1
|
Massey ZB, Li Y, Zhang T, Duong HT. Exploring the effects of cannabis health warnings on protective health intentions among US adults in legal recreational states. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104450. [PMID: 38749214 PMCID: PMC11232112 DOI: 10.1016/j.drugpo.2024.104450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As cannabis policy trends toward liberalization, assessing cannabis health warning effects becomes increasingly important. This study investigated underlying mechanisms accounting for the effectiveness of cannabis health warnings on protective health intentions. METHOD A sample of 1,095 adults (21+) living in legal recreational US states who reported using cannabis in the past 12 months participated in an online experiment. Participants were randomly assigned to view cannabis health warnings that described risks of impaired driving, mental health, and smoke exposure and varied pictures and text (vs. text-only) attributes in warnings. Outcomes were message reactions (cognitive elaboration, fear, and hope), attitudes and beliefs (perceived severity of cannabis harms and perceived susceptibility to cannabis harms, and perceived response and self-efficacy to prevent cannabis harms), and protective health intentions (information-seeking about cannabis health effects and having interpersonal discussions about cannabis harms with family, friends, and medical professionals). RESULTS MANCOVA results showed no significant differences between text-only vs. pictorial attributes on protective health intentions; thus, warning conditions were controlled and analyzed using structural equation modeling (SEM). SEM results showed that attention to cannabis health warnings (text-only or pictorial) elicited higher cognitive elaboration, fear, and hope-an emotion associated with coping actions that motivate positive expectations of future events. These outcomes, in turn, were associated with greater perceived severity and susceptibility and greater perceived response efficacy, respectively. Hope, perceived severity, and perceived response and self-efficacy were independently associated with greater intentions to seek information about cannabis health effects and to discuss cannabis health harms. CONCLUSION Attention to warnings impacted emotions, attitudes, and protective health intentions. Fear is commonly associated with health warning effects, and our results suggest that hope is also an important factor. This research contributes to understanding the effects of cannabis health warnings and can inform regulatory agencies that mandate warnings on cannabis products.
Collapse
Affiliation(s)
- Zachary B Massey
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City, OK, USA; Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.
| | - Yachao Li
- Departments of Communication Studies & Public Health, The College of New Jersey, Ewing Township, NJ, USA
| | - Tianting Zhang
- School of Journalism, University of Missouri, Columbia, MO, USA
| | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
2
|
Popova L, Massey ZB, Giordano NA. Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications. Annu Rev Public Health 2024; 45:425-442. [PMID: 38166502 DOI: 10.1146/annurev-publhealth-060922-042254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.
Collapse
Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA;
| | - Zachary B Massey
- School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
3
|
Gantiva C, Illidge-Cortes J, González-Millares D, Maldonado-Hoyos V, Valencia L. Health warning labels on cannabis products. What is the best design? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104355. [PMID: 38382352 DOI: 10.1016/j.drugpo.2024.104355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Health warning label on cannabis products has been recently studied, and with the latest trends of regulation around the world, there is a need to determine the most effective ways to apply this strategy. The current study aimed to examine the effects of different health warning label designs (pictorial vs text-only, background color, warning themes) on cannabis products. METHODS An online experiment study (N=533) was carried out in Colombia with a between-subject design. Participants were randomly assigned to five package conditions: without warning, text-only white warning, text-only yellow warning, pictorial white warning, and pictorial yellow warning. Participants performed an attention task and rated each of the stimuli based on product appeal, perceived addictiveness, harm perception, and interest in trying cannabis products. RESULTS Pictorial health warnings were generally the most effective. Especially, pictorial health warnings with a yellow background were found to decrease product appeal and interest in trying cannabis products, as well as increase harm perception compared to other designs. The most effective warning themes were mental health, smoke toxicity, aesthetic implications, and traffic accidents. CONCLUSION The current study provides empirical evidence on the effectiveness of different designs of cannabis health warnings. Our results suggest that graphic yellow warnings are the most effective in communicating the risks of cannabis use.
Collapse
|
4
|
Yang S, Cotter LM, Lu L, Kriss LA, Minich M, Liu J, Silver LD, Cascio CN. Countering online marketing and user endorsements with enhanced cannabis warning labels: An online experiment among at-risk youth and young adults. Prev Med 2024; 180:107877. [PMID: 38266719 DOI: 10.1016/j.ypmed.2024.107877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/20/2023] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
As cannabis legalization expands and online marketing intensifies, this study examines whether online social cues can amplify youth-targeted cannabis advertising and whether cannabis warning labels (CWLs) can counteract these influences. A U.S. online sample of 970 adolescents and 1776 young adults susceptible to cannabis use were recruited from Qualtrics in summer 2022. Each participant was randomly assigned to one of the 3 (CWLs: none vs. textual vs. pictorial) by 3 (comments: none vs. anti-cannabis vs. pro-cannabis) conditions in an online experiment. Participants were exposed to three online marketing posts promoting marijuana edibles (randomly selected from a large pool, N = 1260), each with either no warning label, a textual warning, or a pictorial warning (text and picture), and with either five comments (pro- or anti-cannabis in valence) or none. Results showed that among adolescents, pro-cannabis comments increased product appeal (vs. anti-cannabis comments: b = 0.18, p = .025; vs. no comments: b = 0.21, p = .021), and did so more than young adults. For adolescents, only pictorial warnings reduced product appeal (b = -0.20, p = .028). For young adults, both pictorial (b = -0.18, p = .002) and textual warnings (b = -0.12, p = .029) reduced product appeal. Furthermore, both textual (adolescents: b = -0.20, p = .004; young adults: b = -0.15, p = .005) and pictorial (adolescents: b = -0.30, p < .001; young adults: b = -0.18, p = .001) warnings reduced cannabis use intentions. Findings support requiring enhanced CWLs accompany online marketing ads.
Collapse
Affiliation(s)
- Sijia Yang
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America.
| | - Lynne M Cotter
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Linqi Lu
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Lauren A Kriss
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America; UT Center for Health Communication, Austin, TX, United States of America
| | - Matt Minich
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| | - Jiaying Liu
- Department of Communication, University of California, Santa Barbara, CA, United States of America
| | - Lynn D Silver
- Public Health Institute, Oakland, CA, United States of America
| | - Christopher N Cascio
- School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, United States of America
| |
Collapse
|
5
|
Massey ZB, Hammond D, Froeliger B. A systematic review of cannabis health warning research. Prev Med Rep 2024; 37:102573. [PMID: 38222305 PMCID: PMC10787239 DOI: 10.1016/j.pmedr.2023.102573] [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: 10/10/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024] Open
Abstract
Background Cannabis legalization provides an opportunity to communicate with consumers through mandated health warnings on cannabis packaging. However, research on cannabis health warnings is a nascent field. Therefore, a review is needed to synthesize cannabis health warning research and inform ongoing policy discussions. Methods This paper used systematic review guidelines to search online databases, including PubMed Central, Scopus, Web of Science, Jstor, Communication and Mass Media Complete, Medline, PsycINFO, and Google Scholar. Search strings combined the terms "cannabis" or "marijuana" with "health warning" or "health warning message" or "warning label" or "health warning label" or "health information label." Results were synthesized narratively. Results The search identified 90 research articles. After screening, 17 studies on the impact of cannabis health warnings were retained. Retained studies focused on the hypothetical effects of cannabis health warnings (n = 11; 64.7 %) and "real world" effects of implementing warnings post-legalization (n = 6; 35.3 %). Evidence indicated mandated cannabis health warnings improved noticing and recall of health warning content. Cannabis health warnings describing risks of addiction were consistently rated the least effective. Pictorial cannabis health warnings generally outperformed text-only warnings when displayed on their own, while experiments with warnings on products had mixed results. Cannabis health warnings decreased product appeal, mainly when package branding was minimized. Conclusions Health warnings on cannabis packaging are an important strategy to communicate risk to consumers. Mandating warnings increased notice, recall, and health knowledge. Warnings with pictures and describing specific risks were most effective, as was showing warnings without product branding.
Collapse
Affiliation(s)
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Brett Froeliger
- Department of Psychiatry & Psychological Sciences, University of Missouri, Columbia, MO, USA
| |
Collapse
|
6
|
Tveleneva A, Kim SJ, Minich M, Liu J, Padon A, Silver L, Yang S. Yet Again Conversations Matter: The Importance of Interpersonal Discussions, Educational Campaigns, and Advertising on Cannabis-Related Risk Perceptions, Attitudes, and Intentions in At-Risk Young Adults. JOURNAL OF HEALTH COMMUNICATION 2022; 27:717-726. [PMID: 36475420 DOI: 10.1080/10810730.2022.2153291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The present study seeks to evaluate the relationships between cannabis-related communication and outcomes of interest such as cannabis-related risk perceptions, attitudes, and behaviors among young adults. Young adults who were at risk for cannabis use were surveyed online in 2020. Results showed that exposure to online educational messages was associated with higher intentions of engaging in peer intervention, while exposure to online advertising was related to higher intention to use cannabis. Anti-cannabis interpersonal discussion was associated with increased risk perceptions, less favorable cannabis attitudes, and a higher likelihood of peer intervention. More pro-cannabis interpersonal discussion was associated with decreased risk perceptions, more favorable cannabis attitudes, higher use intention, and decreased likelihood of peer intervention. In addition, pro-cannabis interpersonal discussion mediated the relationship between exposure to advertising and cannabis risk perceptions, intentions to use cannabis, attitudes about cannabis, and the likelihood of peer intervention. In contrast, anti-cannabis interpersonal discussion mediated the relationship between exposure to educational messages online and cannabis risk perceptions and the likelihood of peer intervention. These findings underscore the need to regulate online cannabis marketing and the importance of investing in online education campaigns to increase public understanding of the risks associated with cannabis consumption in young adulthood.
Collapse
Affiliation(s)
- Arina Tveleneva
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sang Jung Kim
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Matt Minich
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jiaying Liu
- Department of Communication Studies, University of Georgia, Athens, Georgia, USA
| | - Alisa Padon
- Public Health Institute, Oakland, California, USA
| | - Lynn Silver
- Public Health Institute, Oakland, California, USA
| | - Sijia Yang
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|