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Brennan E, Maloney E, Ophir Y, Cappella JN. Designing Effective Testimonial Pictorial Warning Labels for Tobacco Products. HEALTH COMMUNICATION 2019; 34:1383-1394. [PMID: 29985636 PMCID: PMC6326893 DOI: 10.1080/10410236.2018.1493417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Warning labels on tobacco products sometimes feature images and stories of real people whose health has been affected by smoking. We examined effects of some of the design elements that may contribute to the effectiveness of these testimonial pictorial warning labels (PWLs). Beginning with a testimonial PWL that contained an image of a person and a basic warning statement (e.g., "Smoking can kill you"), we examined the impact of adding: (a) text detailing the person's name, age and health status (identifiers); and (b) explanatory statements that elaborated on the basic warning using a testimonial or non-testimonial message. In an online experiment, 1255 adult smokers in the United States were randomly assigned to one of six experimental conditions (2 [identifier: none/identifier] × 3 [explanatory statement: none/non-testimonial/testimonial]), or a control condition (text only warning labels that currently appear on packs in the United States). In each condition, participants were exposed to multiple labels each focused on a different health effect. Effectiveness was assessed using emotional responses, engagement and behavioral intentions measured immediately post-exposure, and quit attempts measured at five-week follow up. Testimonial PWLs were more effective than the text only labels. However, there was little evidence that adding identifiers or the explanatory statements enhanced effectiveness; rather, there was some evidence that testimonial explanatory statements reduced effectiveness. These findings suggest that the most effective design for testimonial PWLs may be to combine a basic warning statement with an image of a real person, without any additional textual components.
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Affiliation(s)
- Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria
| | - Erin Maloney
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
| | - Yotam Ophir
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
| | - Joseph N Cappella
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
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52
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Mantzari E, Pechey R, Codling S, Sexton O, Hollands GJ, Marteau TM. The impact of 'on-pack' pictorial health warning labels and calorie information labels on drink choice: A laboratory experiment. Appetite 2019; 145:104484. [PMID: 31626833 PMCID: PMC8161725 DOI: 10.1016/j.appet.2019.104484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/20/2019] [Accepted: 10/06/2019] [Indexed: 02/04/2023]
Abstract
Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA. Health warning labels reduce hypothetical selection of SSBs in online studies but uncertainty surrounds their impact on selection of drinks for consumption. Calorie information labels are also promising but their impact on SSB selection is unclear. This laboratory study assessed the impact on SSB selection of ‘on-pack’ labels placed directly on physical products: i.a pictorial health warning label depicting an adverse health consequence of excess sugar consumption; and ii.calorie information labels. Potential moderation of any effects by socio-economic position (SEP) was also examined. Participants - 401 adults, resident in England, approximately half of whom were of lower SEP and half of higher SEP, were asked to select a drink from a range of two non-SSBs and four SSBs (subsequent to completing a separate study assessing the effects of food availability on snack selection). The drinks included ‘on-pack’ labels according to randomisation: Group 1: pictorial health warning label on SSBs; Group 2: calorie information label on all drinks; Group 3: no additional label. The primary outcome was the proportion of participants selecting an SSB. Compared to not having additional labels (39%), neither the pictorial health warning label (40%) nor calorie information labels (43%) affected the proportion of participants selecting an SSB. Lower SEP participants (45%) were more likely to select an SSB compared to those of higher SEP (35%), but SEP did not moderate the impact of labels on drink selection. In conclusion, pictorial health warning labels may be less effective in reducing SSB selection in lab-based compared with online settings, or depending on label design and placement. Findings suggest that effects might be absent when choosing from real products with actual ‘on-pack’ labels, positioned in a ‘realistic’ manner. Field studies are needed to further assess the impact of ‘on-pack’ SSB warning labels in real-world settings to rule out the possible contribution of study design factors.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Rachel Pechey
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Saphsa Codling
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Olivia Sexton
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK.
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Lambert V, Ferguson SG, Niederdeppe J, Hammond D, Hardin JW, Thrasher JF. Exploring the impact of efficacy messages on cessation-related outcomes using Ecological Momentary Assessment. Tob Induc Dis 2019; 16:44. [PMID: 31516442 PMCID: PMC6659513 DOI: 10.18332/tid/94460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Observational studies indicate that cigarette package inserts with efficacy messages about the benefits of quitting (i.e. response efficacy) and recommendations for successful cessation increase smokers' self-efficacy to quit and promote sustained cessation. However, the effects of inserts with such efficacy messages have not been studied using experimental designs. This study used ecological momentary assessment (EMA) to assess smokers' responses to efficacy inserts. METHODS In a randomized case-crossover study among smokers from the United States (n=23), participants received a one-week supply of cigarettes with efficacy inserts and a one-week supply without any inserts, and were randomized to use the packs with inserts on either the first or second week of the study. For 14 consecutive days, participants used a smartphone to answer brief surveys on cessation-related variables during smoking sessions and at the beginning of each day. Multilevel mixed-effects linear and logistic regression models compared responses during the insert period to those of the non-insert period. RESULTS The insert period was associated with greater desire to quit (b=0.21, p=0.012), motivation to quit (b=0.18, p=0.001), self-efficacy to cut down (b=0.26, p<0.001) and to quit (b=0.28, p<0.000), and response efficacy/perceived benefits of quitting (b=0.13, p=0.012). Insert exposure was not significantly associated with forgoing cigarettes (OR=1.9, p=0.2). CONCLUSIONS Results from this EMA study suggest that inserts with efficacy messages may promote determinants of smoking cessation. This is consistent with observational research in Canada, which is the only country to use inserts with efficacy messages as well as pictorial warnings about smoking risks on the outside of packs. Future studies should assess the extent to which efficacy inserts can not only be used to communicate health information to smokers but also work in synergy with pictorial warnings.
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Affiliation(s)
- Victoria Lambert
- Department of Health Promotion, Education, & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | | | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, United States
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Canada
| | - James W Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - James F Thrasher
- Department of Health Promotion, Education, & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States.,Department of Tobacco Research, Center for Population Health Studies, National Institute of Public Health, Cuernavaca, Mexico
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Li Y, Yang B, Owusu D, Popova L. Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers. Tob Control 2019; 29:496-501. [PMID: 31420374 DOI: 10.1136/tobaccocontrol-2019-055116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Cigarette pictorial warning labels (PWLs) could produce stronger quit intentions than text-only warning labels (TWLs) due to greater emotional arousal. Yet, it remains unclear whether PWLs that elicit different levels of emotions produce different outcomes. To better understand the role of negative emotions in the effects of PWLs, this study developed two sets of PWLs arousing different emotional levels (high vs low) but equally high on informativeness and compared them to each other and to the current TWLs. METHODS Adult US smokers (n=1503) were randomised to view nine high-emotion-arousing or low-emotion-arousing PWLs or TWLs. After each label, participants reported the negative emotions they felt while looking at the label. After seeing all the labels, participants reported their intentions to quit smoking. Mediation analyses tested whether message condition influenced quit intentions indirectly through negative emotions. RESULTS Compared with TWLs, PWLs produced higher levels of negative emotions (b=0.27, SE=0.04, p<0.001). Compared with low-emotion arousing PWLs, high-emotion-arousing PWLs produced higher levels of negative emotions (b=0.24, SE=0.07, p<0.001). Higher negative emotions predicted stronger quit intentions (b=0.20, SE=0.03, p<0.001). Negative emotions mediated the effects of PWLs versus TWLs and high-emotion-arousing versus low- emotion-arousing PWLs on quit intentions. CONCLUSIONS The results provide additional evidence for negative emotions as the mechanism through which PWLs motivate smokers to consider quitting. The findings call on the Food and Drug Administration to design and implement high-emotion-arousing cigarette warning labels.
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Affiliation(s)
- Yachao Li
- Department of Communication Studies and Department of Public Health, The College of New Jersey, Ewing, New Jersey, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Stevens EM, Cohn AM, Villanti AC, Leshner G, Wedel A, Wagener TL. Perceived Effectiveness of Anti-Marijuana Messages in Adult Users and Nonusers: An Examination of Responses to Messages About Marijuana's Effects on Cognitive Performance, Driving, and Health. J Stud Alcohol Drugs 2019; 80:415-422. [PMID: 31495378 PMCID: PMC6739640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/24/2019] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE Marijuana use is associated with negative cognitive and health outcomes and risky driving. Given the rapidly changing policies regarding legal recreational and medicinal marijuana use, it is important to examine what types of marijuana prevention messages may be effective in minimizing such outcomes. This study examined cognitive and affective responses to anti-marijuana public health messages in a sample of adult marijuana users and nonusers to determine the correlates of perceived message effectiveness. METHOD Participants (N = 203; mean age = 37.7 years) were adult marijuana users and nonusers recruited via Amazon Mechanical Turk (August 2017). After completing self-report measures of marijuana use, they viewed six anti-marijuana messages presented in a random order, addressing marijuana's effects in each of three topic areas: cognitive performance, driving, and adverse health outcomes (e.g., two messages per topic). Participants completed assessments of cognitive and affective perceptions after viewing each message. For each message topic, a linear regression model was used to determine which cognitive and affective perceptions were most predictive of perceived message effectiveness. RESULTS For all message topics, nonusers perceived the messages as more effective than did users (p < .001). In the majority of analyses, greater message effectiveness was associated with increased perceived harm of marijuana and increased liking of the message. For driving and health messages, greater message effectiveness was also significantly correlated with lower pleasant affect. CONCLUSIONS The findings suggest that audience perceptions may be uniquely predictive of message effectiveness, depending on the topic.
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Affiliation(s)
- Elise M. Stevens
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Amy M. Cohn
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Andrea C. Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
| | | | - Amelia Wedel
- College of Arts and Sciences, Psychology, Syracuse University, Syracuse, New York
| | - Theodore L. Wagener
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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56
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Lochbuehler K, Wileyto EP, Mercincavage M, Souprountchouk V, Burdge JZ, Tang KZ, Cappella JN, Strasser AA. Temporal Effects of Message Congruency on Attention to and Recall of Pictorial Health Warning Labels on Cigarette Packages. Nicotine Tob Res 2019; 21:879-886. [PMID: 29917125 DOI: 10.1093/ntr/nty124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/14/2018] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Recent research has shown that message congruency is beneficial to recall of pictorial health warning label (PWL) content after initial exposure. Despite less attention to the text warning, smokers exposed to congruent PWLs were more likely to recall the text and the message. This study aimed to replicate these findings and to examine whether congruency also affects recall after multiple exposures over time. METHODS A total of 320 daily smokers (39.7% female; cigarettes/day: M = 15.31, SD = 7.15) were randomized to one congruent or incongruent PWL and attended 4 laboratory sessions over 10 days. During each session, eye movements were recorded while viewing the PWL and open-ended recall of label content was assessed after exposure. RESULTS Smokers who were exposed to a congruent PWL were more likely to recall the text (p = .01) and the message (p = .02) and less likely to recall the image (p = .003) of the PWL after initial exposure. By day 4, incongruent PWLs were recalled equally well as congruent PWLs. Independent of condition, image recall was initially high and remained high whereas text and message recall was relatively low initially but increased over time. It was not until day 7 that about 80% of text and message recall was observed. CONCLUSIONS Even when exposed to the same PWL over time, smokers require multiple exposures to recall the text and the message of a PWL. More research on the effects of congruency in the natural environment, where smokers are exposed to multiple PWLs, is needed. IMPLICATIONS The findings of this study, and of previous work showing that message congruency in PWLs is beneficial to initial recall of PWL content, could potentially help to address legal challenges regarding the implementation of PWLs in the United States. Factually correct text warnings have been uncontested on US cigarettes packages since 1966. Congruent PWLs simply provide a means to visually support the same information as the existing text using a medium that better garners attention to the health information. Investigating and understanding longer-term effects of congruency are important and can empirically inform future warning label development, both in the United States via the Family Smoking Prevention and Tobacco Control Act, and via other governing bodies.
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Affiliation(s)
- Kirsten Lochbuehler
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa Mercincavage
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan Z Burdge
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathy Z Tang
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph N Cappella
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Thrasher JF, Brewer NT, Niederdeppe J, Peters E, Strasser AA, Grana R, Kaufman AR. Advancing Tobacco Product Warning Labels Research Methods and Theory: A Summary of a Grantee Meeting Held by the US National Cancer Institute. Nicotine Tob Res 2019; 21:855-862. [PMID: 29444268 PMCID: PMC6775856 DOI: 10.1093/ntr/nty017] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/31/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The World Health Organization's Framework Convention on Tobacco Control recommends prominent pictorial health warnings on tobacco products. To advance research methods, theory and understanding of how tobacco product warning labels (TPWLs) work, the US National Cancer Institute convened a grantee meeting. Our article describes the key insights that emerged from the meeting, situated within the context of the scientific literature. RESULTS & RECOMMENDATIONS First, presentations confirmed that large, pictorial TPWLs motivate people to try to quit and encourage smoking cessation. Second, pictorial TPWLs increase attention, knowledge, negative affect, and thinking about the warning. Third, TPWL studies have primarily used brief-exposure laboratory studies and observational studies of sustained exposure through national policy implementation, with a few randomized trials involving several weeks of exposure-with generally consistent results found across study designs. Fourth, novel assessment methods include brain imaging, eye tracking and "best-worst" discrete choice experiments. To make TPWL even more effective, research is needed to confirm the mechanisms of their influence, their impact across vulnerable populations, and their effect on social media posts about tobacco products. Research is also needed on the effect of trial design choices, the predictive validity of new measurement approaches, and warning labels for non-cigarette tobacco products. IMPLICATIONS To improve scientific understanding of TPWL effects, this grantee meeting summary describes emerging research methods, theory and study results. Directions for future research include examination of the mechanisms of how warning labels work across diverse tobacco products and across different populations and contexts.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Ellen Peters
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel Grana
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Bekalu MA, Ramanadhan S, Bigman CA, Nagler RH, Viswanath K. Graphic and Arousing? Emotional and Cognitive Reactions to Tobacco Graphic Health Warnings and Associated Quit-Related Outcomes Among Low SEP Population Groups. HEALTH COMMUNICATION 2019; 34:726-734. [PMID: 29388802 DOI: 10.1080/10410236.2018.1434733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Research on graphic health warnings (GHWs) indicates that beyond changing cognitions about the health effects of smoking, GHWs evoke emotional reactions that can influence quit-related outcomes. Emotions can be classified based on valence (positive or negative) and arousal (calm or excited). However, although considerable research has examined the differential effectiveness of positive versus negative GHW-evoked emotions, research investigating the role of arousal activation in quit-related behaviors is scarce. This study examined associations between quit-related outcomes (intention and attempt to quit) and GHWs-evoked negative emotions classified as high and low in arousal activation as well as cognitive reactions among smokers of low socioeconomic position (SEP). It also examined whether perceived health risks of smoking moderate the relationship between emotional and cognitive reactions to GHWs and quit-related outcomes. Data were collected from low SEP smokers in three Massachusetts communities. Participants were screened and randomized to view one of the nine GHWs initially proposed for use by the U.S. Food and Drug Administration (FDA) and answered pre- and post-exposure questions. Results showed that GHW-evoked negative emotions high in arousal activation and cognitive reactions were both significantly associated with intention to quit during immediate post-test, controlling for age, warning label difference, and prior quit intention. However, these associations did not hold for quit attempts at follow-up. Perceived health risks of smoking moderated the association between cognitive reactions to GHWs and quit attempts at follow-up. The findings suggest that not all negative emotions evoked by GHWs are effective. Negative emotions high in arousal activation may be more effective in influencing quit-related behavioral intentions in low SEP groups. Additionally, unlike emotional reactions, cognitive reactions to GHWs may have effects that last relatively longer, but only among smokers who had low levels of perceived health risks of smoking at baseline.
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Affiliation(s)
- Mesfin Awoke Bekalu
- a Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health; Center for Community-Based Research, Dana-Farber Cancer Institute
| | - Shoba Ramanadhan
- a Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health; Center for Community-Based Research, Dana-Farber Cancer Institute
| | - Cabral A Bigman
- b Department of Communication , University of Illinois at Urbana-Champaign
| | - Rebekah H Nagler
- c School of Journalism & Mass Communication; School of Public Health , University of Minnesota
| | - Kasisomayajula Viswanath
- a Department of Social and Behavioral Sciences , Harvard T.H. Chan School of Public Health; Center for Community-Based Research, Dana-Farber Cancer Institute
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Skurka C, Kalaji M, Dorf MC, Kemp D, Greiner Safi A, Byrne S, Mathios AD, Avery RJ, Niederdeppe J. Independent or synergistic? Effects of varying size and using pictorial images in tobacco health warning labels. Drug Alcohol Depend 2019; 198:87-94. [PMID: 30889524 PMCID: PMC6662195 DOI: 10.1016/j.drugalcdep.2019.01.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Legal challenges have blocked the implementation of large, pictorial health warning labels (HWLs) in the U.S. In light of future legal questions the U.S. Food and Drug Administration may face in proposing alternative HWLs, we examined whether less restrictive HWL versions on the front of packs-smaller HWLs and/or text-only HWLs that do not include pictorial imagery-may be sufficient to promote cognitive and affective outcomes associated with smoking cessation. METHODS We recruited low-income smokers in two separate experiments through field-based recruitment methods (Study 1, N = 497) or Amazon Mechanical Turk (MTurk) (Study 2, N = 495). In both studies, we randomly assigned participants to a no-HWL control condition or one of four HWL conditions in a 2 (pictorial vs. text-only) × 2 (50% vs. 30% size) between-subjects design. RESULTS Relative to text-only HWLs, pictorial HWLs increased negative affect but not risk belief acceptance, cognitive elaboration about smoking harms, or quit intentions. The 50% HWLs increased quit intentions relative to the control condition in both studies. The 50% HWLs also outperformed the 30% HWLs in promoting quit intentions in Study 2. Subsequent analyses revealed that this effect in Study 2 may have been driven by the 50% HWLs strengthening the relationship between risk-related thoughts and intentions, although there was no evidence for this pattern in Study 1. We found no evidence for interaction effects between the pictorial and size manipulations. CONCLUSIONS Our findings suggest that 50% HWLs, whether pictorial or text-only, can encourage low-income smokers to consider quitting under some conditions.
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Affiliation(s)
- Chris Skurka
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA.
| | - Motasem Kalaji
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Michael C Dorf
- Cornell Law School, 247 Hughes Hall, Ithaca, NY, 14853, USA
| | - Deena Kemp
- Stan Richards School of Advertising and Public Relations, University of Texas at Austin, 300 W. Dean Keaton, Austin, TX, 78712, USA
| | - Amelia Greiner Safi
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA; Department of Population Medicine and Diagnostic Sciences, Cornell University, S2002 Schurman Hall, Ithaca, NY, 14853, USA
| | - Sahara Byrne
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Alan D Mathios
- College of Human Ecology, Cornell University, 1300 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, 2301G Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
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Byrne S, Greiner Safi A, Kemp D, Skurka C, Davydova J, Scolere L, Mathios AD, Avery RJ, Dorf MC, Steinhardt J, Niederdeppe J. Effects of Varying Color, Imagery, and Text of Cigarette Package Warning Labels among Socioeconomically Disadvantaged Middle School Youth and Adult Smokers. HEALTH COMMUNICATION 2019; 34:306-316. [PMID: 29236526 PMCID: PMC5999539 DOI: 10.1080/10410236.2017.1407228] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The U.S. Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 paved the way for the Food and Drug Administration (FDA) to propose nine different graphic warning labels (GWLs) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements. Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies' free speech without sufficiently advancing the government's public health interests. This study examines whether less extensive alternatives to the original full-color GWLs, including black-and-white GWLs and text-only options, have similar or divergent effects on visual attention, negative affect, and health risk beliefs. We used a mobile media research lab to conduct a randomized experiment with two populations residing in socioeconomically disadvantaged communities: biochemically confirmed adult smokers (N = 313) and middle school youth (N = 340). Results indicate that full-color GWLs capture attention for longer than black-and-white GWLs among both youth and adult smokers. Among adults, packages with GWLs (in either color or black-and-white) engendered more negative affect than those with text-only labels, while text-only produced greater negative affect than the packages with brand imagery only. Among youth, GWLs and text-only labels produced comparable levels of negative affect, albeit more so than brand imagery. We thus offer mixed findings related to the claim that a less extensive alternative could satisfy the government's compelling public health interest to reduce cigarette smoking rates.
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Affiliation(s)
- Sahara Byrne
- a Department of Communication , Cornell University
| | - Amelia Greiner Safi
- a Department of Communication , Cornell University
- e Department of Population Medicine and Diagnostic Sciences , College of Veterinary Medicine, Cornell University
| | - Deena Kemp
- a Department of Communication , Cornell University
| | | | | | - Leah Scolere
- a Department of Communication , Cornell University
| | | | - Rosemary J Avery
- c Department of Policy Analysis and Management , Cornell University
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Hall MG, Saffer AJ, Noar SM. A Secondary Audience's Reactions to "The Real Cost" Advertisements: Results From a Study of U.S. Young Adult Smokers and Susceptible Nonsmokers. Am J Prev Med 2019; 56:S57-S64. [PMID: 30661527 PMCID: PMC6373760 DOI: 10.1016/j.amepre.2018.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Exposure to "The Real Cost" campaign has prevented smoking initiation among its target audience (U.S. youth aged 12-17 years). This study examines reactions to "The Real Cost" advertisements among a potential secondary audience: U.S. young adults. METHODS An online convenience sample of young adult (ages 18-29 years) smokers (n=225) and susceptible nonsmokers (n=339) participated in a within-subjects experiment in 2017. Participants viewed three TV ads from "The Real Cost" campaign and reported their past exposure to, conversations about, and reactions to the ads. In 2017, analyses examined message-level and person-level predictors of perceived message effectiveness using multilevel modeling. RESULTS About half of smokers (47%) and susceptible nonsmokers (51%) had seen at least one of the three ads in the past 3 months. About one in four smokers (23%) and susceptible nonsmokers (24%) had at least one conversation about the ads in the past 3 months. Susceptible nonsmokers rated the ads higher on perceived message effectiveness than smokers (p<0.01), but lower on message relevance and negative affective reactions to the ads (both p<0.05). In both samples, ads that elicited higher negative affective reactions and message relevance, and lower message reactance (i.e., resistance) received higher perceived message effectiveness ratings (all p<0.05). CONCLUSIONS "The Real Cost" ads have reached and generated conversations among a convenience sample of young adult smokers and susceptible nonsmokers. Increasing the perceived relevance and emotional reactions of campaigns may increase their impact. Future studies should examine reactions to "The Real Cost" campaign and effects on smoking behavior using nationally representative samples of young adults. SUPPLEMENT INFORMATION This article is part of a supplement entitled Fifth Anniversary Retrospective of "The Real Cost," the Food and Drug Administration's Historic Youth Smoking Prevention Media Campaign, which is sponsored by the U.S. Food and Drug Administration.
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Affiliation(s)
- Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
| | - Adam J Saffer
- School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina
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62
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Niederdeppe J, Kemp D, Jesch E, Scolere L, Greiner Safi A, Porticella N, Avery RJ, Dorf MC, Mathios AD, Byrne S. Using graphic warning labels to counter effects of social cues and brand imagery in cigarette advertising. HEALTH EDUCATION RESEARCH 2019; 34:38-49. [PMID: 30358853 PMCID: PMC6315110 DOI: 10.1093/her/cyy039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 06/08/2023]
Abstract
Exposure to cigarette advertising can increase the likelihood of youth smoking initiation and may encourage people who already smoke to continue. Requiring prominent, graphic warning labels could reduce these effects. We test whether graphic versus text-only warning labels in cigarette advertisements influence cognitive and emotional factors associated with youth susceptibility to smoking and adult intentions to quit. We conducted two randomized, between-subjects experiments with middle-school youth (n = 474) and adult smokers (n = 451). Both studies employed a two (graphic or text-only warnings) by two (advertisements with social cues or brand imagery) factorial design with a fifth, offset control group (social cue advertisements with the current US Surgeon General's Warning). Graphic warnings outperformed text-only warnings in reducing visual attention to the advertisement, generating visual attention to the warning and arousing more negative affect. Graphic warnings also reduced the appeal of cigarette brands among youth relative to social cue advertisements with the Surgeon General's warnings. None of the warnings (graphic or textual) influenced health risk beliefs. Graphic warning labels on cigarette advertisements appear to have effects similar to those observed on cigarette packs in previous work, with an added benefit of reducing cigarette brand appeal among youth.
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Affiliation(s)
- J Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - D Kemp
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - E Jesch
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - L Scolere
- Department of Design and Merchandising, Colorado State University, Fort Collins, CO, USA
| | - A Greiner Safi
- Department of Communication, Cornell University, Ithaca, NY, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA
| | - N Porticella
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - R J Avery
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - M C Dorf
- Cornell Law School, Ithaca, NY, USA
| | - A D Mathios
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - S Byrne
- Department of Communication, Cornell University, Ithaca, NY, USA
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63
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Asfar T, Schmidt M, Ebrahimi Kalan M, Wu W, Ward KD, Nakkash RT, Thrasher J, Eissenberg T, Ben Romdhane H, Maziak W. Delphi study among international expert panel to develop waterpipe-specific health warning labels. Tob Control 2019; 29:159-167. [PMID: 30696784 DOI: 10.1136/tobaccocontrol-2018-054718] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Waterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control. METHODS A panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median. RESULTS Starting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP's harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes. CONCLUSION This study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP's harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.
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Affiliation(s)
- Taghrid Asfar
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.,Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Public Health Sciences, University of Miami, Miller School of Medicine, Miami, Florida, US
| | - Michael Schmidt
- Department of Art, The University of Memphis, Memphis, Tennessee, USA
| | - Mohammad Ebrahimi Kalan
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Kenneth D Ward
- Syrian Center for Tobacco Studies, Aleppo, Syria.,School of Public Health, The University of Memphis, Miami, Florida, USA
| | - Rima T Nakkash
- Health Behaviour and Education Department, American University of Beirut, Beirut, Lebanon
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Thomas Eissenberg
- Syrian Center for Tobacco Studies, Aleppo, Syria.,USA Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory, Faculty of Medicine of Tunis-Tunisia, Tunis, Tunisia
| | - Wasim Maziak
- Syrian Center for Tobacco Studies, Aleppo, Syria.,Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, Florida, USA
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64
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Lok I, Eschelmuller E, Haukaas T, Ventura C, Bebamzadeh A, Slovic P, Dunn E. Can We Apply the Psychology of Risk Perception to Increase Earthquake Preparation? COLLABRA: PSYCHOLOGY 2019. [DOI: 10.1525/collabra.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Can we encourage people to prepare for a natural disaster by altering the way that scientific information about risk is presented? In assessing the risk posed by a particular hazard, people tend to be guided more strongly by their emotional reactions than by logical or statistical analysis; human beings are driven to protect themselves from risks that that they have actually experienced, that are easy to envision, or that are linked to vivid, concrete images. Thus, even if people recognize that earthquakes pose an important threat, they may be unmotivated to take action to prepare for this abstract risk in the absence of direct personal experience. Harnessing past research and theorizing, we developed a novel intervention to transform scientific information into vivid, emotionally evocative imagery. In a pre-registered study, 411 participants were shown publicly available statistics or a vivid, scientifically-grounded image of what a local school would look like after a major earthquake. When invited to sign a petition to make schools safer, 77.3% participants agreed after looking at the image compared to 68% who agreed after looking at statistics. These findings suggest that using vivid images to communicate scientific information can be an effective strategy for motivating people to support risk mitigation initiatives.
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Affiliation(s)
- Iris Lok
- Department of Psychology, University of British Columbia, Vancouver, BC, CA
| | - Evan Eschelmuller
- Department of Psychology, University of British Columbia, Vancouver, BC, CA
| | - Terje Haukaas
- Department of Civil Engineering, University of British Columbia, Vancouver, BC, CA
| | - Carlos Ventura
- Department of Civil Engineering, University of British Columbia, Vancouver, BC, CA
| | - Armin Bebamzadeh
- Department of Civil Engineering, University of British Columbia, Vancouver, BC, CA
| | - Paul Slovic
- Department of Psychology, University of Oregon, Eugene, OR, US
- Decision Research, Eugene, OR, US
| | - Elizabeth Dunn
- Department of Psychology, University of British Columbia, Vancouver, BC, CA
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65
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Campbell BK, Le T, Yip D, Griffin KB, Gubner NR, Guydish JR. Sex Differences in Graphic Warning Label Ratings by Addictions Clients. TOB REGUL SCI 2019; 5:3-14. [PMID: 31236435 PMCID: PMC6590904 DOI: 10.18001/trs.5.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Research on sex differences in responses to cigarette graphic warning labels (GWLs) has been limited despite tobacco-related, health disparities for women. We examined whether women had stronger responses to certain labels than to others, whether this pattern differed from men's, and whether there were overall sex ratings differences. METHODS Smokers (N = 881) in 24, addictions treatment programs rated 3 of 9 Food and Drug Administration-developed labels on credibility, message reactance, quit motivation, and negative emotions. Participants rated one label depicting a woman and/or baby, and 2 depicting tobacco-related disease or male images. RESULTS Women's (n = 432) ratings of labels depicting women/babies versus other labels did not differ from men's (n = 449) ratings. Women had higher ratings than men across all labels combined on credibility (p < .001), quit motivation (p = .007), and negative emotions (p < .001). Individual labels were analyzed for sex differences. Women's ratings were higher on credibility for 3 of 9 labels, and on negative emotions for 7 of 9 labels. CONCLUSIONS Female smokers in addictions treatment had generally stronger responses to GWLs than men, supporting GWL implementation in the United States to help close the sex gap in smoking cessation.
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Affiliation(s)
- Barbara K. Campbell
- OHSU/PSU School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Kayla B. Griffin
- Morgan State University, 1700 E. Cold Springs Lane, Baltimore, MD 21251, USA
| | - Noah R. Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Joseph R. Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
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66
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Mantzari E, Vasiljevic M, Turney I, Pilling M, Marteau T. Impact of warning labels on sugar-sweetened beverages on parental selection: An online experimental study. Prev Med Rep 2018; 12:259-267. [PMID: 30406003 PMCID: PMC6215029 DOI: 10.1016/j.pmedr.2018.10.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/12/2018] [Accepted: 10/21/2018] [Indexed: 12/12/2022] Open
Abstract
Sugar-sweetened beverages (SSBs) are one of the largest added sugar sources to diets in the UK and USA, particularly among young people. Warning labels, including calorie information labels, could reduce SSB consumption but uncertainty surrounds the labels that are most effective. This study assessed the impact of labels containing (a) each of two image-based warnings and (b) calorie information, singly and together, on SSB selection by parents of 11-16-year-olds living in the UK. Using a 3 (disease image, sugar content image, no image) × 2 (calorie information, no calorie information) between-subjects experimental design, 2002 participants were randomised to see beverages with one of six labels and selected one for their child to consume. The primary outcome was the proportion of participants selecting an SSB. Data were collected in December 2017. Logistic regressions showed SSB selection was lower when labels contained an image-based warning (35%), compared to not having any label (49%) or just calorie information (43.5%). The disease image lowered selection more than the sugar image (32% vs 40.5%). Providing calorie information with the disease image had no additional impact on selection (33%) but enhanced the impact of the sugar image (36%). Image-based warning labels discourage SSB selection by parents for their children. Images depicting health consequences of excess sugar consumption have larger effects than those depicting sugar content. Calorie information does not add to the effect of the former but does to that of the latter. Field studies are needed to assess the impact of SSB warning labels in real-life settings.
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Affiliation(s)
- Eleni Mantzari
- Behaviour and Health Research Unit, University of Cambridge, UK
| | | | | | - Mark Pilling
- Behaviour and Health Research Unit, University of Cambridge, UK
| | - Theresa Marteau
- Behaviour and Health Research Unit, University of Cambridge, UK
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67
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Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, Smith F, MacDonald J, Price L, Flowers P. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol 2018; 24:66-87. [PMID: 30221433 PMCID: PMC6585774 DOI: 10.1111/bjhp.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Indexed: 11/26/2022]
Abstract
Objectives In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). Methods A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. Conclusions The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the ‘post‐antibiotic’ era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health‐related behavioural change.
What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an ‘affective’ analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Affiliation(s)
- Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Milton Keynes, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lesley Price
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Paul Flowers
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
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68
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Brodar KE, Byron MJ, Peebles K, Hall MG, Pepper JK, Brewer NT. "That's probably what my mama's lungs look like": how adolescent children react to pictorial warnings on their parents' cigarette packs. BMC Public Health 2018; 18:1125. [PMID: 30219038 PMCID: PMC6139175 DOI: 10.1186/s12889-018-6011-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pictorial cigarette pack warnings discourage smoking, but most evidence comes from studies of adults. Our qualitative study explored adolescents' reactions to pictorial warnings on their parents' cigarette packs. METHODS We interviewed 24 adolescents whose parents received pictorial warnings on their cigarette packs as part of a randomized clinical trial. We conducted a thematic content analysis of the interview transcripts. RESULTS Pictorial cigarette pack warnings led adolescents to imagine the depicted health effects happening to their parents, which elicited negative emotions. The warnings inspired adolescents to initiate conversations with their parents and others about quitting smoking. Adolescents believed the warnings would help smokers quit and prevent youth from starting smoking. Some current smokers said the warnings made them consider quitting. CONCLUSIONS Conversations about the pictorial warnings may amplify their effectiveness for smokers, their adolescent children, and friends of the adolescent children. Cigarette pack warnings may reach a broad audience that includes adolescent children of smokers.
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Affiliation(s)
- Kaitlyn E Brodar
- Department of Psychology, University of Miami, 5665 Ponce de Leon Drive, Coral Gables, FL, 33146-0751, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC, 27599, USA
| | - M Justin Byron
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC, 27599, USA.,Department of Family Medicine, School of Medicine, University of North Carolina, 590 Manning Dr., Chapel Hill, NC, 27599, USA
| | - Kathryn Peebles
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Jessica K Pepper
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 325 Rosenau Hall CB7440, Chapel Hill, NC, 27599, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, 27599, USA.
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69
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Donnelly GE, Zatz LY, Svirsky D, John LK. The Effect of Graphic Warnings on Sugary-Drink Purchasing. Psychol Sci 2018; 29:1321-1333. [PMID: 29912624 PMCID: PMC6088502 DOI: 10.1177/0956797618766361] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 02/28/2018] [Indexed: 11/17/2022] Open
Abstract
Governments have proposed text warning labels to decrease consumption of sugary drinks-a contributor to chronic diseases such as diabetes. However, they may be less effective than more evocative, graphic warning labels. We field-tested the effectiveness of graphic warning labels (vs. text warning labels, calorie labels, and no labels), provided insight into psychological mechanisms driving effectiveness, and assessed consumer sentiment. Study 1 indicated that graphic warning labels reduced the share of sugary drinks purchased in a cafeteria from 21.4% at baseline to 18.2%-an effect driven by substitution of water for sugary drinks. Study 2 showed that graphic warning labels heighten negative affect and prompt consideration of health consequences. Study 3 indicated that public support for graphic warning labels can be increased by conveying effectiveness information. These findings could spur more effective labeling policies that facilitate healthier choices, do not decrease overall beverage purchases, and are publicly accepted.
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Affiliation(s)
| | - Laura Y. Zatz
- Department of Nutrition, Harvard T. H.
Chan School of Public Health
- Department of Social & Behavioral
Sciences, Harvard T. H. Chan School of Public Health
| | - Dan Svirsky
- Negotiation, Organizations & Markets
Unit, Harvard Business School
| | - Leslie K. John
- Negotiation, Organizations & Markets
Unit, Harvard Business School
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70
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Hall MG, Mendel JR, Noar SM, Brewer NT. Why smokers avoid cigarette pack risk messages: Two randomized clinical trials in the United States. Soc Sci Med 2018; 213:165-172. [PMID: 30096636 DOI: 10.1016/j.socscimed.2018.07.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/10/2018] [Accepted: 07/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Message avoidance (e.g., trying not to look at the message) may be motivated by reactance, a maladaptive rejection of the message. An alternative view is that avoidance indicates that a message is eliciting fear and other negative affect, thereby increasing the likelihood of behavioral change. We sought to identify which psychological mechanism-reactance or fear and other negative affect-explains message avoidance. We also examined whether avoidance was associated with more forgoing or butting out of cigarettes. METHOD Trial 1 randomly assigned 2149 adult U.S. smokers to receive either pictorial warnings (intervention) or text-only warnings (control) on their cigarette packs for four weeks in 2014 and 2015. Trial 2 randomly assigned 719 adult U.S. smokers to receive either messages about toxic chemicals in cigarette smoke (intervention) or messages about not littering cigarette butts (control) for three weeks in 2016 and 2017. Negative affect included fear, anxiety, disgust, sadness, and guilt. Reactance included perceived threat to freedom, anger, and counterarguing. RESULTS Intervention messages led to greater message avoidance in both trials (both p < .001). In Trial 1, intervention messages elicited greater negative affect, which in turn was associated with greater avoidance (mediated effect = 0.21, p < .001). In contrast, reactance explained only a small part of the effect in Trial 1 (mediated effect = 0.03, p < .001). Similarly, in Trial 2, intervention messages elicited greater negative affect, which was associated with more avoidance (mediated effect = 0.12, p < .001); reactance did not explain any of the effect. In both trials, avoidance was associated with more forgoing or butting out of cigarettes (ps < .001). CONCLUSIONS Smokers may avoid cigarette pack risk messages because they evoke aversive types of emotion. These studies add to a growing body of evidence that, in the context of cigarette pack messages, avoidance is not a form of defensive processing but instead a sign of deeper processing.
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Affiliation(s)
- Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA.
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, USA
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71
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Skurka C, Byrne S, Davydova J, Kemp D, Safi AG, Avery RJ, Dorf MC, Mathios AD, Niederdeppe J. Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth. Soc Sci Med 2018; 211:294-303. [PMID: 29980116 DOI: 10.1016/j.socscimed.2018.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/16/2018] [Accepted: 06/24/2018] [Indexed: 11/17/2022]
Abstract
RATIONALE The United States courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking's health effects. However, research in judgment and decision-making suggests these relationships are more complex. OBJECTIVE In this article, we draw on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth). METHOD We tested these competing mediation models using data from two experiments with two populations each-adult smokers (Ns = 313 and 238) and primarily non-smoking middle-school youth (Ns = 340 and 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern United States. RESULTS The best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of label exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that label exposure indirectly promoted adults' quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of label exposure on strengthened risk beliefs among adults and youth. CONCLUSIONS These results speak to the importance of negative affect in directly motivating adult smokers' quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking.
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Affiliation(s)
- Chris Skurka
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA.
| | - Sahara Byrne
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Julie Davydova
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Deena Kemp
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Amelia Greiner Safi
- Department of Communication and Department of Population Medicine and Diagnostic Sciences, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, 2301G Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Michael C Dorf
- Cornell University Law School, 247 Hughes Hall, Ithaca, NY, 14853, USA
| | - Alan D Mathios
- College of Human Ecology, Cornell University, 1300 Martha Van Rensselaer Hall, Ithaca, NY, 14853, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, 450B Mann Library Building, Ithaca, NY, 14853, USA
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72
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Peters E, Shoots-Reinhard B. Don't throw the baby out with the bath water: commentary on Kok, Peters, Kessels, ten Hoor, and Ruiter (2018). Health Psychol Rev 2018; 12:140-143. [PMID: 29478394 PMCID: PMC5914174 DOI: 10.1080/17437199.2018.1445542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ellen Peters
- a Department of Psychology , The Ohio State University , Columbus , OH , USA
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73
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Janssen E, Ruiter RAC, Waters EA. Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations. J Behav Med 2018; 41:318-332. [PMID: 29027602 PMCID: PMC5899069 DOI: 10.1007/s10865-017-9894-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/07/2017] [Indexed: 12/17/2022]
Abstract
A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N = 1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., "risk ladders") to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent) × 2 (numerical format: words/words and numbers) × 3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p = .01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p = .03). Further, absolute cognitive perceived risk of developing "any of the diseases shown in the picture" was higher among people who did not receive social comparison information (p = .03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.
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Affiliation(s)
- Eva Janssen
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Erika A Waters
- School of Medicine, Department of Surgery (Division of Public Health Sciences), Washington University in Saint Louis, Campus Box 8100, 600 S. Euclid Ave, Saint Louis, MO, 63110, USA.
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74
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Borah P, Xiao X. The Importance of 'Likes': The Interplay of Message Framing, Source, and Social Endorsement on Credibility Perceptions of Health Information on Facebook. JOURNAL OF HEALTH COMMUNICATION 2018; 23:399-411. [PMID: 29601271 DOI: 10.1080/10810730.2018.1455770] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Online sources not only permeate the information-seeking environment of the younger generation, but also have profound influence in shaping their beliefs and behaviors. In this landscape, examining the factors responsible for credibility perceptions of online information is fundamental, particularly for health-related information. Using a 2 (frames: gain vs. loss) × 2 (source: expert vs. non-expert) × 2 (social endorsement: high vs. low) randomized between-subjects experimental design, this study examines the effect of health message framing and the moderating effects of social endorsement and source type on credibility perceptions of Facebook posts. Testing across two issues--physical activity and alcohol consumption--findings indicate that the gain-framed message was perceived as most credible. Additionally, significant three-way interactions suggest that social endorsement and source type affect the relationship between message framing and credibility perceptions. Specifically, the findings demonstrate that a gain-framed message from an expert source with high number of 'likes' is considered the most credible message. These findings have significant implications for information gathering from social media sources, such as the influence of 'likes' on health information.
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Affiliation(s)
- Porismita Borah
- a GTZN 224, Edward R. Murrow College of Communication , Washington State University , Pullman , WA , USA
| | - Xizhu Xiao
- a GTZN 224, Edward R. Murrow College of Communication , Washington State University , Pullman , WA , USA
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75
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Van Dessel P, Smith CT, De Houwer J. Graphic cigarette pack warnings do not produce more negative implicit evaluations of smoking compared to text-only warnings. PLoS One 2018; 13:e0194627. [PMID: 29543890 PMCID: PMC5854435 DOI: 10.1371/journal.pone.0194627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/06/2018] [Indexed: 11/24/2022] Open
Abstract
Graphic warnings (GWs) on cigarette packs are widely used internationally with the aim of reducing smoking behavior. In the current study, we investigated whether GWs influence implicit evaluations of smoking, a potential moderator of smoking behavior, as measured with an Implicit Association Test (IAT). Results showed that viewing a GW did not produce more negative implicit evaluations of smoking for daily smokers, occasional smokers, or non-smokers, compared to viewing a text-only warning. If anything, effects were in the direction of evaluations of smoking being more positive after certain participants (i.e., daily and occasional smokers) viewed a GW. We also did not find any beneficial effects of GWs on explicit evaluations of smoking. These results contrast with the observation that non-smokers and occasional smokers (but not daily smokers) believed that GWs would be more effective than the text-only warnings. We discuss implications and limitations of these findings and provide recommendations for improving the effectiveness of cigarette pack warnings on implicit evaluations.
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Affiliation(s)
- Pieter Van Dessel
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
- * E-mail:
| | - Colin Tucker Smith
- Department of Psychology, University of Florida, Gainesville, Florida, United States of America
| | - Jan De Houwer
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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76
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Popova L, Thrul J, Glantz SA. Effects of Large Cigarette Warning Labels on Smokers' Expected Longevity. Am J Health Behav 2018; 42:85-92. [PMID: 29458517 DOI: 10.5993/ajhb.42.2.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Smokers underestimate the health risks of smoking and overestimate their expected longevity. Warning labels on cigarette packs might help correct these misperceptions. METHODS We carried out an online study with 1200 smokers (18-62 years old), randomized to 3 conditions: text warning labels, pictorial warning labels, and a control group (water bottle labels). Warning labels were based on those proposed by the US Food and Drug Administration in 2010. Participants in each condition saw 4 randomly selected labels and rated their expected longevity and chances of surviving to age 75 after exposure. Analyses of covariance controlled for cigarettes per day and self-rated health. RESULTS Compared to control, both text and pictorial warnings reduced participants' expected longevity (text: mean = 76.8 years, pictorial: 77.3, control 79.4) and their estimated chances of living to 75 (text: 62.0%, pictorial: 63.0%, control 66.5%). The contrast between text and pictorial labels combined and control showed significantly reduced expected longevity (p = .011) and chances of living to 75 (p = .004). Differences between text and pictorial conditions were not statistically significant. CONCLUSIONS Large text or pictorial warnings on cigarette packs might help smokers develop a more accurate understanding of the effects of smoking on their longevity.
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Affiliation(s)
- Lucy Popova
- Center for Tobacco Control Research and Education, University of California, San Fransisco CA
| | - Johannes Thrul
- Center for Tobacco Control Research and Education, University of California, San Fransisco CA
| | - Stanton A. Glantz
- Department of Medicine, Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
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77
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Abstract
Objectives Our aim was to identify message characteristics for cigarette pack inserts that aim to help smokers quit. Methods US adult smokers from an online consumer panel (N = 665) participated in a discrete choice experiment with a 2x2x2x2x4 within-subjects balanced incomplete block design, manipulating: image (vs no image), text type (testimonial vs informational), cessation resource information (vs none), call to action (vs none), and message topic (well-being, financial benefit, cravings, social support). Participants evaluated 9 choice sets, each with 4 inserts, selecting: (1) the most and least helpful for quitting; and (2) the most and least motivating to quit. Linear models regressed choices on insert characteristics, controlling for sociodemographics and smoking-related variables. We assessed interactions between insert characteristics and smoker attributes (ie, education, quit intention, self-efficacy). Results Inserts were most helpful and motivating when they included an image, provided cessation resource information, or referenced well-being and financial benefits. Significant interactions indicated that inserts with cessation resource information were relatively more helpful and motivating among smokers with low self-efficacy, an intention to quit, or lower education. Conclusion Cigarette pack inserts with imagery and cessation resource information may be particularly effective in promoting smoking cessation.
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78
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Thrasher JF, Islam F, Davis RE, Popova L, Lambert V, Cho YJ, Salloum RG, Louviere J, Hammond D. Testing Cessation Messages for Cigarette Package Inserts: Findings from a Best/Worst Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E282. [PMID: 29415523 PMCID: PMC5858351 DOI: 10.3390/ijerph15020282] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/20/2018] [Accepted: 02/01/2018] [Indexed: 11/16/2022]
Abstract
This study assessed smokers' responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed models regressed choices on insert and smoker characteristics. For DCE 1, the most motivating messages involved novel disease topics and imagery of younger women. For DCE 2, topics of social support, stress reduction and nicotine replacement therapy were selected as most helpful, with no differences by imagery type. For DCE 3, imagery influenced choices more than topic, with imagery of a family or a mom and baby selected as most motivating. Statistically significant interactions for all three experiments indicated that the influence of imagery type on choices depended on the message topic. Messages to promote smoking cessation through cigarette pack inserts should consider specific combinations of message topic and imagery.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Farahnaz Islam
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Lucy Popova
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30302, USA.
| | - Victoria Lambert
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Yoo Jin Cho
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes & Policy, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Jordan Louviere
- Institute for Choice and School of Marketing, University of South Australia, Adelaide, SA 5001, Australia.
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON N2L3G1, Canada.
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79
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Jradi H, Saddik B. Graphic warnings and text warning labels on cigarette packages in Riyadh Kingdom of Saudi Arabia: Awareness and perceptions. Ann Thorac Med 2018; 13:22-29. [PMID: 29387252 PMCID: PMC5772104 DOI: 10.4103/atm.atm_45_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Graphic warning labels have been shown to be effective in smoking initiation and cessation and were implemented in Saudi Arabia in 2012. To date, no study has assessed the effectiveness of these labels and the Saudi population's perceptions on the effectiveness of cigarette health warning labels. METHODS We used a cross-sectional qualitative study comprising of nine focus groups among 3 different community group members including health-care workers, adult women and adult men. We conducted in-depth interviews among community leaders. Both focus groups and interviews assessed awareness levels and elicited perceptions about health warning labels on cigarette boxes currently used in the Kingdom of Saudi Arabia. RESULTS While most participants in the study were aware and supported the use of graphic warning labels on cigarette packages, the awareness of the specific details on the labels was low. Participants perceived the effectiveness of current labels somewhat vague in smoking cessation and advocated for stronger and more aggressive graphics. Community leaders, however, preferred text-only labels and did not support aggressive labels which were deemed culturally and religiously inappropriate. CONCLUSIONS The study suggests that while graphic warning labels are perceived as necessary on cigarette packages the currently used messages are not clear and therefore do not serve their intended purposes. Measures should be undertaken to ensure that pictorial cigarette labels used in Saudi Arabia are culturally and ethnically appropriate and are rotated on a regular basis to ensure salience among smokers and nonsmokers alike.
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Affiliation(s)
- Hoda Jradi
- Department of Community and Environmental Health, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basema Saddik
- Department of Community and Environmental Health, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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80
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Evans AT, Peters E, Shoben AB, Meilleur LR, Klein EG, Tompkins MK, Tusler M. Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement. Psychol Health 2018; 33:213-234. [PMID: 28385093 PMCID: PMC5632120 DOI: 10.1080/08870446.2017.1310864] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g. 'exercise can undo the negative effects of smoking') and perceptions of cigarette danger versus other products. DESIGN 736 adult and 469 teen smokers/vulnerable smokers viewed one of three warning label types (text-only, low emotion graphic or high emotion graphic) four times over two weeks. MAIN OUTCOME MEASURES Emotional reactions to the warnings were reported during the first and fourth exposures. Participants reported how often they considered the warnings, smoking myth endorsement, risk perceptions and perceptions of cigarette danger relative to smokeless tobacco and electronic cigarettes. RESULTS In structural equation models, emotional reactions influenced risk perceptions and smoking myth endorsement through two processes. Emotion acted as information about risk, directly increasing smoking risk perceptions and decreasing smoking myth endorsement. Emotion also acted as a spotlight, motivating consideration of the warning information. Warning consideration increased risk perceptions, but also increased smoking myth endorsement. Emotional reactions to warnings decreased perceptions of cigarette danger relative to other products. CONCLUSIONS Emotional reactions to cigarette warnings increase smoking risk perceptions, but also smoking myth endorsement and misperceptions that cigarettes are less dangerous than potentially harm-reducing tobacco products.
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Affiliation(s)
- AT Evans
- Department of Psychology, The Ohio State University, Columbus, OH, USA
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - E Peters
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - AB Shoben
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - LR Meilleur
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - EG Klein
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - MK Tompkins
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - M Tusler
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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81
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Romer D, Ferguson SG, Strasser AA, Evans AT, Tompkins MK, Macisco J, Fardal M, Tusler M, Ellen P. Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption. Ann Behav Med 2018; 52:53-64. [PMID: 28488230 PMCID: PMC5680153 DOI: 10.1007/s12160-017-9916-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit. Purpose Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings. Methods Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking. Analyses examined the effects of pictorial versus text-only warnings and self-efficacy for quitting on cigarette consumption during and 1 month after the trial as mediated by emotional and cognitive responses as well as satisfaction with smoking. Results Stronger emotional responses to pictorial than text-only warnings predicted reduced satisfaction with smoking during the trial and lower cigarette consumption at follow-up among the majority of smokers who continued to smoke. Consistent with the efficacy-desire model, those with moderate efficacy reported the greatest reduction in consumption at follow-up. However, a small proportion of smokers (7%) who reported 7-day abstinence at follow-up did not exhibit a significant relation with self-efficacy. Conclusions Pictorial warning labels proposed by FDA create unfavorable emotional reactions to smoking that predict reduced cigarette use compared to text alone, with even smokers low in self-efficacy exhibiting some reduction. Predictions that low self-efficacy smokers will respond unfavorably to warnings were not supported.
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Affiliation(s)
- Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail T Evans
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | | | - Joseph Macisco
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Michael Fardal
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Martin Tusler
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Peters Ellen
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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82
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Klein EG, Quisenberry AJ, Shoben AB, Cooper S, Ferketich AK, Berman M, Peters E, Wewers ME. Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving. Nicotine Tob Res 2018; 19:1172-1177. [PMID: 28339596 DOI: 10.1093/ntr/ntx021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022]
Abstract
Introduction Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products. Methods A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall. Results Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08). Conclusions GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users. Implications Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.
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Affiliation(s)
| | | | | | - Sarah Cooper
- College of Public Health, Ohio State University, Columbus, OH
| | - Amy K Ferketich
- College of Public Health, Ohio State University, Columbus, OH
| | - Micah Berman
- College of Public Health, Ohio State University, Columbus, OH.,College of Law, Ohio State University, Columbus, OH
| | - Ellen Peters
- College of Arts and Sciences, Ohio State University, Columbus, OH
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83
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Evans AT, Peters E, Shoben AB, Meilleur LR, Klein EG, Tompkins MK, Romer D, Tusler M. Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers' Quit Intentions Relative to Text-Only Warnings. Nicotine Tob Res 2018; 19:1155-1162. [PMID: 28031378 DOI: 10.1093/ntr/ntw389] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022]
Abstract
Introduction Cigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion. Methods Nationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over 2 weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling. Results Participants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = 0.21; bTeen = 0.27, p's < .004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -0.18; bTeen = -0.22, p's < .018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult = 0.66; bTeen = 0.85, p's < .001) and greater quit intentions among adults (bAdult = 1.00, p < .001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions. Conclusion Warning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions versus text-only warnings. Implications This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions versus text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions versus text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers' risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.
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Affiliation(s)
- Abigail T Evans
- Department of Psychology, Ohio State University, Columbus, OH.,College of Public Health, Ohio State University, Columbus, OH
| | - Ellen Peters
- Department of Psychology, Ohio State University, Columbus, OH
| | | | | | | | | | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
| | - Martin Tusler
- Department of Psychology, Ohio State University, Columbus, OH
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84
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Shi Z, Wang AL, Emery LF, Sheerin KM, Romer D. The Importance of Relevant Emotional Arousal in the Efficacy of Pictorial Health Warnings for Cigarettes. Nicotine Tob Res 2017; 19:750-755. [PMID: 28003509 DOI: 10.1093/ntr/ntw322] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 11/30/2016] [Indexed: 11/12/2022]
Abstract
Introduction Warning labels for cigarettes proposed by Food and Drug Administration (FDA) were rejected by the courts partly because they were thought to be emotionally evocative but have no educational value. To address this issue, we compared three types of smoking warnings: (1) FDA-proposed warnings with pictures illustrating the smoking hazards; (2) warnings with the same text information paired with equally aversive but smoking-irrelevant images; and (3) text-only warnings. Methods Smokers recruited through Amazon's Mechanical Turk were randomly assigned to one of the three conditions. They reported how many cigarettes they smoked per day (CPD) during the past week and then viewed eight different warnings. After viewing each warning, they rated its believability and perceived ability to motivate quitting. One week later, 62.3% of participants again reported CPD during the past week, rated how the warnings they viewed the week before changed their feeling about smoking, rated their intention to quit in the next 30 days, and recalled as much as they could about each of the warnings they viewed. Results Compared to the irrelevant image and text-only warnings, FDA warnings were seen as more believable and able to motivate quitting and at the follow-up, produced lower CPD, worse feeling about smoking, and more memory for warning information, controlling for age and baseline CPD. Conclusions Emotionally evocative warning images are not effective in communicating the risks of smoking, unless they pertain to smoking-related hazards. In future versions of warning labels, pictorial contents should be pretested for the ability to enhance the health-hazard message. Implications Our study shows that contrary to court opinions, FDA-proposed pictorial warnings for cigarettes are more effective in communicating smoking-related hazards than warnings that merely contain emotionally aversive but smoking-irrelevant images. The suggestion that FDA's proposed warnings employed emotionally arousing pictures with no information value was not supported. Pictures that illustrate the risk carry information that enhances the persuasiveness of the warning. The congruence between pictures and text should be a criterion for selecting warning images in the future.
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Affiliation(s)
- Zhenhao Shi
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
| | - An-Li Wang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lydia F Emery
- Department of Psychology, Northwestern University, Evanston, IL
| | - Kaitlin M Sheerin
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA
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Hall MG, Sheeran P, Noar SM, Boynton MH, Ribisl KM, Parada H, Johnson TO, Brewer NT. Negative affect, message reactance and perceived risk: how do pictorial cigarette pack warnings change quit intentions? Tob Control 2017; 27:e136-e142. [PMID: 29248897 DOI: 10.1136/tobaccocontrol-2017-053972] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pictorial warnings on cigarette packs increase motivation to quit smoking. We sought to examine the potential mediating role of negative affect, message reactance (ie, an oppositional reaction to a message) and perceived risk in shaping quit intentions. METHODS In 2014 and 2015, we randomly assigned 2149 adult US smokers to receive either pictorial warnings or text-only warnings applied to their cigarette packs for 4 weeks. Analyses used structural equation modelling with bootstrapped SEs to test our theorised mediational model. FINDINGS Pictorial warnings increased negative affect, message reactance and quit intentions (all P<0.001), but not perceived risk (ie, perceived likelihood and severity of harms of smoking). Negative affect mediated the impact of pictorial warnings on quit intentions (mediated effect=0.16, P<0.001). Message reactance weakened the impact of pictorial warnings on quit intentions, although the effect was small (mediated effect=-0.04, P<0.001). Although pictorial warnings did not directly influence perceived risk, the model showed additional small mediation effects on quit intentions through negative affect and its positive association with perceived risk (mediated effect=0.02, P<0.001), as well as reactance and its negative association with perceived risk (mediated effect=-0.01, P<0.001). CONCLUSIONS Pictorial cigarette pack warnings increased quit intentions by increasing negative affect. Message reactance partially attenuated this increase in intentions. The opposing associations of negative affect and reactance on perceived risk may explain why pictorial warnings did not lead to observable changes in perceived risk.
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Affiliation(s)
- Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcella H Boynton
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Humberto Parada
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trent O Johnson
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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86
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Abstract
Can we educate decision makers to make better decisions? In the present paper, I argue that we can in at least two broad ways: (1) teaching concrete knowledge about a specific decision or decision type and (2) teaching more abstract decision-making competencies thought to lead to better decisions. Teaching knowledge can be done using decision aids and similar techniques that provide important information about a specific choice (e.g., a medical treatment option). In these cases, information presented using evidence-based techniques to improve comprehension and use of information will have greater effects on judgments and choices. Teaching more abstract decision competencies, on the other hand, involves formal schooling (with the bulk of formal education falling during childhood) or training in a specific competency important to decision processes and outcomes; I use numeracy interventions as an exemplar.
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87
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Cho YJ, Thrasher JF, Yong HH, Szklo AS, O'Connor RJ, Bansal-Travers M, Hammond D, Fong GT, Hardin J, Borland R. Path analysis of warning label effects on negative emotions and quit attempts: A longitudinal study of smokers in Australia, Canada, Mexico, and the US. Soc Sci Med 2017; 197:226-234. [PMID: 29096946 DOI: 10.1016/j.socscimed.2017.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cigarette pack health warning labels can elicit negative emotions among smokers, yet little is known about how these negative emotions influence behavior change. OBJECTIVE Guided by psychological theories emphasizing the role of emotions on risk concern and behavior change, we investigated whether smokers who reported stronger negative emotional responses when viewing warnings reported stronger responses to warnings in daily life and were more likely to try to quit at follow-up. METHODS We analyzed data from 5439 adult smokers from Australia, Canada, Mexico, and the US, who were surveyed every four months from September 2012 to September 2014. Participants were shown warnings already implemented on packs in their country and reported negative emotional responses (i.e., fear, disgust, worry), which were averaged (range = 1 to 9). Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Models were adjusted for socio-demographic and smoking-related characteristics, survey wave, and the number of prior surveys answered. RESULTS Smokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. There was no significant interaction of negative emotions with self-efficacy or nicotine dependence. CONCLUSION Negative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts.
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Affiliation(s)
- Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA; Department of Tobacco Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Hua-Hie Yong
- The Cancer Council Victoria, Carlton, Victoria, Australia
| | - André Salem Szklo
- Division of Epidemiology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Ron Borland
- The Cancer Council Victoria, Carlton, Victoria, Australia
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88
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The role of negative affect and message credibility in perceived effectiveness of smokeless tobacco health warning labels in Navi Mumbai, India and Dhaka, Bangladesh: A moderated-mediation analysis. Addict Behav 2017; 73:22-29. [PMID: 28441573 DOI: 10.1016/j.addbeh.2017.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE There is strong evidence showing that pictorial health warnings are more effective than text-only warnings. However, much of this evidence comes from high-income countries and is limited to cigarette packaging. Moreover, few studies have identified mechanisms that might explain the impact of warnings. METHODS The current study examined the potential mediating role of negative affect and the moderating influence of message credibility in perceived effectiveness of smokeless tobacco warnings in two low- and middle-income countries (LMICs). Field interviews were conducted in India and Bangladesh, with adult (19+ years) smokeless tobacco users (n=1053), and youth (16-18years) users (n=304) and non-users (n=687). Respondents were randomly assigned to view warnings in one of four conditions: (1) Text-only, (2) pictorial with symbolic imagery, (3) pictorial with graphic images of health effects, or (4) pictorial with personalized graphic images plus a personal testimonial. RESULTS The findings provide support for the mediating influence of negative affect in perceived effectiveness, for adult and youth smokeless tobacco users who viewed pictorial warnings (vs. text-only), and graphic health warnings (vs. personal testimonials). Among adults, message credibility moderated the indirect effect; the association was stronger when credibility was high and weaker when it was low. Among youth users and non-users, message credibility did not moderate the indirect effect. CONCLUSIONS Consistent with research from high-income countries, these findings highlight the importance of selecting imagery that will elicit negative emotional reactions and be perceived as credible. Differential effects among adults and youth highlight the importance of pre-testing images.
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89
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Francis DB, Hall MG, Noar SM, Ribisl KM, Brewer NT. Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments. Nicotine Tob Res 2017; 19:1127-1137. [PMID: 28431080 PMCID: PMC5896543 DOI: 10.1093/ntr/ntx082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to describe characteristics and psychometric properties of measures used in pictorial cigarette pack warning experiments and provide recommendations for future studies. METHODS Our systematic review identified 68 pictorial cigarette pack warning experiments conducted between 2000 and 2016 in 22 countries. Two independent coders coded all studies on study features, including sample characteristics, theoretical framework, and constructs assessed. We also coded measurement characteristics, including construct, number of items, source, reliability, and validity. RESULTS We identified 278 measures representing 61 constructs. The most commonly assessed construct categories were warning reactions (62% of studies) and perceived effectiveness (60%). The most commonly used outcomes were affective reactions (35%), perceived likelihood of harm (22%), intention to quit smoking (22%), perceptions that warnings motivate people to quit smoking (18%), and credibility (16%). Only 4 studies assessed smoking behavior. More than half (54%) of all measures were single items. For multi-item measures, studies reported reliability data 68% of the time (mean α = 0.88, range α = 0.68-0.98). Studies reported sources of measures only 33% of the time and rarely reported validity data. Of 68 studies, 37 (54%) mentioned a theory as informing the study. CONCLUSIONS Our review found great variability in constructs and measures used to evaluate the impact of cigarette pack pictorial warnings. Many measures were single items with unknown psychometric properties. Recommendations for future studies include a greater emphasis on theoretical models that inform measurement, use of reliable and validated (preferably multi-item) measures, and better reporting of measure sources. IMPLICATIONS Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the need for standardized, theory-based measures.
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Affiliation(s)
- Diane B Francis
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, LA
- School of Media and Journalism, University of North Carolina at Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC
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90
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Droulers O, Gallopel-Morvan K, Lacoste-Badie S, Lajante M. The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods. PLoS One 2017; 12:e0184415. [PMID: 28910317 PMCID: PMC5598963 DOI: 10.1371/journal.pone.0184415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
Abstract
The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used-for the first time in this context-to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers' emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.).
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Affiliation(s)
- Olivier Droulers
- IGR-IAE Graduate School of Management–CREM UMR 6211, University of Rennes 1, Rennes, France
| | | | | | - Mathieu Lajante
- Faculty of Business Administration—Marketing Department, Laval University, Quebec City, Québec
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91
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Mays D, Evans WD. The Effects of Gain-, Loss-, and Balanced-Framed Messages for Preventing Indoor Tanning among Young Adult Women. JOURNAL OF HEALTH COMMUNICATION 2017; 22:604-611. [PMID: 28598730 PMCID: PMC6085748 DOI: 10.1080/10810730.2017.1332119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Indoor tanning (IT) increases the risks of skin cancer, but evidence on how to design health education messaging targeting IT among young adult women remains limited. This study investigated the effects of theory-guided gain-, loss-, and balanced-framed IT prevention messages. Young adult women ages 18-30 who indoor tan (n = 552, mean age = 24.9 years [standard deviation = 3.1]) were recruited online, completed pre-exposure measures, and were randomized to view a gain-, loss-, or balanced-framed message. Participants completed post-exposure measures of message response (emotional response, message receptivity), IT risk (perceived severity, susceptibility), and efficacy (self-efficacy, perceived benefits of avoiding IT) beliefs, and IT behavioral intentions. Loss- and balanced-framed messages promoted significantly greater emotional response and message receptivity and lower IT behavioral intentions than gain-framed messages. The effects of loss- and balanced-framed messages on IT behavioral intentions were mediated by greater emotional response and message receptivity compared with the gain-framed message. These results can inform the development of public health education campaigns to prevent and reduce IT among young adult women. Future research can build from these findings by investigating additional message themes and tailoring strategies to maximize their effects, examining the effects of framed messages prospectively, and investigating ways to enhance message receptivity, such as through novel message delivery channels (e.g., mobile devices).
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Affiliation(s)
- Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street NW, Suite 4100, Washington, DC 20007, USA
- Correspondence to: D. Mays.
| | - W. Douglas Evans
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Avenue, NW, 2 floor, Washington, DC 20037, USA
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92
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Saddleson ML, Wileyto EP, Darwar R, Ware S, Strasser AA. The Importance of Filter Collection for Accurate Measurement of Cigarette Smoking. TOB REGUL SCI 2017; 3:248-257. [PMID: 30135863 PMCID: PMC6101261 DOI: 10.18001/trs.3.3.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We examined the impact of cigarette filter collection on reports of cigarettes per day (CPD) versus self-reported CPD and to assess the utility of a pre-intervention baseline period in smoking studies. METHODS Using baseline data from 522 non-treatment seeking smokers, we assessed differences in self-reported CPD via phone screen (CPD PS) and during baseline (CPD BL). We analyzed self-reported cigarette measures to predict carbon monoxide (CO), a measure of smoke exposure. RESULTS On average, CPD PS was 2.8 CPD more than CPD BL, and reporting multiples of 10 were more often found in CPD PS compared with CPD BL (54.7% vs17.2%, respectively). CPD BL was more strongly associated with CO than self-report CPD. Number of cigarettes smoked today, time since last cigarette, and nicotine dependence were significantly associated with CO. CONCLUSIONS CPD BL using filter collection is a more accurate measure of cigarette consumption than self-report, which may have implications for assessment of nicotine dependence. When feasible, studies should include a pre-intervention baseline period for comparison data with study outcomes. In addition to CPD BL, studies should assess time since last cigarette and the number of cigarettes smoked today when using CO as a biological measure of smoke exposure.
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Affiliation(s)
- Megan L Saddleson
- Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rahul Darwar
- Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Ware
- Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew A Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Kiviniemi MT, Ellis EM, Hall MG, Moss JL, Lillie SE, Brewer NT, Klein WM. Mediation, moderation, and context: Understanding complex relations among cognition, affect, and health behaviour. Psychol Health 2017; 33:98-116. [DOI: 10.1080/08870446.2017.1324973] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Marc T. Kiviniemi
- Department of Community Health and Health Behavior, University at Buffalo, SUNY, Buffalo, NY, USA
| | - Erin M. Ellis
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Marissa G. Hall
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer L. Moss
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
| | - Sarah E. Lillie
- Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - Noel T. Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC, USA
| | - William M.P. Klein
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA
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Cameron LD, Biesecker BB, Peters E, Taber JM, Klein WMP. Self-Regulation Principles Underlying Risk Perception and Decision Making within the Context of Genomic Testing. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017; 11. [PMID: 29225669 DOI: 10.1111/spc3.12315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Advances in theory and research on self-regulation and decision-making processes have yielded important insights into how cognitive, emotional, and social processes shape risk perceptions and risk-related decisions. We examine how self-regulation theory can be applied to inform our understanding of decision-making processes within the context of genomic testing, a clinical arena in which individuals face complex risk information and potentially life-altering decisions. After presenting key principles of self-regulation, we present a genomic testing case example to illustrate how principles related to risk representations, approach and avoidance motivations, emotion regulation, defensive responses, temporal construals, and capacities such as numeric abilities can shape decisions and psychological responses during the genomic testing process. We conclude with implications for using self-regulation theory to advance science within genomic testing and opportunities for how this research can inform further developments in self-regulation theory.
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Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior. Drug Alcohol Depend 2017; 173:99-106. [PMID: 28214392 PMCID: PMC5366263 DOI: 10.1016/j.drugalcdep.2016.12.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Tobacco advertising can create false beliefs about health harms that are reinforced by product design features. Reduced nicotine content (RNC) cigarettes may reduce harm, but research has not addressed advertising influences. This study examined RNC cigarette advertising effects on false harm beliefs, and how these beliefs - along with initial subjective ratings of RNC cigarettes - affect subsequent smoking behaviors. We further explored whether subjective ratings moderate associations between false beliefs and behavior. METHODS Seventy-seven daily, non-treatment-seeking smokers (66.2% male) participated in the first 15days of a randomized, controlled, open-label RNC cigarette trial. Participants viewed an RNC cigarette advertisement at baseline before completing a 5-day period of preferred brand cigarette use, followed by a 10-day period of RNC cigarette use (0.6mg nicotine yield). Participants provided pre- and post-advertisement beliefs, and subjective ratings and smoking behaviors for cigarettes smoked during laboratory visits. RESULTS Viewing the advertisement increased beliefs that RNC cigarettes contain less nicotine and are healthier than regular cigarettes (p's<0.001 and 0.011), and decreased the belief that they are less likely to cause cancer (p=0.046). Neither false beliefs nor subjective ratings directly affected smoking behaviors. Significant interactions of strength and taste ratings with beliefs (p's<0.001), however, indicated that among smokers with less negative initial subjective ratings, greater false beliefs were associated with greater RNC cigarette consumption. CONCLUSIONS Smokers may misconstrue RNC cigarettes as less harmful than regular cigarettes. These beliefs, in conjunction with favorable subjective ratings, may increase product use.
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96
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Cigarette graphic health warning labels and information avoidance among individuals from low socioeconomic position in the U.S. Cancer Causes Control 2017; 28:351-360. [PMID: 28255678 DOI: 10.1007/s10552-017-0875-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Although graphic health warning labels (GHWs) on cigarette packs have influenced cessation behaviors in other countries, no U.S. studies have explored the impact of avoidance of GHW content among individuals from low socioeconomic position (SEP). The purpose of this study was to determine the predictors of intention to avoid GHWs, and how avoidance impacts cessation intention, in a low SEP sample in the U.S. METHODS Data come from low SEP smokers (n = 541) involved in a field experiment. The participants responded to questions pre- and post viewing of GHWs assessing SEP, intention to avoid them, emotional reactions, and intention to seek health information or quit smoking. Backwards stepwise logistic regression determined the predictors for intention to avoid GHWs. Simple and adjusted logistic regression analyzed the association between avoidance and its main predictors and outcomes of intentions to seek information or quit smoking. RESULTS Predictors for avoidance included being somewhat addicted to cigarettes (OR 2.3, p = 0.002), younger than 25 (OR 2.6, p = 0.008), and having medium (OR 3.4, p < 0.001) or high (OR 4.7, p < 0.001) levels of negative emotional reaction to the labels. Intention to avoid GHWs was positively associated with the intent to look for health information about smoking (OR 2.2, p = 0.002). Higher levels of negative emotional reaction were positively associated with cessation behaviors, with high negative emotional reaction associated with nine times the odds of quitting (p < 0.001). CONCLUSIONS Results indicate avoidance of GHWs does not detract from the labels' benefit and that GHWs are an effective means of communicating smoking risk information among low SEP groups.
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97
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Icons for health effects of cigarette smoke: a test of semiotic type. J Behav Med 2017; 40:641-650. [PMID: 28220342 DOI: 10.1007/s10865-017-9833-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/29/2017] [Indexed: 10/20/2022]
Abstract
We sought to identify icons to effectively communicate health harms of chemicals in cigarette smoke. Participants were a convenience sample of 701 U.S. adults. A within-subjects online experiment explored the effects of icon semiotic type: symbolic (arbitrary, most abstract), indexical, and iconic (representative, most concrete). Outcomes were perceived representation, affect toward smoking, elaboration, perceived severity, and perceived effectiveness. For not-easy-to-visualize harms of cancer and addiction, symbolic icons received the highest ratings (all p < .001). For easy-to-visualize symptoms of heart attack/stroke, indexical icons received the highest ratings (all p < .001). For easy-to-visualize harm of reproductive organ damage, the iconic image did best (all p < .001). Icon type often had a larger impact among participants with higher health literacy. Symbolic icons may be most effective for health effects not easily visualized. Iconic or indexical icons may be more effective for health effects attributable to specific body parts or symptoms.
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98
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Guydish J, Tajima B, Le T, Henderson C, Yip D, Gruber V, Garcia W, Delucchi KL. Do cigarette graphic warnings encourage smokers to attend a smoking cessation programme: a quasi-experimental study. Tob Control 2016; 27:43-49. [PMID: 27913790 DOI: 10.1136/tobaccocontrol-2016-053207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study assessed whether exposure to cigarette graphic warning labels (GWLs) increased attendance to a smoking cessation programme. METHOD From 2014 to 2016, alternating cohorts of smokers in 3 residential drug treatment programmes received either GWLs (experimental) or transparent (control) labels placed on their cigarette packs for 30 days. The primary outcome was the proportion of participants who chose to attend a smoking cessation group after the labelling period. RESULTS The sample (N=601) was 72.6% male, with a mean age of 41.9 (SD=11.16) and included African-American (37%), White (29.4%) and Hispanic (19.6%) participants. While similar on most measures, controls were more likely to be married, had been in the treatment programme longer and registered higher on expired carbon monoxide (CO). After labelling, the proportion attending at least one cessation group was 26% in the experimental condition and 18.8% among controls. In an intent-to-treat analysis adjusting for group differences at baseline, and for 2 levels of nesting, those who received GWLs were more likely than controls to attend the smoking cessation group (OR=1.58, 95% CI 1.02 to 2.44). CONCLUSIONS Smokers who received GWLs on their cigarette packs were more likely to attend a cessation programme. Thus, this study is one of the first to document a change in a directly observed behavioural outcome as a function of month-long exposure to cigarette pack GWLs.
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Affiliation(s)
- Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Barbara Tajima
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Catherine Henderson
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Valerie Gruber
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | | | - Kevin L Delucchi
- Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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Abstract
The decision in RJ Reynolds vs. FDA (2012) to invalidate FDA's proposed graphic health warnings was based in part on the reasoning that the proposed graphic warnings cued emotional responses and therefore could not be considered "factual." However, this reasoning demonstrated the courts' fundamental misunderstanding of current behavioral-science research. In contrast to the courts' artificial separation of emotions from fact, we synthesize and interpret relevant research in basic decision sciences and describe an evidence-based characterization of how emotions influence consumer decision making through multiple mechanisms. We then explore how behavioral research gets "lost in translation" in the legal process and recommend ways that behavioral scientists can work with attorneys to remedy this problem. In order for science-based tobacco regulation to survive legal challenges from the tobacco industry, courts must have access to and be able to understand and apply the relevant research. Accordingly, behavioral laboratory researchers must consider the courts as an additional audience when designing research and reporting results. Researchers wishing to influence policy should also work closely with public health lawyers to have the greatest impact on the legal system.
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