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Lee DN, Liu J, Stevens H, Oduguwa K, Stevens EM. Does source matter? Examining the effects of health experts, friends, and social media influencers on young adult perceptions of Instagram e-cigarette education messages. Drug Alcohol Depend 2024; 258:111270. [PMID: 38522212 PMCID: PMC11088517 DOI: 10.1016/j.drugalcdep.2024.111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE Young adults' e-cigarette use is a leading public health concern. Using messages from credible sources can help improve message acceptance, yet little research has examined the role of source credibility on young adults' responses to e-cigarette education messages. METHODS We examined the impact of source on young adults' perceptions of e-cigarette education messages and e-cigarettes. In July 2022, we conducted an experimental study using an online sample of young adults (N=459, Mage=24.6) who were randomized to one of three source conditions: expert, friend, or influencer, and viewed e-cigarette education messages. We used one-way ANOVA to estimate the association between the conditions and outcomes (perceived source credibility, message trust, curiosity, use interests, perceived message effectiveness, beliefs, harm perceptions, and intentions to refrain). RESULTS The expert condition was associated with significantly higher perceived source credibility (vs. friend, influencer; p<0.001), message trust (vs. friend, influencer; p<0.001), and curiosity (vs. influencer; p's<0.05). CONCLUSIONS Public health campaigns may leverage health experts to deliver e-cigarette education messages targeting young adults to improve effectiveness of the messages.
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Affiliation(s)
- Donghee N Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA.
| | - Jessica Liu
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Hannah Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Katherine Oduguwa
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Elise M Stevens
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, MA, USA
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Venrick SJ, Margolis KA, Bernat JK, Donaldson E, Pepper JK, Eggers ME, Nonnemaker JM. Believability of messaging concerning a hypothetical product standard to lower a constituent in cigarettes or smokeless tobacco among U.S. Adults who use tobacco. Prev Med Rep 2024; 37:102544. [PMID: 38169982 PMCID: PMC10758972 DOI: 10.1016/j.pmedr.2023.102544] [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: 01/17/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
The U.S. Food and Drug Administration (FDA) has regulatory authority to implement tobacco product standards to reduce harmful and potentially harmful constituents (HPHCs). This study examines people who use tobacco products' awareness of FDA's tobacco regulatory authority, knowledge of HPHCs, and belief in hypothetical tobacco product standard statements. We recruited adults who reported currently using tobacco (N = 1,592) from the National Panel of Tobacco Consumer Studies and randomized them to one of four conditions. Participants viewed a stimulus which consisted of a statement about a hypothetical product standard that would reduce the level of a chemical in cigarettes or smokeless tobacco (ST) and reduce cases of cancer or heart attack and stroke. A small majority of participants correctly believed that FDA regulates tobacco; however, the percentage of participants who recognized HPHCs varied widely depending upon the chemical. People who currently use ST found chemical and health statements more believable than people who did not currently use ST. Participants found it more believable that cigarettes, not ST, could be made with fewer harm-causing chemicals, and their belief in the chemical and health statements did not differ based on the health outcome specified in the hypothetical product standard statement.
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Affiliation(s)
- Samantha J. Venrick
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Katherine A. Margolis
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Jennifer K. Bernat
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
| | - Elisabeth Donaldson
- Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA
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Duong HT, Loud EE, Thrasher JF, Henderson KC, Ashley DL, Popova L. 'It brings light to what you really put into your body': a focus group study of reactions to messages about nicotine reduction in cigarettes. Tob Control 2022; 31:649-654. [PMID: 33863835 PMCID: PMC8521550 DOI: 10.1136/tobaccocontrol-2020-056312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/25/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE In 2017, the US Food and Drug Administration (FDA) announced a proposed regulation to lower nicotine in cigarettes to minimally addictive levels to help smokers quit. We sought to explore effective message strategies communicating about nicotine reduction in cigarettes across the different key audiences that the regulation is most likely to influence. METHODS We designed four types of messages: efficacy messages, risk messages, a message about alternative sources of nicotine and a compensation message. Sixteen virtual focus groups were conducted in Atlanta and San Francisco in April-May 2020. Data were analysed in NVivo 12.0 using a thematic analysis approach. FINDINGS Exclusive smokers were receptive to both efficacy messages and risk messages. Dual users were the only group that was open to resorting to alternative sources of nicotine. Former smokers were critical of these messages as promoting the new kinds of cigarettes and potentially encouraging initiation and relapse of smoking. Non-smokers felt that efficacy messages downplayed the risks of smoking and did not scare people away from smoking. Presenting information that very low nicotine cigarettes (VLNCs) still contain harmful chemicals made smokers question continued smoking in the absence of nicotine and view VLNCs as harmful. CONCLUSIONS Messages communicating about nicotine reduction in cigarettes might help to motivate smokers to quit and can correct the misperceptions that VLNCs are less harmful. The FDA should consider specific target audiences and use different messages that complement each other in communicating about this regulation.
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Affiliation(s)
- Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, Georgia, USA
| | - Emily E Loud
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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4
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Trust in COVID-19 information sources and perceived risk among smokers: A nationally representative survey. PLoS One 2022; 17:e0262097. [PMID: 35085293 PMCID: PMC8794215 DOI: 10.1371/journal.pone.0262097] [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: 04/20/2021] [Accepted: 12/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Public health officials have classified smoking as a risk factor for COVID-19 disease severity. Smokers generally have less trust in health experts than do nonsmokers, leading to reduced risk perceptions. This study addresses smokers' trust in information sources about COVID-19 and how trust is associated with perceived COVID-19 susceptibility and severity among smokers. METHODS AND FINDINGS A nationally representative sample of 1,223 current smokers were surveyed between October and November 2020, indicating their level of trust in COVID-19 information sources, and their perceptions of risk from COVID-19. Multiple differences in trustworthiness emerged; smokers trusted their personal doctor for information about COVID-19 more than other information sources, while news media were generally distrusted. In addition, the FDA was trusted less than the NIH and CDC. Several "trust gaps" were observed, indicating disparities in levels of trust associated with gender, ethnicity, education, and political orientation, which had the strongest association with trust of all factors. Political orientation was also a significant predictor of COVID-19 risk perceptions, but there was no independent effect of political orientation when accounting for trust, which was predictive of all risk perception outcomes. CONCLUSIONS Trusted sources, such as personal doctors, may most effectively convey COVID-19 information across political orientations and sociodemographic groups. News media may be ineffective at informing smokers due to their low credibility. The results suggest that trust may explain the apparent effect of political orientation on COVID-19 risk perceptions. Implications for researchers, communication professionals, and policy makers are discussed.
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Erku DA, Bauld L, Dawkins L, Gartner CE, Steadman KJ, Noar SM, Shrestha S, Morphett K. Does the content and source credibility of health and risk messages related to nicotine vaping products have an impact on harm perception and behavioural intentions? A systematic review. Addiction 2021; 116:3290-3303. [PMID: 33751707 DOI: 10.1111/add.15473] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/02/2020] [Accepted: 02/24/2021] [Indexed: 01/10/2023]
Abstract
AIMS To systematically review the literature on (i) whether and how various risk messages about nicotine vaping products (NVPs) alter harm perception and behavioural intentions of smokers and non-smokers and (ii) how trust in sources of NVP risk communication affects message reception and behavioural intentions. METHODS Seven electronic databases and reference lists of relevant articles were searched for articles published up to April 2020. Experimental and quasi-experimental studies on message effects and cross-sectional studies on source credibility were included. The Newcastle-Ottawa Scale and the Evidence Project Risk of Bias Tool were used to assess the quality of observational and intervention studies, respectively. For each outcome variable, we indicated whether there was an effect (as a 'yes' or 'no') and used effect direction plots to display information on the direction of effects. RESULTS Nicotine addiction messages resulted in greater health and addiction risk perceptions, relative risk messages comparing the health risks of NVPs to cigarette smoking increased the perception that NVPs are less harmful than combustible cigarettes, and a nicotine fact sheet corrected misperceptions of nicotine and NVPs. Smokers' intention to purchase, try or switch to NVPs was higher when exposed to a relative risk message and lower when exposed to nicotine addiction warnings. Trust in NVP risk information from public health agencies was associated with lower odds of; (i) NVP use and (ii) perceiving NVPs as less harmful, whereas those who trusted information from NVP companies were more likely to perceive NVPs as less harmful than combustible cigarettes. CONCLUSIONS Relative risk messages may help improve the accuracy of harm perceptions of nicotine vaping products and increase smokers' intentions to quit smoking and/or to switch to vaping, although the literature is nascent.
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Affiliation(s)
- Daniel A Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.,School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Lynne Dawkins
- Centre for Addictive Behaviours Research, School of Applied Sciences, London South Bank University, 103 Borough Road, London, UK
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.,Queensland Alliance for Environmental Health Sciences, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kathryn J Steadman
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-3365, USA
| | - Shakti Shrestha
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD, 4102, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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Malt L, Verron T, Cahours X, Guo M, Weaver S, Walele T, O’Connell G. Perception of the relative harm of electronic cigarettes compared to cigarettes amongst US adults from 2013 to 2016: analysis of the Population Assessment of Tobacco and Health (PATH) study data. Harm Reduct J 2020; 17:65. [PMID: 32948187 PMCID: PMC7501702 DOI: 10.1186/s12954-020-00410-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electronic cigarettes (e-cigarettes) have been characterised as significantly less harmful than cigarettes by many health agencies and regulators globally. In this study, we examined to what extent perceived relative harms of e-cigarettes compared to cigarettes have changed in the USA. METHODS We analysed the data from the longitudinal and nationally representative, Population Assessment of Tobacco and Health Study to assess the relative perceived harm of e-cigarettes amongst US adults between 2013 and 2016. RESULTS The proportion of US adults who correctly perceived e-cigarettes as less harmful than cigarettes decreased each year from 41.1% (CI 40.1-42.1%) in 2013-2014, 31.5% (CI 30.8-32.2%) in 2014-2015 and 25.3% (CI 24.6-26.0%) in 2015-2016. Concurrently, the proportion of US adults who perceived e-cigarettes as equally, or more, harmful than cigarettes increased from 53.7% (CI 52.3-55.1%), 64.9% (CI 63.6-66.2%) to 72.7% (CI 71.5-73.9%) respectively. The proportion of US adults who held negative relative harm perceptions of e-cigarettes increased regardless of current smoking or vaping status by 24.6% and 29.6% respectively within 3 years. In Wave 3, the proportion of current smokers who perceived the relative harm of e-cigarettes as less harmful was lower at 29.3% (CI 28.2-30.4%) compared to current e-cigarette users at 43.5% (CI 40.3-46.7%). Former smokers who used e-cigarettes and believed that they were equally, or more, harmful than cigarettes in 2014-2015 had significantly higher rates of smoking relapse in the following year, 29% and 37% (p < 2.2e-16), respectively, compared to those with positive relative harm perceptions who reported relapse rates of 19%. CONCLUSIONS In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms. Further research is required to elucidate why the relative harm of e-cigarettes is misunderstood and continues to deteriorate.
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Affiliation(s)
- Layla Malt
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Thomas Verron
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Xavier Cahours
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Mengran Guo
- SEITA, Imperial Brands, 143 Boulevard Romain Rolland, 75014 Paris, France
| | - Sarah Weaver
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Tanvir Walele
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
| | - Grant O’Connell
- Imperial Brands Plc., 121 Winterstoke Road, Bristol, BS3 2LL UK
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Smokers' and Young Adult Non-Smokers' Perceptions and Perceived Impact of Snus and E-Cigarette Modified Risk Messages. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186807. [PMID: 32961924 PMCID: PMC7558440 DOI: 10.3390/ijerph17186807] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022]
Abstract
Although no tobacco products are safe, tobacco companies in the United States may request regulatory authorization to make certain “modified risk tobacco product” (MRTP) claims in their marketing. However, few qualitative studies have explored consumer perceptions and understanding of comparative risk messages and wordings. We examined consumer perceptions of statements indicating reduced risks and exposure to chemicals from snus and e-cigarettes relative to smoking. We conducted 12 focus groups with adult smokers (ages 21–66) and young adult (YA) non-smokers (ages 18–25) (n = 57) in the USA in 2019. Participants shared reactions to modified risk and exposure messages and message variations. Participants largely understood claims, including language about “switching completely.” However, participants expressed desire for more message specificity, evidence, risk reduction reasons, and statistics/quantitative information. Claim believability and acceptance was also limited by existing negative product beliefs and experiences, negative media reports, and skepticism about message source. YAs did not express product interest based on message exposure. Some YAs suggested the included “smoker” language made the messages less interesting/relevant. Given existing proposals for and use of MRTP messages, additional research on their wording, framing, delivery, and effects may help inform regulatory or organizational decisions about such messages, optimize potential benefits, and mitigate unintended consequences.
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8
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Popova L, Owusu D, Nyman AL, Weaver SR, Yang B, Huang J, Ashley DL. Effects of Framing Nicotine Reduction in Cigarettes on Anticipated Tobacco Product Use Intentions and Risk Perceptions Among US Adult Smokers. Nicotine Tob Res 2020; 21:S108-S116. [PMID: 31867652 PMCID: PMC6939750 DOI: 10.1093/ntr/ntz146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/16/2019] [Indexed: 12/29/2022]
Abstract
Introduction In 2017, the US Food and Drug Administration (FDA) proposed lowering the amount of nicotine in combusted cigarettes to minimally addictive levels. If used, to encourage cessation and maximize the benefits of this action, the FDA needs to determine the most effective way to communicate to the public the practical impact of this nicotine tobacco product standard. Methods Data were collected in 2018 from a nationally representative, online probability sample of 1198 adult smokers (aged ≥18 years old) in the United States. Smokers were randomly assigned one of five versions of the question regarding what they would most likely do if nicotine in cigarettes was reduced (nicotine levels were reduced by 95%; the government reduced nicotine levels by 95%; cigarettes were no longer addictive; cigarettes no longer relieved cravings; cigarettes were changed so that you would be able to quit more easily). Effects of framing on anticipated tobacco use intentions and perceived risk of very low nicotine cigarettes (VLNCs) were evaluated with multinomial logistic regressions. Results Framing the nicotine tobacco product standard as cigarettes no longer relieved cravings resulted in the highest proportion of smokers reporting they intend to quit in response to this standard (43.9%), lowest proportions reporting anticipated intentions to continue using combusted tobacco products (45.3%), and lowest proportion believing that VLNCs are less harmful than regular cigarettes (26%). Conclusions Different frames of nicotine reduction in cigarettes differentially affected smokers’ anticipated tobacco use intentions and perceived risk of VLNCs. Presenting reduction as making cigarettes unable to relieve cravings might be particularly effective at motivating cessation.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA
| | - Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, GA
| | - Amy L Nyman
- School of Public Health, Georgia State University, Atlanta, GA
| | - Scott R Weaver
- School of Public Health, Georgia State University, Atlanta, GA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA
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9
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Chen X, Orom H, Kiviniemi MT, Waters EA, Schofield E, Li Y, Hay JL. Cultural Worldviews and Perceived Risk of Colon Cancer and Diabetes. HEALTH RISK & SOCIETY 2020; 22:324-345. [PMID: 33762881 DOI: 10.1080/13698575.2020.1827142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with different cultural worldviews conceptualize risks in distinct ways, yet this work has not extended to personal illness risk perception. The purpose of this study was to 1) examine the relationships between two types of cultural worldviews (Hierarchy-Egalitarian; Individualism-Communitarianism) and perceived risk (perceived severity and susceptibility) for diabetes and colon cancer, 2) test whether health literacy modifies the above relationships, and 3) investigate whether trust in government health information functions as a putative mediator of the relations between cultural worldviews and disease perceived risk. We recruited (N=600) participants from a nationally-representative Internet survey panel. Results were weighted so the findings are representative of the general United States population. People with a more hierarchical worldview expressed lower perceived susceptibility to developing both diabetes and colon cancer, and perceived these diseases to be less severe, relative to those with a less hierarchical (more egalitarian) worldview. There was no significant association between individualistic worldview and perceived risk. Health literacy modified the relationships between hierarchical worldview and perceived risk; the associations between hierarchical worldview and lower perceived severity were stronger for those with limited health literacy. We did not observe indirect effects of cultural worldviews on perceived risk through trust in health information from government sources. It may be useful to identify specifically tailored risk communication strategies for people with hierarchical and individualistic worldviews, especially those with limited health literacy, that emphasize their important cultural values. Further research examining cultural components of illness risk perceptions may enhance our understanding of risk-protective behaviors.
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Affiliation(s)
- Xuewei Chen
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, Stillwater, OK, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
| | - Marc T Kiviniemi
- Department of Health, Behavior, and Society, University of Kentucky, Lexington, KY, USA
| | - Erika A Waters
- Department of Surgery (Division of Public Health Sciences), Washington University in Saint Louis, Saint Louis, MO, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Vereen RN, Westmaas JL, Bontemps-Jones J, Jackson K, Alcaraz KI. Trust of Information about Tobacco and E-Cigarettes from Health Professionals versus Tobacco or Electronic Cigarette Companies: Differences by Subgroups and Implications for Tobacco Messaging. HEALTH COMMUNICATION 2020; 35:89-95. [PMID: 30422690 DOI: 10.1080/10410236.2018.1544875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Smoking behavior may be influenced by perceived trust of information from tobacco and e-cigarette companies about their products. The purpose of this study was to identify sociodemographic subgroups with more trust in tobacco product (tobacco and e-cigarette) companies than health professionals and explore associations between this relative trust and tobacco product use.Health Information National Trends Survey (HINTS 4, FDA Cycle) data were analyzed (N = 3,738). Two relative trust measures were developed identifying respondents who trust tobacco companies or e-cigarette companies as much as or more than health professionals for information about the health effects of tobacco products or e-cigarettes versus those who place more trust in health professionals. Dependent variables were smoking status (current, former, never) and e-cigarette use (ever, never). Bivariate analyses and multivariable logistic regressions were conducted in SAS 9.4 using jackknife replicate weights.Respondents who trusted tobacco or e-cigarette companies as much as or more than health professionals were disproportionately from racial/ethnic minority groups or had low levels of income or education (all p < 0.05). Relative trust was not associated with smoking status. After controlling for demographics, respondents who trusted e-cigarette companies as much as or more than health professionals had 87% greater odds (95% CI: 1.16, 3.00) of e-cigarette use, compared to respondents who placed higher trust in health professionals.Findings suggest that population subgroups with greater trust in e-cigarette companies relative to health professionals are more prone to e-cigarette use. Targeted communication strategies may be needed for underserved populations and to counter messaging from e-cigarette companies.
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Affiliation(s)
- Rhyan N Vereen
- Behavioral and Epidemiology Research Group, American Cancer Society
| | - J Lee Westmaas
- Behavioral and Epidemiology Research Group, American Cancer Society
| | | | - Kelsi Jackson
- Community Strategies Division, Health Management Associates
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Owusu D, Lawley R, Yang B, Henderson K, Bethea B, LaRose C, Stallworth S, Popova L. 'The lesser devil you don't know': a qualitative study of smokers' responses to messages communicating comparative risk of electronic and combusted cigarettes. Tob Control 2019; 29:217-223. [PMID: 31040224 DOI: 10.1136/tobaccocontrol-2018-054883] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Communicating to smokers that e-cigarettes deliver lower levels of harmful chemicals than combusted cigarettes is a challenging issue. This study qualitatively explored smokers' interpretations of messages communicating the risk of e-cigarettes relative to cigarettes (comparative risk messages). METHOD We developed 12 print comparative risk messages and evaluated them in 12 focus groups with 72 adult smokers (18+ years old) in Atlanta, Georgia. RESULTS Participants interpreted uncertainty about health effects of e-cigarettes as an indicator of significant unknown risks, which some believed to be potentially more severe than the known effects of cigarettes (such as cancer and heart disease). Also, participants were sceptical about the lower risk claims. Some participants misinterpreted what 'switching completely' or 'switching 100% of the time' means, perceiving switching from e-cigarettes to combusted cigarettes as comparable with the use of both products. When chemicals in e-cigarettes were mentioned (eg, nicotine or formaldehyde), participants viewed e-cigarettes as very harmful and had difficulty reconciling this belief with the reduced risk claim. Comparative risk messages emphasising smoking risks were perceived as effective. Participants also appreciated being given an option to switch if they cannot quit. Participants suggested the inclusion of more facts and statistics and a credible message source (eg, public health agencies) to increase message effectiveness. CONCLUSION Comparative risk messages may be more acceptable to smokers if they show direct comparisons of the number of toxic chemicals in cigarettes and e-cigarettes, are attributed to a credible source(s), and emphasise smoking risks.
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Affiliation(s)
- Daniel Owusu
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Rachel Lawley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Bo Yang
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Brittaney Bethea
- Department of Communication, Georgia State University, Atlanta, Georgia, USA
| | | | | | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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12
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Annechino R, Antin TMJ. Truth Telling about Tobacco and Nicotine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040530. [PMID: 30781769 PMCID: PMC6406267 DOI: 10.3390/ijerph16040530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 01/22/2023]
Abstract
Research suggests that many people in the US are misinformed about the relative harms of various tobacco and nicotine products. Concerns about public misinformation have often been framed as relevant only to the degree that public health institutions agree to prioritize conventional approaches to tobacco harm reduction. We argue that while the information priorities of public health professionals are important, ethical and credible information sharing also requires consideration of broader issues related to public trust. To promote trust, public health institutions must develop truth telling relationships with the communities they serve and be genuinely responsive to what people themselves want to know about tobacco and nicotine products.
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Affiliation(s)
- Rachelle Annechino
- Critical Public Health Research Group, Prevention Research Center, 2150 Shattuck Avenue, Suite 601, Berkeley, CA 94704, USA.
| | - Tamar M J Antin
- Center for Critical Public Health, Institute for Scientific Analysis, 1150 Ballena Boulevard, Suite 211, Alameda, CA 94501, USA.
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Popova L, Majeed B, Owusu D, Spears CA, Ashley DL. Who are the smokers who never plan to quit and what do they think about the risks of using tobacco products? Addict Behav 2018; 87:62-68. [PMID: 29958136 PMCID: PMC6109416 DOI: 10.1016/j.addbeh.2018.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/18/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoking cigarettes is the most harmful way to use tobacco. Smokers who do not plan to quit present a particular challenge in reducing the morbidity and mortality from tobacco use. Switching to a lower harm product might encourage them to end their use of combusted cigarettes. This study aimed to better understand smokers who do not intend to quit (including their demographic and worldviews as indicators of their social, cultural, and political dispositions) and their perceived risks of cigarettes and possible lower-risk products such as e-cigarettes. METHODS Participants were 2572 current smokers. Data were pooled from 2015 and 2016 cross-sectional surveys of national probability samples of U.S. adults and analyzed with multivariable logistic regressions. RESULTS Smokers who never plan to quit comprise 14.3% of current U.S. smokers and are more likely to be older (24.2% among 65+ years old vs. 9.8% among 18-24) and less likely to have ever used e-cigarettes. A one-unit increase in hierarchical worldview (measured on a 1-6 scale) was associated with a 20% increase in the odds of never planning to quit. Those who denied that cigarettes cause disease or death (aORs between 1.6 and 2.0) or were uncertain (aORs: 2.5-2.7) were more likely to never plan to quit compared to those who agreed. They did not view risks of e-cigarettes substantially different compared to smokers who plan to quit. CONCLUSION One in seven U.S. smokers never plans to quit and might benefit from interventions which reflect their hierarchical worldviews and increase their risk perceptions of combustible cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA.
| | - Ban Majeed
- Department of Population Health Sciences, Medical College of Georgia, 1120 15th Street, Augusta, Georgia 30912, USA
| | - Daniel Owusu
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - Claire Adams Spears
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
| | - David L Ashley
- School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, Georgia 30302, USA
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Robertson L, Hoek J, Blank ML, Richards R, Ling P, Popova L, McMillan L. A qualitative exploration of information-seeking by electronic nicotine delivery systems (ENDS) users in New Zealand. BMJ Open 2018; 8:e023375. [PMID: 30366916 PMCID: PMC6224741 DOI: 10.1136/bmjopen-2018-023375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Given recent increases in awareness and uptake of electronic nicotine delivery systems (ENDS), we aimed to explore ENDS users' information needs and search behaviours and whether information gaps exist. DESIGN Qualitative study using semistructured interviews that probed participants' smoking behaviours and ENDS use; data in this study examine ENDS information-seeking behaviours. We used qualitative description to analyse interview transcripts. PARTICIPANTS AND SETTING We recruited 39 current ENDS users (20 dual users and 19 exclusive ENDS users who reported having previously smoked cigarettes regularly) aged 18 and over, from three urban centres in New Zealand. RESULTS Several participants used Google to search for information on ENDS' health effects, but described the material they retrieved as vague or contradictory. Some interpreted the absence of information on long-term health effects as evidence ENDS did not pose potential health risks, and several perceived e-liquids as benign. Many relied on information sourced from other ENDS users, gleaned from online forums, YouTube or from discussions with friends and acquaintances; these sources typically presented ENDS positively. Several participants found specialist ENDS retailers provided valuable advice; non-specialist store staff generally lacked detailed product knowledge and sometimes offered inaccurate information. CONCLUSION People seeking information on ENDS' health effects are more likely to retrieve recommendations, product reviews and endorsements from online sources or through exchanges with other users, than they are to find scientific data. Health authorities could help meet potential users' information needs by, first, creating and frequently updating objective lay summaries of the latest scientific evidence; second, by mandating licensing for retailers with guidelines to disclose uncertainty over ENDS' efficacy for cessation and longer-term health effects, and the need for complete substitution of ENDS for combustible cigarettes among those who use these products.
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Affiliation(s)
- Lindsay Robertson
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Dunedin, New Zealand
- Department of Marketing, University of Otago, Wellington, New Zealand
| | - Mei-Ling Blank
- Department of Public Health, University of Otago, Dunedin, New Zealand
- Department of Marketing, University of Otago, Wellington, New Zealand
| | - Rosalina Richards
- Cancer Society Social and Behavioural Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, Dunedin, New Zealand
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lydia McMillan
- Department of Public Health, University of Otago, Dunedin, New Zealand
- Department of Marketing, University of Otago, Wellington, New Zealand
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Popova L, Lempert LK, Glantz SA. Light and mild redux: heated tobacco products' reduced exposure claims are likely to be misunderstood as reduced risk claims. Tob Control 2018; 27:s87-s95. [PMID: 30209208 PMCID: PMC6202239 DOI: 10.1136/tobaccocontrol-2018-054324] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/29/2022]
Abstract
Introduction Heated tobacco products (HTPs) are being marketed in several countries around the world with claims that they are less harmful than combusted cigarettes, based on assertions that they expose users to lower levels of toxicants. In the USA, Philip Morris International (PMI) has submitted an application to the Food and Drug Administration (FDA) in 2016 seeking authorisation to market its HTPs, IQOS, with reduced risk and reduced exposure claims. Methods We examined the PMI’s Perception and Behavior Assessment Studies evaluating perceptions of reduced risk claims that were submitted to the FDA and made publicly available. Results Qualitative and quantitative studies conducted by PMI demonstrate that adult consumers in the USA perceive reduced exposure claims as reduced risk claims. Conclusion The data in the PMI modified risk tobacco product IQOS application do not support reduced risk claims and the reduced exposure claims are perceived as reduced risk claims, which is explicitly prohibited by the FDA. Allowing PMI to promote IQOS as reduced exposure would amount to a legally sanctioned repeat of the ‘light’ and ‘mild’ fraud which, for conventional cigarettes, is prohibited by the US law and the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA.,Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
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