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Kaai SC, Sansone G, Meng G, Ong'ang'o JR, Goma F, Ikamari L, Quah ACK, Fong GT. Quasi-experimental evaluation of Kenya's pictorial health warnings versus Zambia's single text-only warning: findings from the International Tobacco Control (ITC) Project. Tob Control 2023; 32:139-145. [PMID: 34117097 PMCID: PMC9985766 DOI: 10.1136/tobaccocontrol-2020-056396] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/13/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Population studies in mostly high-income countries have shown that pictorial health warnings (PHWs) are much more effective than text-only warnings. This is the first quasi-experimental evaluation of the introduction of PHWs in Africa, comparing the change from text-only to PHWs in Kenya to the unchanged text-only health warning in Zambia. METHODS Data were from International Tobacco Control (ITC) Surveys in Kenya (n=1495), and Zambia (n=1628), cohort surveys of nationally representative samples of adult smokers in each country. The ITC Kenya Survey was conducted in 2012 and 2018 (2 years after the 2016 introduction of three PHWs). The ITC Zambia Survey was conducted in 2012 and 2014 with no change to the single text-only warning. Validated indicators of health warning effectiveness (HWIs) (salience: noticing, reading; cognitive reactions: thinking about health risks, thinking about quitting; and behavioural reactions: avoiding warnings; forgoing a cigarette because of the warnings), and a summary measure-the Labels Impact Index (LII)-measured changes in warning impact between the two countries. RESULTS PHWs implemented in Kenya led to a significant increase in all HWIs and the LII, compared with the text-only warning in Zambia. The failure to implement PHWs in Zambia led to a substantial missed opportunity to increase warning effectiveness (eg, an estimated additional 168 392 smokers in Zambia would have noticed the warnings). CONCLUSIONS The introduction of PHWs in Kenya substantially increased the effectiveness of warnings. These results provide strong empirical support for 34 African countries that still have text-only warnings, of which 31 are Parties of the Framework Convention on Tobacco Control and are thus obligated to implement PHWs.
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Affiliation(s)
- Susan Cherop Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada .,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Genevieve Sansone
- Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Jane Rahedi Ong'ang'o
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Fastone Goma
- School of Medicine, University of Zambia, Lusaka, Zambia.,Centre for Primary Care Research, Eden University, Lusaka, Zambia
| | - Lawrence Ikamari
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Vaihekoski A, Lagström H, Eloranta S, Bäärs S, Hannula A, Lehvikkö M, Salakari M. Influencing adolescents’ attitudes towards nicotine products: A systematic review. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 39:568-584. [PMID: 36284743 PMCID: PMC9549219 DOI: 10.1177/14550725221096908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background and aim: Use of nicotine can harm adolescents’ brains and
increase risk for future addiction to other drugs. Several international studies
show that an acceptable attitude towards nicotine products increases the
initiation or use of the products. Adolescents have limited or distorted
knowledge about nicotine products. Many of them have a positive image of the
properties and effects of nicotine products, which increases the chances of
smoking or using snus. Yet, we know little about the relationship between youth
nicotine use, youth attitudes towards nicotine products and the interventions to
influence these attitudes. This systematic review synthesised adolescents’
attitudes towards nicotine products and the ways to influence them.
Methods: Systematic searches were carried out from PubMed,
MEDLINE, CINAHL, and MEDIC databases and were targeted to randomised controlled
trial (RCT) studies published in 2010–2021. Results: A total of
seven RCT studies were reviewed with a total population (age range 9–17 years,
adolescents 11–17 years) of 15,974. Findings were classified into four
categories: school-based interventions, tobacco prevention campaigns,
advertisements’ influence on adolescents’ opinions towards nicotine products,
and their responses to cigarette pack warnings. Conclusion: Based
on this systematic literature review, particularly school-based interventions
have an effect on adolescents’ attitudes towards smoking and preventing them
from starting to smoke, when they are targeted before the age of puberty.
School-based interventions should be further implemented and strengthened, as
the school has been shown to have significant potential to support youth’s
health. There is a need for further information about the most effective
interventions in the different age groups and the qualitative studies on the
topic.
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Affiliation(s)
| | - Hanna Lagström
- University of Turku, Turku, Finland; and Turku University Hospital, Turku, Finland
| | - Sini Eloranta
- University of Turku, Turku, Finland; University of Oulu, Oulu, Finland; and Turku University of Applied Science, Turku, Finland
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Roberto CA, Ng SW, Ganderats-Fuentes M, Hammond D, Barquera S, Jauregui A, Taillie LS. The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation. Annu Rev Nutr 2021; 41:529-550. [PMID: 34339293 DOI: 10.1146/annurev-nutr-111120-094932] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improve population health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
| | - Montserrat Ganderats-Fuentes
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada;
| | - Simon Barquera
- Department of Nutrition Policy Research, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Alejandra Jauregui
- Department of Physical Activity and Healthy Lifestyles, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
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4
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Lazard AJ. Social Media Message Designs to Educate Adolescents About E-Cigarettes. J Adolesc Health 2021; 68:130-137. [PMID: 32654836 DOI: 10.1016/j.jadohealth.2020.05.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/05/2020] [Accepted: 05/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE E-cigarette use is increasing among adolescents, despite potential harms. Social media messages are a promising way to educate youth about e-cigarettes, yet little is known about what message topics and formats will have beneficial impacts for message reception, reach, e-cigarette knowledge, and beliefs about harms. METHODS A national convenience sample of adolescents (n = 928, aged 15-18 years) in high school was recruited for an online experiment. In October 2019, participants were randomized to view one of three social media formats (visual based, quiz, and text only) or a no-message control. Participants in format conditions viewed six unique topics in a random order. Outcomes were e-cigarette knowledge and beliefs. Message reactions and sharing preferences were also assessed among youth who saw social media messages. RESULTS Social media messages led to greater knowledge (Cohen's f = .19; p < .001) and beliefs (f = .16; p < .001) about harms of e-cigarettes compared with the control, regardless of format. Almost four in five adolescents (79%) reported they would share the social media messages, most likely in person (49%) and with friends (52%). Message topics for missing out because of lung damage, having uncontrolled moods, and ingesting specific harmful chemicals elicited higher intended message reactions. CONCLUSIONS Social media messages can educate about e-cigarette harms. Social media campaigns are a promising e-cigarette education strategy to reach youth, directly and potentially through peer-to-peer sharing.
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Affiliation(s)
- Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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5
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Butler EN, Hall MG, Chen MS, Pepper JK, Blanton H, Brewer NT. The Prototypes of Tobacco Users Scale (POTUS) for Cigarette Smoking and E-Cigarette Use: Development and Validation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6081. [PMID: 32825565 PMCID: PMC7503746 DOI: 10.3390/ijerph17176081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022]
Abstract
Endorsing prototypes of cigarette smokers predicts cigarette smoking, but less is known about prototypes of users of other tobacco products. Our study sought to establish the reliability and validity of a measure of prototypes of smokers and e-cigarette users. Participants were from a national survey of smokers and non-smokers (n = 1414), a randomized clinical trial (RCT) of adult smokers (n = 2149), and adolescent children of adults in the trial (n = 112). The Prototypes of Tobacco Users Scale (POTUS) has four positive adjectives (cool, sexy, smart, and healthy) and four negative adjectives (disgusting, unattractive, immature, and inconsiderate) describing cigarette smokers and e-cigarette users. Confirmatory factor analyses identified a two-factor solution. The POTUS demonstrated strong internal consistency reliability in all three samples (median α = 0.85) and good test-retest reliability among adults in the RCT (median r = 0.61, 1-4 weeks follow-up). In the RCT, smokers more often agreed with negative prototypes for smokers than for e-cigarette users (mean = 2.03 vs. 1.67, p < 0.05); negative prototypes at baseline were also associated with more forgoing of cigarettes and making a quit attempt at the end of the trial (Week 4 follow-up). The POTUS may be useful to public health researchers seeking to design interventions that reduce tobacco initiation or cessation through the manipulation of tobacco user prototypes.
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Affiliation(s)
- Eboneé N. Butler
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599 USA;
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - May S. Chen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
| | | | - Hart Blanton
- Department of Communication, Texas A&M University, College Station, TX 77843, USA;
| | - Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (M.G.H.); (M.S.C.)
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
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6
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Perry CL, Creamer MR, Chaffee BW, Unger JB, Sutfin EL, Kong G, Shang C, Clendennen SL, Krishnan-Sarin S, Pentz MA. Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science. Nicotine Tob Res 2020; 22:1063-1076. [PMID: 31127298 PMCID: PMC7457341 DOI: 10.1093/ntr/ntz059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. IMPLICATIONS The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
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Affiliation(s)
- Cheryl L Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | - MeLisa R Creamer
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Jennifer B Unger
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| | | | | | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephanie L Clendennen
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Mary Ann Pentz
- Keck School of Medicine,University of Southern California, Los Angeles, CA
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7
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Brewer NT, Parada H, Hall MG, Boynton MH, Noar SM, Ribisl KM. Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts. Ann Behav Med 2020; 53:232-243. [PMID: 29850764 DOI: 10.1093/abm/kay032] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Our randomized trial found that pictorial cigarette pack warnings elicited more quit attempts than text-only warnings. PURPOSE In the current study, we sought to identify psychological mechanisms that explain why pictorial cigarette pack warnings change behavior. METHODS In 2014 and 2015, we recruited 2,149 adult smokers in NC and CA, USA. We randomly assigned smokers to receive on their cigarette packs for 4 weeks either a text-only warning (one of the USA's current warnings on the side of cigarette packs) or a pictorial warning (one of the USA's proposed text warnings with pictures on the top half of the front and back of cigarette packs). RESULTS Pictorial warnings increased attention to, reactions to, and social interactions about cigarette pack warnings (all p < .05). However, pictorial warnings changed almost no belief or attitude measures. Mediators of the impact of pictorial warnings included increased attention, negative affect, social interactions, thinking about the warning and harms of smoking, and intentions to quit (all p < .05). Analyses also found that pictorial warnings led to greater avoidance of the warnings, which was associated with more quit attempts (p < .05). CONCLUSIONS Pictorial warnings increased quit attempts by eliciting aversive reactions and by keeping the message vividly in smokers' minds. Contrary to predictions from several theories of health behavior, the warnings exerted little of their influence through changes in beliefs and attitudes and none of their influence through changes in risk perception. We propose the Tobacco Warnings Model based on these findings. CLINICAL TRIAL INFORMATION ClinicalTrials.gov identifier: NCT02247908; https://clinicaltrials.gov/ct2/show/NCT02247908.
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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, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Humberto Parada
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Division of Epidemiology and Biostatistics, The Graduate School of Public Health, San Diego State University, CA, USA
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,School of Media and Journalism, University of North Carolina, Carroll, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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8
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Cruz TB, Rose SW, Lienemann BA, Byron MJ, Meissner HI, Baezconde-Garbanati L, Huang LL, Carroll DM, Soto C, Unger JB. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature. Tob Induc Dis 2019; 17:68. [PMID: 31582956 PMCID: PMC6770621 DOI: 10.18332/tid/111397] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups. METHODS Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group. RESULTS There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results. CONCLUSIONS We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.
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Affiliation(s)
- Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, United States.,Center for Health Equity Transformation and Behavioral Science, University of Kentucky College of Medicine, Lexington, United States
| | - Brianna A Lienemann
- Keck School of Medicine, University of Southern California, Los Angeles, United States.,Moores Cancer Center, University of California San Diego, San Diego, United States
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, United States
| | | | - Li-Ling Huang
- Global Health and Health Security, Taipei Medical University, Taipei, Taiwan
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
| | - Claradina Soto
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, United States
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Fairchild VP, Aronowitz CA, Langleben DD, Wang AL. Brain Responses to Anti-Smoking Health Warnings In Youth. CURRENT ADDICTION REPORTS 2019; 5:372-378. [PMID: 31396471 DOI: 10.1007/s40429-018-0221-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of the Review Adolescents and young adults are a critical target for smoking prevention efforts. Health education is a key approach to these efforts, yet little is known about how adolescents and young adults process health information. One novel approach to understanding the neurobiological mechanisms of cognitive processing of public health communications is to use neuroimaging techniques to map the brain regions involved and make inferences about the neural systems engaged in the processing of health information. We reviewed recent studies that employed functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to examine the brain responses of adolescents and young adults to anti-smoking health messages and videos. Findings This narrative literature review found that the medial prefrontal cortex, amygdala, and hippocampus were the brain regions most commonly engaged in response to health warnings. Developmental factors modulate the relationship between brain regions, regulated emotional reaction, and frontal regions that are responsible for decision making. Summary Research that integrates neurophysiology and behavior to study adolescent and young adult neurocognitive responses to health messaging is an important tool for identifying optimal methods to communicate the health hazards of smoking to this vulnerable population.
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Affiliation(s)
- Victoria P Fairchild
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Veterans Administration Medical Center, Philadelphia, PA 19104 USA
| | - Catherine A Aronowitz
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Daniel D Langleben
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, and the Veterans Administration Medical Center, Philadelphia, PA 19104 USA.,Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - An-Li Wang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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Hammond D, Reid JL, Driezen P, Thrasher JF, Gupta PC, Nargis N, Li Q, Yuan J, Boudreau C, Fong GT, Cummings KM, Borland R. Are the Same Health Warnings Effective Across Different Countries? An Experimental Study in Seven Countries. Nicotine Tob Res 2019; 21:887-895. [PMID: 30452728 PMCID: PMC6588394 DOI: 10.1093/ntr/nty248] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/13/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION More than 100 countries have implemented pictorial health warnings on cigarette packages. However, few studies have compared how consumers from different geographic and cultural contexts respond to health warning content. The current study compares perceptions of warnings among adult smokers and youth in seven countries, to examine the efficacy of different health warning themes and images. METHODS Between 2010 and 2012, online and face-to-face surveys were conducted with ~500 adult smokers and ~500 youth (age 16-18) smokers and nonsmokers in each of Mexico, United States, China, Germany, India, Bangladesh, and Republic of Korea (total N = 8182). Respondents were randomized to view and rate sets of 5-7 health warnings (each set for a different health effect); each set included a text-only warning and various types (ie, themes) of pictorial warnings, including graphic health effects, "lived experience," symbolic images, and personal testimonials. Mixed-effects models were utilized to examine perceived effectiveness of warning themes, and between-country differences in responses. RESULTS Overall, pictorial warnings were rated as more effective than text-only warnings (p < .001). Among pictorial themes, "graphic" health effects were rated as more effective than warnings depicting "lived experience" (p < .001) or "symbolic" images (p < .001). Pictorial warnings with personal testimonials were rated as more effective than the same images with didactic text (p < .001). While the magnitude of differences between warning themes varied across countries, the pattern of findings was generally consistent. CONCLUSIONS The findings support the efficacy of graphic pictorial warnings across diverse geographic and cultural contexts, and support sharing health warning images across jurisdictions. IMPLICATIONS Although over 100 countries have implemented pictorial health warnings on cigarette packages, there is little research on the most effective types of message content across geographic and cultural contexts. The current study examined perceived effectiveness of text and pictorial health warnings featuring different message content-graphic health effects, "lived experience," personal testimonials, and symbolic imagery-among more than 8000 adults and youth in Mexico, United States, China, Germany, India, Bangladesh, and Korea. Across countries, "graphic" pictorial messages were rated as most effective. Consistencies across countries in rating message content suggests there may be "globally effective" themes and styles for designing effective health warnings.
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Affiliation(s)
- David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Departamento de Investigaciones sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica (INSP), Cuernavaca, Mexico
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Nigar Nargis
- Department of Economics and Bureau of Economic Research, University of Dhaka, Dhaka, Bangladesh
| | - Qiang Li
- China Tobacco Control Office, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Jiang Yuan
- China Tobacco Control Office, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Christian Boudreau
- Department of Statistics & Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Geoffrey T Fong
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavorial Sciences, Medical University of South Carolina, Charleston, SC
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
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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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Francis DB, Mason N, Ross JC, Noar SM. Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies. Tob Induc Dis 2019; 17:41. [PMID: 31516484 PMCID: PMC6662785 DOI: 10.18332/tid/108614] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.
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Affiliation(s)
- Diane B Francis
- Department of Communication, University of Kentucky, Lexington, United States
| | - Nia Mason
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, United States
| | - Seth M Noar
- School of Media & Journalism, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, United States
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13
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Ratih SP, Susanna D. Perceived effectiveness of pictorial health warnings on changes in smoking behaviour in Asia: a literature review. BMC Public Health 2018; 18:1165. [PMID: 30305061 PMCID: PMC6180548 DOI: 10.1186/s12889-018-6072-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several Asian countries have implemented pictorial health warnings on cigarette packs as suggested by the World Health Organization with various policies based on countries' systems. The study is aimed to analyse multiple research studies on the perceived effectiveness of Pictorial Health Warnings as a deterrent to smoking intention and as a stimulant of smoking behaviour in smokers and non-smokers in Asian countries. METHOD Peer-reviewed articles were identified through multiple science databases indexed by Scopus, MEDLINE or PubMed. The review was limited to articles that reported original research findings, were conducted in Asian countries and were available for review by January 2010. A PRISMA Flow diagram was used to identify the articles through the process of data screening and extractions. RESULT A total of 14 original articles which met the criteria were included in the review, consisting of 12 quantitative studies and 2 studies with both quantitative and qualitative methods from 17 jurisdictions. The reviewed studies found that pictorial health warnings were associated with a greater perception of salience (reading and noticing the warning), emotional effects, and cognitive increase. Additionally, in the reviewed studies, pictorial health warnings were perceived as more effective in deterring smoking initiation and encouraging smoking cessation than text-only warnings. Several studies also evaluated the effectiveness of a new pictorial warning compared with the old one. However, the relevance of refreshing the pictures of pictorial health warnings and the length of the effective period of the implementation of pictorial health warnings were less frequently studied. CONCLUSION Pictorial health warnings perceived as more effective in deterring smoking initiation among non-smokers and as well as in stimulating smoking cessation among smokers. Future studies on pictorial health warnings should study the relevance of changing or refreshing pictorial health warning on cigarette packages in a period of time.
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Affiliation(s)
- Suci Puspita Ratih
- Faculty of Public Health, Universitas Indonesia, Depok, 16424, West Java, Indonesia.,Department of Public Health, Faculty of Sports Sciences, Universitas Negeri Malang, Malang, 65145, East Java, Indonesia
| | - Dewi Susanna
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java, 16424, Indonesia.
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14
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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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15
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McKelvey K, Popova L, Kim M, Lempert LK, Chaffee BW, Vijayaraghavan M, Ling P, Halpern-Felsher B. IQOS labelling will mislead consumers. Tob Control 2018; 27:s48-s54. [PMID: 30158208 PMCID: PMC6252493 DOI: 10.1136/tobaccocontrol-2018-054333] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Abstract
Background Philip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: ‘switching completely from conventional cigarettes to the IQOS system…’ (1) ‘can reduce the risks of tobacco-related diseases;’ (2) ‘significantly reduce[s] your body’s exposure to harmful or potentially harmful chemicals;’ and (3) ‘presents less risk of harm than continuing to smoke cigarettes.’ Consumers may misunderstand what is meant by ‘switching completely'. Methods We critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk. Results We found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase ‘switching completely'; the proposed claims will not decrease smokers’ intentions to quit; and IQOS users will in fact ‘switch completely’ from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading. Conclusion Consumers will not understand the condition of the claims—that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free.
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Affiliation(s)
- Karma McKelvey
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.,Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, California, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.,General Internal Medicine/Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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16
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Parada H, Hall MG, Boynton MH, Brewer NT. Trajectories of Responses to Pictorial Cigarette Pack Warnings. Nicotine Tob Res 2018; 20:876-881. [PMID: 29059340 PMCID: PMC5991219 DOI: 10.1093/ntr/ntx182] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/15/2017] [Indexed: 11/14/2022]
Abstract
Background Pictorial warnings on cigarette packs are a cost-effective policy-level intervention for smoking cessation; however, little research has examined changes in the impact of warnings over time, especially shortly following the first exposure to pictorial warnings. We sought to characterize the trajectories of responses to pictorial cigarette pack warnings soon after first exposure. Methods Participants were 2149 adult smokers in North Carolina and California, United States. In 2014-2015, we randomized smokers to have pictorial (intervention) or text-only (control) warnings on their cigarette packs for 4 weeks. Weekly surveys assessed psychosocial and behavioral outcomes. Results After 1 week, smokers in the intervention arm reported higher levels of most outcomes, compared with the control arm. Over subsequent weeks, smokers in both trial arms had decreases in thinking about the harms of smoking (β = -0.046), positive (β = -0.036), and negative (β = -0.042) smoking reinforcement attitudes, and increases in quit intentions (β = 0.070) and cigarette forgoing (β = 0.137) (all p < .05). Only negative affective reactions decreased more in the intervention versus control condition (pinteraction < .01). Conclusions The impact of pictorial cigarette pack warnings on emotions and cognitions may wane over time. In contrast, quit intentions and cigarette forgoing may continue to increase, at least during the initial period after introduction. Rotation of pictorial warnings may help prevent warning wear-out. Implications Cigarette smoking is the leading cause of preventable morbidity and mortality and warnings on cigarette packs are a cost-effective policy-level intervention. Prior studies reporting on cigarette pack warning "wear out" have been limited by being short-term single-session experimental studies. Ours are the first study to experimentally examine the trajectories of several outcomes after first exposure and report that the impact of pictorial cigarette pack warnings on emotions and cognitions may wane over time while quit intentions and cigarette forgoing may continue to increase. Trials Registration ClinicalTrials.gov identifier: NCT02247908; https://clinicaltrials.gov/ct2/show/NCT02247908.
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Affiliation(s)
- Humberto Parada
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, McGavran-Greenberg Hall, Chapel Hill, NC, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Rosenau Hall, Chapel Hill, NC, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Rosenau Hall, Chapel Hill, NC, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Rosenau Hall, Chapel Hill, NC, USA
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17
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El-Shahawy O, Nicksic NE, Ramôa C, Jawad M, Niaura R, Abrams D, Sherman SE. Linking Global Youth Tobacco Survey Data to the WHO Framework Convention on Tobacco Control: the Case for Egypt. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0184-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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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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19
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Symptoms during Adolescents' First Use of Cigarettes and E-Cigarettes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101260. [PMID: 29053574 PMCID: PMC5664761 DOI: 10.3390/ijerph14101260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
Symptoms adolescents experience during their first time using a cigarette predict their current use, but little is known regarding the symptoms experienced during first e-cigarette use. We conducted a pilot study to understand the symptoms adolescents experience when they first tried cigarettes and e-cigarettes and the associations between these symptoms and current use. Participants were 41 adolescents in two U.S. cities who had tried cigarettes or e-cigarettes. We asked adolescents to recall the symptoms they experienced during their first cigarette or e-cigarette and categorized symptoms as negative (felt bad, coughing/chest pain, bad taste, upset stomach, dizzy/lightheaded) or positive (felt relaxed, rush/buzz). Adolescents reported fewer negative symptoms for first e-cigarette than first cigarette use (all p < 0.05). Current cigarette smoking was associated with endorsing fewer negative symptoms (OR = 0.49, 95% CI = [0.25, 0.95]) and more positive symptoms (OR = 7.11, 95% CI = [1.47, 34.33]) at first cigarette use. First e-cigarette use symptoms were not associated with current e-cigarette use. Adolescents reported fewer negative symptoms from first e-cigarette than from first cigarette, and e-cigarette symptoms did not influence use as they do for cigarettes. Additional research is needed to confirm these findings in longitudinal studies.
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20
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Reid JL, Mutti-Packer S, Gupta PC, Li Q, Yuan J, Nargis N, Hussain AKMG, Hammond D. Influence of Health Warnings on Beliefs about the Health Effects of Cigarette Smoking, in the Context of an Experimental Study in Four Asian Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080868. [PMID: 28767068 PMCID: PMC5580572 DOI: 10.3390/ijerph14080868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
Cigarette package health warnings can be an important and low-cost means of communicating the health risks of smoking. We examined whether viewing health warnings in an experimental study influenced beliefs about the health effects of smoking, by conducting surveys with ~500 adult male smokers and ~500 male and female youth (age 16-18) in Beijing, China (n = 1070), Mumbai area, India (n = 1012), Dhaka, Bangladesh (n = 1018), and Republic of Korea (n = 1362). Each respondent was randomly assigned to view and rate pictorial health warnings for 2 of 15 different health effects, after which they reported beliefs about whether smoking caused 12 health effects. Respondents who viewed relevant health warnings (vs. other warnings) were significantly more likely to believe that smoking caused that particular health effect, for several health effects in each sample. Approximately three-quarters of respondents in China (Beijing), Bangladesh (Dhaka), and Korea (which had general, text-only warnings) thought that cigarette packages should display more health information, compared to approximately half of respondents in the Mumbai area, India (which had detailed pictorial warnings). Pictorial health warnings that convey the risk of specific health effects from smoking can increase beliefs and knowledge about the health consequences of smoking, particularly for health effects that are lesser-known.
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Affiliation(s)
- Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
| | - Seema Mutti-Packer
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada.
| | - Prakash C Gupta
- Healis-Sekhsaria Institute for Public Health, 501 Technocity, TTC Industrial Area, Mahape, Navi Mumbai, Maharashtra 400701, India.
| | - Qiang Li
- Tobacco Control Office, Chinese Center for Disease Control and Prevention (China CDC), 27 Nan Wei Road, Beijing 100050, China.
- Boehringer Ingelheim (China) Investment Co. Ltd., 18/F, Pingan International Finance Center, Xinyuan S. Rd., Beijing 100027, China.
| | - Jiang Yuan
- Tobacco Control Office, Chinese Center for Disease Control and Prevention (China CDC), 27 Nan Wei Road, Beijing 100050, China.
| | - Nigar Nargis
- American Cancer Society, 555 11th St. NW, Washington, DC 20004, USA.
- Department of Economics, University of Dhaka, Dhaka 1000, Bangladesh.
| | | | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada.
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