Huang LL, Lazard AJ, Pepper JK, Noar SM, Ranney LM, Goldstein AO. Impact of The Real Cost Campaign on Adolescents' Recall, Attitudes, and Risk Perceptions about Tobacco Use: A National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010042. [PMID: 28054993 PMCID: PMC5295293 DOI: 10.3390/ijerph14010042] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 11/30/2016] [Indexed: 01/19/2023]
Abstract
The Food and Drug Administration’s (FDA) The Real Cost campaign advertisements (ads) have targeted U.S. youth with messages designed to prevent and reduce tobacco use. This study examined exposure to The Real Cost campaign, including ad and slogan recall, and associations with attitudes and risk perceptions among U.S. adolescents. We analyzed data from a nationally representative sample of adolescents aged 13 to 17 years (n = 1125) surveyed by phone from October 2014 to June 2015. We assessed aided recall of and attitudes toward four campaign ads and the one slogan. Logistic regression models assessed whether aided recall of The Real Cost ads or slogan was associated with perceived likelihood of serious health consequences of cigarette smoking. Most (88%) adolescents reported seeing or hearing at least one of four ads for The Real Cost, and 54% recalled The Real Cost slogan. The majority of adolescents reported more negative attitudes toward tobacco products after seeing or hearing the ads. Recall of any The Real Cost ad was significantly associated with greater perceptions of serious health consequences of cigarette smoking (Adjusted Odd Ratios (AOR) = 5.58, 95% Confidence Interval (CI) = 1.20–25.90). The FDA’s The Real Cost campaign has achieved very high reach and is associated with more negative attitudes toward tobacco products and greater risk perceptions of cigarette smoking among U.S. adolescents.
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Peebles K, Hall MG, Pepper JK, Byron MJ, Noar SM, Brewer NT. Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs. J Adolesc Health 2016; 59:635-641. [PMID: 27646499 PMCID: PMC5341376 DOI: 10.1016/j.jadohealth.2016.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/02/2016] [Accepted: 07/02/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE Pictorial cigarette pack warnings are a promising policy solution to increase smoking cessation among adults. However, little is known regarding adolescents' responses to pictorial warnings, particularly in real-world settings. METHODS Participants were 112 adolescent children, ages 13-17, whose parents received either text-only warnings on the side of their cigarette packs or pictorial warnings on the top half of the front and back of their cigarette packs for 4 weeks as part of a trial. We measured adolescents' recall and recognition of these warnings, negative emotional reactions to the warnings, perceived effectiveness of the warnings, social interactions about the warnings, and smoking risk beliefs. RESULTS Adolescents accurately recalled pictorial warnings more often than text-only warnings (82% vs. 19%, p < .001). Recognition of warnings was also higher for pictorial than text-only warnings (82% vs. 34%, p < .001). Pictorial warnings drew greater attention (p < .001), elicited greater negative emotional reactions (p < .05), and sparked more social interactions (p < .01) than text-only warnings. CONCLUSIONS Pictorial warnings on cigarette packs may have important effects on adolescent children of smokers. Future research should further investigate the impact of such messages on adolescents' susceptibility to smoking initiation and interest in quitting smoking, particularly as the United States and other countries work to implement pictorial warning regulations.
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Francis DB, Noar SM, Widman L, Willoughby JF, Sanchez DM, Garrett KP. Perceptions of a campus-wide condom distribution programme: An exploratory study. HEALTH EDUCATION JOURNAL 2016; 75:998-1011. [PMID: 27917002 PMCID: PMC5130150 DOI: 10.1177/0017896916648994] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses. DESIGN Quantitative, cross-sectional study. SETTING Large public university in the Southeastern USA. METHOD Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers. RESULTS Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2months that the dispensers were available, 33% had used them. More than one-third of students (37%) - and 53% of sexually active students - indicated intentions to use the dispensers in the next 6months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students' intentions to use the dispensers (p<.001). CONCLUSION Overall, results indicate that over a short time period, this condom distribution programme was successful in reaching students and providing free condoms. Implications for implementing condom distribution programmes on college campuses as well as future directions for research are discussed.
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Widman L, Golin CE, Noar SM, Massey J, Prinstein MJ. ProjectHeartforGirls.com: Development of a Web-Based HIV/STD Prevention Program for Adolescent Girls Emphasizing Sexual Communication Skills. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:365-377. [PMID: 27710087 PMCID: PMC5257203 DOI: 10.1521/aeap.2016.28.5.365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This article describes the development of ProjectHeartforGirls.com , an interactive web-based program designed to improve sexual communication skills and reduce the risk of HIV/STDs among adolescent girls, a population at heightened risk for negative sexual health outcomes (Centers for Disease Control and Prevention, 2013). Although sexual communication is a critical predictor of safer sex among teens, there are few online interventions that target these skills as a central program component. We developed ProjectHeartforGirls.com to fill this gap. Program development involved (1) identifying the target population (ethnically diverse high school girls), (2) clarifying the theoretical foundation (Reasoned Action Model), (3) conducting formative qualitative research (n = 25 girls), (4) drafting initial program content, (5) receiving ongoing feedback from a teen advisory board (n = 5 girls), (6) programming online content, and (7) conducting usability testing (n = 6 girls). These steps are described along with the final intervention product, which is currently being evaluated in a randomized controlled trial.
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Myrick JG, Noar SM, Kelley D, Zeitany AE. The Relationships Between Female Adolescents’ Media Use, Indoor Tanning Outcome Expectations, and Behavioral Intentions. HEALTH EDUCATION & BEHAVIOR 2016; 44:403-410. [DOI: 10.1177/1090198116667251] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background. Unlike other types of cancer, skin cancer incidence rates are on the rise and adolescent females are particularly likely to tan indoors, a major risk factor. However, little research has examined the role of media use in encouraging or discouraging this dangerous behavior in this population. Aims. To empirically assess the links between media use, indoor tanning-related outcome expectations, and behavioral intentions. Method. A survey of adolescent females ( N = 510) ages 15 to 18 in the Southeastern United States assessed demographics, types of media use, and indoor tanning intentions. Results. Significant correlations between media use and indoor tanning outcome expectations were found. Use of interpersonal and social media (i.e., talking on the phone, texting, and online social media) were positively associated with positive outcome expectations about indoor tanning and negatively associated with negative outcome expectations. A path analysis revealed that interpersonal/social media use had indirect associations with indoor tanning intentions via tanning outcome expectations. Mass media use (e.g., news media, entertainment media, and magazines) was not significantly associated with most indoor tanning outcome expectations but did have a direct negative association with behavioral intentions. Discussion. There are important relationships between media use, indoor tanning outcome expectations, and behavioral intentions. Interpersonal and social media use may help cultivate outcome expectations that encourage indoor tanning, which in turn may increase intentions to tan, while news media consumption in particular may reduce intentions to tan. Conclusion. These findings highlight the social nature of adolescent females and point to specific intervention channels for reducing indoor tanning among this population.
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Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Soc Sci Med 2016; 164:118-129. [PMID: 27423739 PMCID: PMC5026824 DOI: 10.1016/j.socscimed.2016.06.011] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings. METHODS We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior. RESULTS We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies. CONCLUSIONS Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.
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Brewer NT, Morgan JC, Baig SA, Mendel JR, Boynton MH, Pepper JK, Byron MJ, Noar SM, Agans RP, Ribisl KM. Public understanding of cigarette smoke constituents: three US surveys. Tob Control 2016; 26:592-599. [PMID: 27924009 PMCID: PMC5495614 DOI: 10.1136/tobaccocontrol-2015-052897] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 09/11/2016] [Accepted: 09/23/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The Tobacco Control Act requires public disclosure of information about toxic constituents in cigarette smoke. To inform these efforts, we studied public understanding of cigarette smoke constituents. METHODS We conducted phone surveys with national probability samples of adolescents (n=1125) and adults (n=5014) and an internet survey with a convenience sample of adults (n=4137), all in the USA. We assessed understanding of cigarette smoke constituents in general and of 24 specific constituents. RESULTS Respondents commonly and incorrectly believed that harmful chemicals in cigarette smoke mostly originate in additives introduced by cigarette manufacturers (43-72%). Almost all participants had heard that nicotine is in cigarette smoke, and many had also heard about carbon monoxide, ammonia, arsenic and formaldehyde. Less than one-quarter had heard of most other listed constituents being in cigarette smoke. Constituents most likely to discourage respondents from wanting to smoke were ammonia, arsenic, formaldehyde, hydrogen cyanide, lead and uranium. Respondents more often reported being discouraged by constituents that they had heard are in cigarette smoke (all p<0.05). Constituents with names that started with a number or ended in 'ene' or 'ine' were less likely to discourage people from wanting to smoke (all p<0.05). DISCUSSION Many people were unaware that burning the cigarette is the primary source of toxic constituents in cigarette smoke. Constituents that may most discourage cigarette smoking have familiar names, like arsenic and formaldehyde and do not start with a number or end in ene/ine. Our findings may help campaign designers develop constituent messages that discourage smoking.
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Noar SM. A Health Educator's Guide to Theories of Health Behavior. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 24:75-92. [PMID: 17690053 DOI: 10.2190/dalp-3f95-gct3-m922] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerous health behavior theories (HBTs), each which attempt to explain why individuals engage in (or fail to engage in) health-related behaviors, exist in the literature. While much attention has been devoted to testing individual theories, little attention has been paid to issues that arise in the selection of theories. The current article has three goals. First, to describe some of the most widely used individual-level HBTs. Second, to discuss the application of these theories to successful health promotion efforts. And finally, to compare and contrast numerous HBTs and provide an example for how a selected theory might be applied to a health education program. The overriding goal is to provide guidance to researchers, health educators and other interventionists with regard to the important decision of which theory to use as a basis for one's health promotion efforts.
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Myrick JG, Noar SM, Kelley D, Zeitany AE, Morales-Pico BM, Thomas NE. A longitudinal test of the Comprehensive Indoor Tanning Expectations Scale: The importance of affective beliefs in predicting indoor tanning behavior. J Health Psychol 2016; 22:3-15. [DOI: 10.1177/1359105315595116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In order to better understand drivers of dangerous indoor tanning behaviors, researchers developed the Comprehensive Indoor Tanning Expectations scale. To examine the longitudinal effectiveness of Comprehensive Indoor Tanning Expectations, we surveyed young women in the Southeastern United States at two time points ( N = 553). The scale demonstrated strong test–retest reliability. Participants who believed indoor tanning would improve their mood and afford social approval were significantly more likely to tan 6 months later, while participants who believed indoor tanning leads to psychological/physical discomfort were significantly less likely to tan 6 months later. Knowing the psychological bases for indoor tanning can inform intervention and message design.
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Brewer NT, Hall MG, Noar SM, Parada H, Stein-Seroussi A, Bach LE, Hanley S, Ribisl KM. Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial. JAMA Intern Med 2016; 176:905-12. [PMID: 27273839 PMCID: PMC5458743 DOI: 10.1001/jamainternmed.2016.2621] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Pictorial warnings on cigarette packs draw attention and increase quit intentions, but their effect on smoking behavior remains uncertain. OBJECTIVE To assess the effect of adding pictorial warnings to the front and back of cigarette packs. DESIGN, SETTING, AND PARTICIPANTS This 4-week between-participant randomized clinical trial was carried out in California and North Carolina. We recruited a convenience sample of adult cigarette smokers from the general population beginning September 2014 through August 2015. Of 2149 smokers who enrolled, 88% completed the trial. No participants withdrew owing to adverse events. INTERVENTIONS We randomly assigned participants to receive on their cigarette packs for 4 weeks either text-only warnings (one of the Surgeon General's warnings currently in use in the United States on the side of the cigarette packs) or pictorial warnings (one of the Family Smoking Prevention and Tobacco Control Act's required text warnings and pictures that showed harms of smoking on the top half of the front and back of the cigarette packs). MAIN OUTCOMES AND MEASURES The primary trial outcome was attempting to quit smoking during the study. We hypothesized that smokers randomized to receive pictorial warnings would be more likely to report a quit attempt during the study than smokers randomized to receive a text-only Surgeon General's warning. RESULTS Of the 2149 participants who began the trial (1039 men, 1060 women, and 34 transgender people; mean [SD] age, 39.7 [13.4] years for text-only warning, 39.8 [13.7] for pictorial warnings), 1901 completed it. In intent-to-treat analyses (n = 2149), smokers whose packs had pictorial warnings were more likely than those whose packs had text-only warnings to attempt to quit smoking during the 4-week trial (40% vs 34%; odds ratio [OR], 1.29; 95% CI, 1.09-1.54). The findings did not differ across any demographic groups. Having quit smoking for at least the 7 days prior to the end of the trial was more common among smokers who received pictorial than those who received text-only warnings (5.7% vs 3.8%; OR, 1.53; 95% CI, 1.02-2.29). Pictorial warnings also increased forgoing a cigarette, intentions to quit smoking, negative emotional reactions, thinking about the harms of smoking, and conversations about quitting. CONCLUSIONS AND RELEVANCE Pictorial warnings effectively increased intentions to quit, forgoing cigarettes, quit attempts, and successfully quitting smoking over 4 weeks. Our trial findings suggest that implementing pictorial warnings on cigarette packs in the United States would discourage smoking. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02247908.
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Moracco KE, Morgan JC, Mendel J, Teal R, Noar SM, Ribisl KM, Hall MG, Brewer NT. "My First Thought was Croutons": Perceptions of Cigarettes and Cigarette Smoke Constituents Among Adult Smokers and Nonsmokers. Nicotine Tob Res 2016; 18:1566-74. [PMID: 26681775 PMCID: PMC4902881 DOI: 10.1093/ntr/ntv281] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/09/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Understanding what people think about harmful and potentially harmful constituents in cigarettes and cigarette smoke has new urgency given legislation requiring US Food and Drug Administration (FDA) to disclose constituent information. Our study sought to obtain qualitative information on what people think about these constituents and the language they use to talk about them. METHODS We conducted six focus groups in 2014 with 40 adults in North Carolina. Open-ended questions focused on cigarette and cigarette smoke constituents in general and on the 18 constituents on the FDA's abbreviated list. We coded the transcripts for emergent themes, and all four coders discussed themes until we reached consensus. RESULTS Participants knew that cigarette smoke contains chemicals but did not know how many chemicals nor what those chemicals are, beyond tar and nicotine. Dangers of constituents mentioned included "chemicals," physical disease, and addiction. Participants incorrectly believed harmful constituents came primarily from tobacco companies' additives. For unfamiliar constituents, people tried to make associations based on similar-sounding words. Recognizable constituents that participants associated with health harms most discouraged them from wanting to smoke. Most participants wanted to know health harms associated with constituents and what else the chemicals were in. CONCLUSIONS Participants showed enthusiasm for learning more information about constituents, and also showed substantial misunderstandings about the source of harmful constituents. Our findings contribute to the limited body of research on adults' knowledge and perceptions of cigarette smoke constituents and can aid the FDA as it plans to disclose constituent information to the public. IMPLICATIONS Our study provides information about adults' understanding of cigarette smoke constituents and what adults would like to know about these constituents. This information can help communication campaigns describe cigarette smoke constituents in a way that discourages people from wanting to smoke.
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Cornacchione J, Wagoner KG, Wiseman KD, Kelley D, Noar SM, Smith MH, Sutfin EL. Adolescent and Young Adult Perceptions of Hookah and Little Cigars/Cigarillos: Implications for Risk Messages. JOURNAL OF HEALTH COMMUNICATION 2016; 21:818-825. [PMID: 27337629 PMCID: PMC5003089 DOI: 10.1080/10810730.2016.1177141] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n = 47) and susceptible nonusers (n = 30). Transcripts were coded for emergent themes on participants' perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.
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Boynton MH, Agans RP, Bowling JM, Brewer NT, Sutfin EL, Goldstein AO, Noar SM, Ribisl KM. Understanding how perceptions of tobacco constituents and the FDA relate to effective and credible tobacco risk messaging: A national phone survey of U.S. adults, 2014-2015. BMC Public Health 2016; 16:516. [PMID: 27333921 PMCID: PMC4918079 DOI: 10.1186/s12889-016-3151-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/25/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The passage of the 2009 Family Smoking Prevention and Tobacco Control Act has necessitated the execution of timely, innovative, and policy-relevant tobacco control research to inform Food and Drug Administration (FDA) regulatory and messaging efforts. With recent dramatic changes to tobacco product availability and patterns of use, nationally representative data on tobacco-related perceptions and behaviors are vital, especially for vulnerable populations. METHODS The UNC Center for Regulatory Research on Tobacco Communication conducted a telephone survey with a national sample of adults ages 18 and older living in the United States (U.S.). The survey assessed regulatory relevant factors such as tobacco product use, tobacco constituent perceptions, and tobacco regulatory agency credibility. The study oversampled high smoking/low income areas as well as cell phone numbers to ensure adequate representation among smokers and young adults, respectively. Coverage extended to approximately 98 % of U.S. households. RESULTS The final dataset (N = 5,014) generated weighted estimates that were largely comparable to other national demographic and tobacco use estimates. Results revealed that over one quarter of U.S. adults, and over one third of smokers, reported having looked for information about tobacco constituents in cigarette smoke; however, the vast majority was unaware of what constituents might actually be present. Although only a minority of people reported trust in the federal government, two thirds felt that the FDA can effectively regulate tobacco products. CONCLUSIONS As the FDA continues their regulatory and messaging activities, they should expand both the breadth and availability of constituent-related information, targeting these efforts to reach all segments of the U.S. population, especially those disproportionately vulnerable to tobacco product use and its associated negative health outcomes.
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Noar SM, Harrington NG, Aldrich RS. The Role of Message Tailoring in the Development of Persuasive Health Communication Messages. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23808985.2009.11679085] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kelley DE, Noar SM, Myrick JG, Morales-Pico B, Zeitany A, Thomas NE. An Empirical Analysis of Indoor Tanners: Implications for Audience Segmentation in Campaigns. JOURNAL OF HEALTH COMMUNICATION 2016; 21:564-574. [PMID: 27115046 DOI: 10.1080/10810730.2015.1114051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tanning bed use before age 35 has been strongly associated with several types of skin cancer. The current study sought to advance an understanding of audience segmentation for indoor tanning among young women. Panhellenic sorority systems at two universities in the Southeastern United States participated in this study. A total of 1,481 young women took the survey; 421 (28%) had tanned indoors in the previous 12 months and were the focus of the analyses reported in this article. Results suggested two distinct tanner types: regular (n = 60) and irregular (n = 353) tanners. Regular tanners tanned more frequently (M = 36.2 vs. 8.6 times per year) and reported significantly higher positive outcome expectations (p < .001) and lower negative outcome expectations (p < .01) than irregular tanners, among other significant differences. Hierarchical logistic regression analysis revealed several significant (p < .001) predictors of regular tanning type, with tanning dependence emerging as the strongest predictor of this classification (OR = 2.25). Implications for developing anti-tanning messages directed at regular and irregular tanners are discussed.
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Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control 2016. [PMID: 25948713 DOI: 10.1136/tobaccocontrol-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings. DATA SOURCES We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles. STUDY SELECTION We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33,613) met criteria. DATA EXTRACTION AND SYNTHESIS Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures. RESULTS Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes. CONCLUSIONS The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.
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Tripicchio G, Heo M, Diewald L, Noar SM, Dooley R, Pietrobelli A, Burger KS, Faith MS. Restricting Advertisements for High-Fat, High-Sugar Foods during Children's Television Programs: Attitudes in a US Population-Based Sample. Child Obes 2016; 12:113-8. [PMID: 26977541 DOI: 10.1089/chi.2015.0174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Children in the United States (US) are frequently exposed to advertisements for high-fat, high-sugar (HFHS) foods, which is linked to greater demand for and consumption of those foods. Restricting advertisements for HFHS foods may be a viable obesity prevention strategy-however, public support for policy change is unclear. METHODS A secondary analysis of the 2012 Annenberg National Health Communication Survey was conducted. Respondents (N = 1838) were 53.2% female, mean age 50.0 ± 16.5 years. Race/ethnic composition was 76.8% white, 7.4% black, 9.2% Hispanic, and 6.6% other. The percentage of respondents supporting and opposing the regulation was calculated and logistic regression models identified predictors of support. Potential predictors included sociodemographic variables, attitudes towards other health regulations (e.g., smoking bans in public places), and various health behaviors (e.g., fruit and vegetable intake). RESULTS A total of 56.3% of respondents supported or strongly supported advertisement restrictions, while only 8.2% strongly opposed. Approximately 20% had no opinion. Greatest support was found among respondents who supported smoking bans in public settings (OR = 4.3), who supported banning trans fats in restaurants (OR = 1.7), and who were older (OR = 1.7). CONCLUSION The US adult population appears to have an appetite for restricting HFHS advertising to children, with more than half the populace supporting such a policy in 2012. This may be an opportune time to implement and rigorously evaluate such childhood obesity prevention strategies.
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