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Ozarka E, Teddy L, Blank ML, Waa A, Hoek J. Managing Fear Responses: A Qualitative Analysis of Pictorial Warning Labels Five Years Post-Plain Packaging. Nicotine Tob Res 2024:ntae112. [PMID: 38839052 DOI: 10.1093/ntr/ntae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Although pictorial warning labels (PWLs) now dominate tobacco packages sold in many countries, few studies have probed how people who smoke respond to the threats presented several years post-plain packaging and larger PWLs. Understanding how people manage the fear and dissonance PWLs arouse, and the strategies they use to rationalize, diminish, and reject risk messages, could inform future PWL design. AIMS AND METHODS We undertook 27 in-depth interviews with people aged 18 and over (16 female, 8 Māori, and 13 aged ≤35) who smoked roll-your-own tobacco and lived in Aotearoa New Zealand. We probed participants' views on current PWLs and how they responded to these, then asked them to use alternative images and headlines to create new PWLs. We drew on the extended parallel processing model to interpret the data, which we analyzed using a reflexive thematic analysis approach. RESULTS People who smoke dislike PWLs, which they think reduce them to diseased body parts. While a minority thought existing PWLs were believable and effective, most reported avoiding PWLs by hiding or cognitively blocking them. Participants used diverse counterarguments to diminish PWLs' relevance and impact, and a minority displayed strong reactance. Several suggested developing PWLs that recognized them as whole people rather than patients in waiting, and recommended greater use of testimonials, particularly from people who had successfully become smoke free. CONCLUSIONS PWLs using more holistic and diverse messages could elicit greater engagement and responsiveness, and motivate cessation more effectively than existing health-oriented warnings. IMPLICATIONS Our findings suggest existing PWLs, which aim to arouse fear of ill health, could be complemented by warnings that emphasize the benefits of quitting. Continuing to use threat-based PWLs could stimulate greater rationalization and reactance. By contrast, PWLs that aim to illustrate how cessation could benefit people who smoke and their families, rather than instill a fear of disease, could avoid message rejection and counter-argument, and may prove a more powerful way of motivating cessation.
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Affiliation(s)
- Ellen Ozarka
- Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Lani Teddy
- Te Rōpū Rangahau Hauora a Eru Pōmare Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
| | - Andrew Waa
- Te Rōpū Rangahau Hauora a Eru Pōmare Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
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Vázquez-Otero C, Bekalu MA, Dhawan D, Viswanath K. Tobacco-control policy support among people from low socioeconomic positions in Massachusetts. Prev Med Rep 2023; 35:102336. [PMID: 37564123 PMCID: PMC10410238 DOI: 10.1016/j.pmedr.2023.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
People from low socioeconomic positions (SEP) are at a higher risk of smoking, face greater barriers to smoking cessation, and have lower access to health information. To improve tobacco-related health outcomes, policies requiring altering labeling on cigarette packs could be implemented. However, public support is needed to influence the policymaking process. We assessed factors associated with supporting tobacco-control communication policies. We analyzed data from Project CLEAR, a study conducted in Massachusetts. The analytic sample included participants who answered questions on their support for three policies: 1) graphic health warnings (GHWs), 2) Quitline number, and 3) smoking cessation information on cigarette packs (n = 357). Binomial logistic regression modeling was conducted by policy. Independent variables included demographic characteristics and smoking status. We found that younger vs. older individuals (aOR = 0.41, 95 %CI:0.23-0.72), males vs. females (aOR = 0.58, 95 %CI:0.35-0.96), and people who smoke vs. those who don't smoke (aOR = 0.41, 95 %CI:0.24-0.70) were less likely to support a law requiring GHWs. Participants with a low vs. higher level of education (aOR = 0.55, 95 %CI:0.32-0.95) were less likely to support a law requiring a Quitline number. Younger (18-39) vs. older individuals (aOR = 0.53, 95 %CI:0.29-0.94), males vs. females (aOR = 0.57, 95 %CI:0.34-0.96), and participants with a low vs. higher level of education (aOR = 0.56, 95 %CI:0.32-0.98) were less likely to support a law requiring cessation information on cigarette packs. Findings suggest that targeted theory-based public health and communication strategies should be developed to increase awareness and support towards policies that would help reduce cigarette smoking among people from low SEP to eliminate tobacco-related health inequities in the US.
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Affiliation(s)
- Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, TX, USA
| | - Mesfin A. Bekalu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dhriti Dhawan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
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Avery RJ, Kalaji M, Niederdeppe J, Mathios A, Dorf M, Byrne S, Safi AG. Perceived threat and fear responses to e-cigarette warning label messages: Results from 16 focus groups with U.S. youth and adults. PLoS One 2023; 18:e0286806. [PMID: 37352255 PMCID: PMC10289367 DOI: 10.1371/journal.pone.0286806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
AIMS A warning on e-cigarette packaging is one way the U.S. government can inform the public of known harms of e-cigarette use. Currently, the only required warning on these products is: "WARNING: This product contains nicotine. Nicotine is an addictive chemical." This exploratory study aims to inform potential future investigations and FDA decisions regarding alternative warnings that may generate fear in addition to being intentionally informational. METHOD Data were obtained from responses by 16 online focus groups with adult (N = 47, age range = 18-64) and youth (N = 32, age range 14-16) participants with various smoking and vaping experiences. We showed each focus group a set of hypothetical e-cigarette warning labels to determine how they respond to currently existing public statements that communicate information on the toxicity of ingredients in e-cigarettes, potential health risks, addiction to nicotine, and the uncertainty of the science regarding health effects of using these products. The focus group interviews were audio recorded and transcribed. Transcripts were subjected to a multiphase coding process to identify common response themes. Codes derived from the Extended Parallel Processing Model were then applied to understand impact of potentially fear-inducing language by warning category and age group. RESULTS For adults, all warnings-except those about addiction-gave rise to spontaneous danger control (intended) responses, such as quit intentions. Warnings highlighting cognitive and uncertain effects may be particularly promising for adult consumers of tobacco products because both gengerated danger control and response efficacy without evidence of fear control. However, responses also suggest that warnings risk discouraging some adults who use combustible cigarettes from transitioning to e-cigarettes for harm reduction. For youth, while evidence of response efficacy and danger control emerged among youth exposed to messages in all warning categories but one-addiction-unproductive reactions indicative of fear control were also prevalent among youth respondent across most warning types. On average, youth were more skeptical than adults about the harms of using e-cigarettes. POLICY IMPLICATIONS Implications of study findings for the development of future effective e-cigarette warning messages are explored.
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Affiliation(s)
- Rosemary J. Avery
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, United States of America
| | - Motasem Kalaji
- Department of Communication Studies, California State University, Northridge, Los Angeles, CA, United States of America
| | - Jeff Niederdeppe
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, United States of America
- Department of Communication, Cornell University, Ithaca, NY, United States of America
| | - Alan Mathios
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, United States of America
- Department of Economics, Cornell University, Ithaca, NY, United States of America
| | - Michael Dorf
- Law School, Cornell University, Ithaca, NY, United States of America
| | - Sahara Byrne
- Department of Communication, Cornell University, Ithaca, NY, United States of America
| | - Amelia Greiner Safi
- Department of Communication, Cornell University, Ithaca, NY, United States of America
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States of America
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Sultana T, Dhillon G, Oliveira T. The effect of fear and situational motivation on online information avoidance: The case of COVID-19. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2023; 69:102596. [PMID: 36415624 PMCID: PMC9671792 DOI: 10.1016/j.ijinfomgt.2022.102596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/22/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
During the COVID-19 pandemic, a plethora of online sources for information and news dissemination have emerged. Extant research suggests that very quickly, individuals become disinterested and begin avoiding the information. In this study, we investigate how an individual's fear and situational motivation impact Online Information Avoidance. Using the self-determination theory and information avoidance theories, we argue that fear and external regulation are associated with increased Online Information Avoidance. We also argue that intrinsic motivation and identified regulation are associated with a decrease in Online Information Avoidance. Our findings suggest that fear, intrinsic motivation, and external regulation drive Online Information Avoidance, where intrinsic motivation is the most significant driver. We also found that identified regulation is a crucial inhibitor of Online Information Avoidance. While focusing on COVID-19, our study contributes to the broader information systems research literature and specifically to the information avoidance literature during a pandemic or a prolonged crisis. Our study's findings will be useful for governments, health organizations, and communities that utilize online platforms, forums, and related outlets to reach larger audiences for disseminating pertinent information and recommendations during a crisis.
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Affiliation(s)
- Tahmina Sultana
- Information Systems and Supply Chain Management, University of North Carolina Greensboro, Greensboro, United States
- Information Technology and Decision Sciences, University of North Texas, Denton, United States
| | - Gurpreet Dhillon
- Information Technology and Decision Sciences, University of North Texas, Denton, United States
| | - Tiago Oliveira
- NOVA Information Management School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Usidame B, Meng G, Thrasher JF, Thompson ME, Fong GT, Fleischer NL. The Differential Impact of the 2000 Canadian Graphic Warning Label Policy on Smoking Prevalence by Sex and Education: A Difference-in-Difference-in-Difference Model. Nicotine Tob Res 2022; 24:1732-1740. [PMID: 35536724 PMCID: PMC9597072 DOI: 10.1093/ntr/ntac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Using a quasiexperimental design, we compared the impact of the 2000 Canadian introduction of graphic warning labels (GWLs) on differences in smoking prevalence by sex and education, to the United States, where no GWLs were introduced. METHODS We pooled 1999-2004 data from the Canadian Tobacco Use Monitoring Survey and the U.S. Behavioral Risk Factor Surveillance System. We used a difference-in-difference (DD) model to assess the impact of Canadian policy introduction on smoking prevalence, and a difference-in-difference-in-difference (DDD) model to examine differences in the policy impact by sex and education, comparing Canada (the treatment group) with the United States (the control group). RESULTS From 1999 to 2004, smoking prevalence decreased from 23.7% to 18.6% in Canada, and from 21.7% to 20.0% in the United States. Results from the DD regression models showed that Canadian respondents reported lower odds of being a current smoker compared to the U.S. respondents following the 2000 introduction of GWLs (OR = 0.84, 95% CI = 0.74-0.94). The DDD model showed that the impact of the Canadian GWLs versus the United States did not differ by sex or education. CONCLUSIONS The 2000 Canadian GWL policy reduced smoking prevalence overall, with similar reductions for males and females and across education levels. The impact of the Canadian GWLs in reducing smoking prevalence did not reduce differences by sex or education. Although beneficial for all smokers, GWLs may not serve to decrease existing disparities, especially those by socioeconomic status. IMPLICATIONS Existing evidence shows that GWL implementation is associated with reductions in smoking prevalence. But there is limited evidence from past evaluation studies on whether the impact of GWLs on smoking prevalence differs by sociodemographic subgroup. Our findings confirm existing studies that the 2000 implementation of GWLs in Canada was significantly associated with an overall reduction in smoking prevalence in Canada compared to the United States. However, our study improves existing evidence by showing that the impact of the Canadian GWLs on smoking prevalence did not differ by sex or education, and thus did not reduce existing smoking disparities by educational levels.
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Affiliation(s)
- Bukola Usidame
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Mary E Thompson
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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Ding Q, Gu Y, Zhang G, Li X, Zhao Q, Gu D, Yang X, Wang X. What Causes Health Information Avoidance Behavior under Normalized COVID-19 Pandemic? A Research from Fuzzy Set Qualitative Comparative Analysis. Healthcare (Basel) 2022; 10:1381. [PMID: 35893203 PMCID: PMC9331662 DOI: 10.3390/healthcare10081381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/20/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Affected by the normalization of the COVID-19 pandemic, people's lives are subject to many restrictions, and they are under enormous psychological and physical pressure. In this situation, health information may be a burden and cause of anxiety for people; thus, the refusal of health information occurs frequently. Health-information-avoidance behavior has produced potential impacts and harms on people's lives. Based on more than 120,000 words of textual data obtained from semi-structured interviews, summarizing a case collection of 55 events, this paper explores the factors and how they combine to lead to avoidance of health information. First, the influencing factors are constructed according to the existing research, and then the fuzzy set qualitative comparative analysis (fsQCA) method is used to discover the configuration relationship of health-information-avoidance behavior. The results show that the occurrence of health-information avoidance is not the result of a single factor but the result of a configuration of health-information literacy, negative emotions, perceived information, health-information presentation, cross-platform distribution, and the network information environment. These findings provide inspiration for reducing the adverse consequences of avoiding health information and improving the construction of health-information service systems.
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Affiliation(s)
- Qingxiu Ding
- School of Management, Hefei University of Technology, Hefei 230009, China; (Q.D.); (G.Z.); (X.L.); (X.Y.)
| | - Yadi Gu
- Mental Health Education and Counseling Center, University of Shanghai for Science and Technology, Shanghai 200093, China;
| | - Gongrang Zhang
- School of Management, Hefei University of Technology, Hefei 230009, China; (Q.D.); (G.Z.); (X.L.); (X.Y.)
| | - Xingguo Li
- School of Management, Hefei University of Technology, Hefei 230009, China; (Q.D.); (G.Z.); (X.L.); (X.Y.)
| | - Qin Zhao
- School of Foreign Studies, Hefei University of Technology, Hefei 230009, China;
| | - Dongxiao Gu
- School of Management, Hefei University of Technology, Hefei 230009, China; (Q.D.); (G.Z.); (X.L.); (X.Y.)
| | - Xuejie Yang
- School of Management, Hefei University of Technology, Hefei 230009, China; (Q.D.); (G.Z.); (X.L.); (X.Y.)
| | - Xiaoyu Wang
- The Department of Pharmacy of the 1st Affiliated Hospital, Anhui University of Chinese Medicine, Hefei 230031, China
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7
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Sun H, Li J, Cheng Y, Pan X, Shen L, Hua W. Developing a framework for understanding health information behavior change from avoidance to acquisition: a grounded theory exploration. BMC Public Health 2022; 22:1115. [PMID: 35658937 PMCID: PMC9166210 DOI: 10.1186/s12889-022-13522-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health information avoidance is common in real life, but because it is not always conducive to health promotion and maintenance, people often actively switch to health information acquisition. Understanding this process of active change can facilitate intervention in unreasonable avoidance behaviors. However, studies so far have mostly focused on why and how avoidance takes place, little is known about the process of active change from avoidance to acquisition. We thus use a grounded theory approach (GT) to explore how the active change takes place, and to generate a grounded theoretical framework capable of illustrating stages and influencing factors involved in the active change process. METHODS Straussian grounded theory (Corbin & Strauss, 2015) was used to analyze data collected through semi-structured interviews with 30 adults (14 in good health, 11 with disease, 5 in other health status) who had experienced health information behavior change from avoidance to acquisition. These interviews focused on how the change occurred and what effected the change. RESULTS The core category of Health Information Avoidance Change and 12 categories were identified and integrated to form a theoretical framework termed the Health Information Avoidance Change Model (HIACM). This model describes the process using five non-linear stage variables (initiation, preparation, action, maintenance, and abandonment) and seven moderating factor variables (cognitive change, social stimulus, beliefs and attitudes, intrapsychic literacy, social resources, information source, time and material resources). CONCLUSIONS HIACM can be used to explain the process of active change from health information avoidance to health information acquisition. HIAC is a non-linear and holistic process, and it is necessary to dynamically analyze the impact of relevant factors and take targeted intervention measures in stages. HIAC is usually not only an individual behavior, but also a socialized behavior requiring the collaboration of individuals, families, health information providers, healthcare providers, and governments.
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Affiliation(s)
- Haixia Sun
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Jiao Li
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Ying Cheng
- School of Information Management, Nanjing University, Nanjing, China
| | - Xuelian Pan
- School of Information Management, Nanjing University, Nanjing, China
| | - Liu Shen
- Institute of Medical Information & Library, Chinese Academy of Medical Sciences / Peking Union Medical College, Beijing, China
| | - Weina Hua
- School of Information Management, Nanjing University, Nanjing, China
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van Meurs T, Çoban FR, de Koster W, van der Waal J, Oude Groeniger J. Why are anti-smoking health-information interventions less effective among low-socioeconomic status groups? A systematic scoping review. Drug Alcohol Rev 2022; 41:1195-1205. [PMID: 35384097 DOI: 10.1111/dar.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022]
Abstract
ISSUES This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti-smoking health-information interventions (HII) among low-socioeconomic status (SES) adults in high-income countries. APPROACH We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low-SES adults of anti-smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low-SES effects, equity effects, proposed explanations and whether these were studied empirically. KEY FINDINGS Thirty-eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low-SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self-efficacy. IMPLICATIONS Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti-smoking HIIs for low-SES adults. CONCLUSIONS To our knowledge, this is the first review to explore the explanations proposed for why anti-smoking HIIs are (in)effective among low-SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti-smoking interventions.
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Affiliation(s)
- Tim van Meurs
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Feray R Çoban
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Willem de Koster
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen van der Waal
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Joost Oude Groeniger
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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Clarke N, Pechey E, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels on snack selection: An online experimental study. Appetite 2020; 154:104744. [PMID: 32562806 PMCID: PMC7450271 DOI: 10.1016/j.appet.2020.104744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels - particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK.
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Marcus R Munafò
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Song S, Yao X, Wen N. What motivates Chinese consumers to avoid information about the COVID-19 pandemic?: The perspective of the stimulus-organism-response model. Inf Process Manag 2020; 58:102407. [PMID: 33041437 PMCID: PMC7536537 DOI: 10.1016/j.ipm.2020.102407] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/26/2022]
Abstract
This study investigated consumers' information-avoidance behavior in the context of a public health emergency-the COVID-19 pandemic in China. Guided by the stimulus-organism-response paradigm, it proposes a model for exploring the effects of external stimuli (perceived threat and perceived information overload) related to COVID-19 on consumers' internal states (sadness, anxiety, and cognitive dissonance) and their subsequent behavioral intentions to avoid health information and engage in preventive behaviors. With a survey sample (N = 721), we empirically examined the proposed model and tested the hypotheses. The results indicate that sadness, anxiety, and cognitive dissonance, which were a result of perceived threat and perceived information overload, had heterogeneous effects on information avoidance. Anxiety and cognitive dissonance increased information avoidance intention, while sadness decreased information avoidance intention. Moreover, information avoidance predicted a reluctance on the part of consumers to engage in preventive behaviors during the COVID-19 pandemic. These findings not only contribute to the information behavior literature and extend the concept of information avoidance to a public health emergency context, but also yield practical insights for global pandemic control.
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Affiliation(s)
- Shijie Song
- School of Information Management, Nanjing University, Nanjing, China
| | - Xinlin Yao
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, China
| | - Nainan Wen
- School of Journalism and Communication, Nanjing University, Nanjing, China
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Katyal T, Durazo A, Hartman-Filson M, Vijayaraghavan M. Responses to Graphic Warning Labels among Low-income Smokers. Am J Health Behav 2020; 44:603-616. [PMID: 33121579 PMCID: PMC7994008 DOI: 10.5993/ajhb.44.5.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Graphic warning labels (GWLs) are effective in communicating tobacco-related harms. Methods: In this mixed-methods study, we used purposive sampling to recruit 100 low-income smokers in the San Francisco Bay Area between October 2017 and February 2018 to participate in an intervention promoting smoke-free homes. We presented the 2009 Food and Drug Administration-proposed GWLs and explored perceptions of affect, efficacy, and appeal using questionnaires at baseline, 3- and 6-months follow-up. Because of participants' interest in this topic, we subsequently conducted a qualitative sub-study among 20 participants exploring perceived efficacy of GWLs on smoking cessation. Results: In all, 87.3% and 59.2% agreed that GWLs were useful and would motivate cessation behaviors, respectively, at baseline. We found that the most common responses were shock (61.8%) and disgust (55.3%), whereas anger (29.0%) and annoyance (19.7%) were less common. Participants also reported that GWLs unequivocally illustrating smoking's harmful effects were more appealing than non-specific images, as were images that depicted positive cessation-related effects. Conclusions: GWLs appear to be an important health communication among low-income smokers. Future studies on GWLs should examine the association of negative affect and cessation among this population.
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Affiliation(s)
- Toshali Katyal
- School of Public Health, University of California, Berkeley, CA
| | - Arturo Durazo
- Postdoctoral Fellow, Center for Tobacco Control Research and Education, University of California, San Francisco, CA
| | - Marlena Hartman-Filson
- Assistant Professor, Division of General Internal Medicine, University of California, San Francisco, CA
| | - Maya Vijayaraghavan
- Assistant Professor, Division of General Internal Medicine, University of California, San Francisco, CA;,
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Borawska A, Oleksy T, Maison D. Do negative emotions in social advertising really work? Confrontation of classic vs. EEG reaction toward advertising that promotes safe driving. PLoS One 2020; 15:e0233036. [PMID: 32413058 PMCID: PMC7228072 DOI: 10.1371/journal.pone.0233036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Social campaigns are persuasive messages that attempt to communicate positive ideas and practices. One of the main challenges in designing effective social campaigns is the need to compete with other advertisements for viewers' attention. One of the most widely used methods of drawing attention to social advertising is the use of negative emotions. However, the effectiveness of negative emotional appeals in social campaigns is still a topic of debates. The aim of the study was to use both declarative and neural (EEG) measures to examine whether increasing the intensity of negative emotions in a social campaign enhances its effectiveness linearly or only to a certain level (curvilinear relation). The experimental study was conducted (N = 62) with road safety campaign, using three different levels of negative emotional intensity. The results showed that even though advertising with the strongest negative stimuli evoked the strongest negative emotions, it had no significantly stronger influence on behavioral intention (driving less risky) than moderately negative stimuli. Moreover, neural reaction to the negative stimuli in advertising depended on driving style-people with risky driving style payed less attention to more threatening message (higher beta oscillations).
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Affiliation(s)
- Anna Borawska
- Faculty of Finance, Economics and Management, University of Szczecin, Szczecin, Poland
| | - Tomasz Oleksy
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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Brewer NT, Jeong M, Hall MG, Baig SA, Mendel JR, Lazard AJ, Noar SM, Kameny MR, Ribisl KM. Impact of e-cigarette health warnings on motivation to vape and smoke. Tob Control 2019; 28:tobaccocontrol-2018-054878. [PMID: 31292169 PMCID: PMC6824616 DOI: 10.1136/tobaccocontrol-2018-054878] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/07/2019] [Accepted: 03/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND A prevailing hypothesis is that health warnings for electronic cigarettes (e-cigarettes) could drive people away from vaping and towards smoking cigarettes. We consider an alternative hypothesis that e-cigarette warnings discourage both vaping and smoking. METHODS Participants were a national convenience sample of 2218 US adults who used e-cigarettes, cigarettes or both. In August 2018, we randomised participants to one of three warning types (control text about littering, text-only e-cigarette warning or pictorial e-cigarette warning). We further randomised participants viewing e-cigarette warnings to one of three topics (nicotine addiction, health hazards of use, or both health hazards and harms of use). The preregistered primary outcome was intentions to quit vaping among e-cigarette users. Secondary outcomes included interest in smoking and Tobacco Warnings Model constructs: attention, negative affect, anticipated social interactions and cognitive elaboration. RESULTS Text warnings elicited higher intentions to quit vaping than control among e-cigarette users (d=0.44, p<0.001), and pictorial warnings elicited still higher intentions to quit vaping than text (d=0.12, p<0.05). Text warnings elicited lower interest in smoking compared with control among smokers (p<0.05); warnings had no other effects on interest in smoking among smokers or non-smokers. Text warnings about health hazards elicited higher intentions to quit vaping than nicotine addiction warnings. E-cigarette warnings also increased Tobacco Warnings Model constructs. DISCUSSION E-cigarette health warnings may motivate users to quit vaping and discourage smoking. The most promising warnings include health hazards (other than nicotine addiction) and imagery. We found no support for the hypothesis that e-cigarette warnings could encourage smoking cigarettes.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle Jeong
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sabeeh A Baig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Sociomedical Science, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Madeline R Kameny
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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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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