1
|
Zamani-Alavijeh F, Heidari Z, Mostafavi F, Bashirian S, Makvandi Z, Kelishadi R. Psychometric evaluation of a new instrument to hookah tobacco smoking-related factors in the Iranian female university students based on the Extended Parallel Process Model. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:138. [PMID: 38784272 PMCID: PMC11114692 DOI: 10.4103/jehp.jehp_437_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/24/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND The higher prevalence of hookah tobacco smoking (HTS) has become worrisome in women. Thus, it is essential to identify and measure the perceptions associated with this unhealthy behavior as well as the type of response to risk messages to design the effective programs. This study aimed to psychometric evaluation of a new instrument, named the Extended Parallel Process Model-Hookah Tobacco Smoking Questionnaire (EPPM-HTSQ), for female university students. MATERIAL AND METHODS This methodological study was conducted in 2019-2020 in central and western Iran. The first version of the instrument was developed with 97 items. Face, Content, and construct validity methods were used to assess the EPPM-HTSQ validity. The data viability for factorability was guided through Kaiser-Meyer-Olkin (KMO) measure of sample adequacy (Values >0.7) and Bartlett's test of Sphericity (P < 0.05). The Exploratory Factor Analysis (EFA) method with varimax rotation and SPSS software was performed to identify the main factors of the questionnaire and interpretable factors. The internal consistency and external reliability were determined. The test-retest was used for evaluating the stability of tools. RESULTS During the assessment of the face and content validity 71 items remained in the questionnaire. EFA led to the extraction of nine dimensions: "Focusing on superior rewards," "Response Efficacy," "Perceived physical threat," "Perceived social threat," "Self-efficacy," "Fear control," "Attitude," "Fear," and "Intention" Kaiser-Meyer-Olkin (KMO) test (0.957) and Bartlett's test (P < 0.001). Cronbach's alpha (0.871-0.951) and ICC (0.985-0.998) were approved for scale dimensions. CONCLUSION Important findings of the present study were the development and validation of the EPPM-HTSQ for measuring EPPM variables in relation to HTS; introducing a new variable "focusing on superior rewards"; as well as, the new classification of the concept of "perceived threat." The final version of the EPPM-HTSQ is a valid and reliable tool, but it is suggested to be re-evaluated in other studies with different populations and sample sizes.
Collapse
Affiliation(s)
- Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Mostafavi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Bashirian
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zeinab Makvandi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
2
|
Mehlhose C, Risius A. Effects of immediate and distant health consequences: different types of health warning messages on sweets affect the purchase probability. BMC Public Health 2023; 23:1892. [PMID: 37777719 PMCID: PMC10544146 DOI: 10.1186/s12889-023-16760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Several health control policies have been discussed as a regulatory approach to tackle the increasing prevalence of obesity and other health risks related to sugar consumption. Health warnings, like the ones used in tobacco control worldwide, are one of the most promising approaches. However, in the case of health warning messages for food products, it is much more complicated and involves much more consumer involvement than tobacco guidance. Therefore, it is important to better understand the efficacy, evaluation, and reactance of health warning labels in the food sector regarding consumers' behavior, persuasion, and perceptions. The aim of this study was to examine how different types (design and message) of health warning messages in combination with graphical applications affect consumer behavior. METHODS In a 3 × 3 × 3 symmetrical design, 1,040 German participants completed an online discrete choice experiment including various text-only and image-and-text health warning labels on sweets. An accompanying questionnaire assessed socio-demographic variables as well as psychometric scales to understand the relationship between fear, control, reactance, and shocking/inhibiting/mediating health-related warnings. RESULTS Our results suggest that especially emotional graphical images combined with text health warning labels might be more influential. The health effects of immediate (caries) and more distant health consequences (diabetes/obesity) differ in their impact. Further, results show that especially when consumers engage in a danger control process for overweight, warning messages have a negative impact on their choices. CONCLUSION Hence, warning labels on sweets can potentially be a decisive factor when communicating health threats related to excessive sugar consumption. In the context of a targeted health policy, we see the need for further research, especially concerning the perception and understanding of noncommunicable diseases (NCDs) in the population.
Collapse
Affiliation(s)
- Clara Mehlhose
- Marketing of Agricultural and Food Products, Department of Agricultural Economics and Rural Development, University of Göttingen, Platz Der Göttinger Sieben 5, 37073, Göttingen, Germany.
| | - Antje Risius
- Marketing of Agricultural and Food Products, Department of Agricultural Economics and Rural Development, University of Göttingen, Platz Der Göttinger Sieben 5, 37073, Göttingen, Germany
- University of Education Schwäbisch Gmünd, Institute for Health Sciences, Oberbettringer Str. 200, 73525, Schwäbisch Gmünd, Germany
| |
Collapse
|
3
|
Li Y, Duong HT, Massey ZB, Churchill V, Popova L. When Cigarette Smoking Meets COVID-19: How the Two Types of Threat and Efficacy Perceptions Interactively Predict Danger Control and Fear Control Processes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2970. [PMID: 36833665 PMCID: PMC9957251 DOI: 10.3390/ijerph20042970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Growing evidence indicates that communicating the combined risk of smoking and COVID-19 encourages smoking cessation. Guided by the Extended Parallel Process Model (EPPM), we examined how perceived threats of smoking and COVID-19 independently and interactively predicted danger control responses (i.e., quit intentions and COVID-19-protective behavioral intentions) and fear control responses (i.e., fear and fatalism). We also explored the direct and interactive impacts of perceived efficacy of quitting smoking and COVID-protective behaviors on message outcomes. Structural equation modeling results (N = 747 U.S. adults who smoke) indicated that the perceived efficacy of COVID-protective behaviors positively predicted quit intentions. Higher perceived threat of COVID-19 and greater quitting efficacy predicted higher quit intentions directly and indirectly via fear. As perceived COVID-protective efficacy increased, the positive association between perceived quitting efficacy and quit intentions also increased. Smoking-related threat and efficacy perceptions did not predict COVID-protective behavioral intentions. This study added to EPPM by considering how threat and efficacy perceptions deriving from two different yet closely related risks affect protective behaviors. Thus, combining multiple threats in a single message might be a promising strategy to motivate smoking cessation amid the pandemic.
Collapse
Affiliation(s)
- Yachao Li
- Department of Communication Studies, Department of Public Health, The College of New Jersey, Ewing Township, NJ 08628, USA
| | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA 30302, USA
| | - Zachary B. Massey
- School of Journalism, University of Missouri, Columbia, MO 65201, USA
| | - Victoria Churchill
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Impact of Social Media, Extended Parallel Process Model (EPPM) on the Intention to Stay at Home during the COVID-19 Pandemic. SUSTAINABILITY 2022. [DOI: 10.3390/su14127192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Considering how communities perceive the threat and risks of COVID-19, it is essential to examine how emotional regulation stimulated through intrinsic and extrinsic incentive mechanisms via social media can reinforce ‘Stay at home’ intentions. The conceptual framework was developed using the elements of the Extended Parallel Process Model (EPPM). A self-reported questionnaire was used to measure individuals’ intention to stay at home during the pandemic based on the perceived locus of causality as a part of self-determination theory. The empirical research was conducted on a sample of 306 USA respondents. The study results indicate that both components of the EPPM—efficacy and threat—positively affect ‘stay at home’ intentions. Moreover, a positive effect of efficacy on threats was found, as was a moderating effect of threats on the relationship between efficacy and the intention to stay at home. Meanwhile, the influence of social media exposure on threats and behavioral intentions was not significant. People are likely to stay at home as a preventive measure during COVID-19 if there is enough threats and efficacy. However, the abundance of information and opinions in social media can lead to a decreased perceived threat and might disrupt the acceptance of preventive actions.
Collapse
|
6
|
Baldry E, Redlinger-Grosse K, MacFarlane I, Walters ST, Ash E, Steinberger J, Murdy K, Cragun D, Allen-Tice C, Zierhut H. Outcomes from a pilot genetic counseling intervention using motivational interviewing and the extended parallel process model to increase cascade cholesterol screening. J Genet Couns 2021; 31:164-175. [PMID: 34260792 DOI: 10.1002/jgc4.1466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022]
Abstract
Familial hypercholesterolemia (FH) is an inherited condition resulting in increased risk of premature cardiovascular disease. This risk can be reduced with early diagnosis and treatment, but it can be challenging to identify individuals with FH. Cascade screening, the most efficient and cost-effective identification method, requires FH patients to communicate with their at-risk family and encourage them to pursue screening. Beyond FH, patients with conditions increasing disease risk to family members report barriers to the communication process such as insufficient knowledge of the condition and discomfort informing relatives. We conducted a pilot study of a genetic counseling intervention incorporating behavior-change principles from motivational interviewing (MI) and the extended parallel process model (EPPM) to help parents of children with FH overcome these barriers and improve cascade screening rates for FH. Of the 13 participants who completed the intervention and post-intervention surveys, 6 reported contacting and/or screening additional relatives. A large effect size in increasing communication and screening was observed (η2 = 0.20), with the mean percent of at-risk relatives contacted rising from 33% to 45%, and the mean percent screened rising from 32% to 42%. On average, 2.23 new relatives were contacted and 2.46 were screened, per participant, by the end of the study. Direct content analysis revealed that despite the open-ended nature of the goal-setting process, participant goals fell into two categories including those who set goals focused on communicating with and screening family members (n = 9) and those who set goals only focused on managing FH (n = 4). Overall, the communication and screening rates reported after the intervention were higher than previous observations in adult FH populations. These results suggest this EPPM/MI genetic counseling intervention could be a useful tool for increasing communication and cascade screening for FH. With further research on goal-setting techniques, the intervention could be refined and replicated to identify more individuals affected by FH or modified for use with other actionable genetic conditions.
Collapse
Affiliation(s)
- Emma Baldry
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Ian MacFarlane
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Scott T Walters
- Health Sciences Center, University of North Texas, Fort Worth, TX, USA
| | - Erin Ash
- Sarah Lawrence College, Broxville, NY, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kari Murdy
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Carly Allen-Tice
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
7
|
Carfora V, Pastore M, Catellani P. A Cognitive-Emotional Model to Explain Message Framing Effects: Reducing Meat Consumption. Front Psychol 2021; 12:583209. [PMID: 33854457 PMCID: PMC8039126 DOI: 10.3389/fpsyg.2021.583209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/01/2021] [Indexed: 11/13/2022] Open
Abstract
We tested the plausibility of a cognitive-emotional model to understand the effects of messages framed in terms of gain, non-loss, non-gain, and loss, and related to the health consequences of red/processed meat consumption. A total of 544 Italian participants reported their attitude toward reduced red/processed meat consumption and intention to eat red/processed meat (time 1 questionnaire). One week later, participants were randomly assigned to four different message conditions: (a) gain messages focused on the positive health outcomes associated with low meat consumption; (b) non-loss messages focused on the avoided negative health outcomes associated with low meat consumption; (c) non-gain messages focused on the missed positive health outcomes associated with high meat consumption; (d) loss messages focused on the negative health outcomes associated with high meat consumption (message sending). After reading the messages, participants answered a series of questions regarding their emotional and cognitive reactions to the messages, their evaluation of the messages, and again their attitude and intention toward red/processed meat consumption (time 2 questionnaire). Comparing different multivariate linear models under the Bayesian approach, we selected the model with the highest plausibility conditioned to observed data. In this model, message-induced fear influenced systematic processing, which in turn positively influenced message evaluation and attitude, leading to reduced intention to consume red/processed meat. Vice versa, message-induced anger reduced systematic processing, which in turn negatively influenced message evaluation, and led to no effect on attitude and intention. The comparison among message conditions showed that gain and non-loss messages activated integrated emotional and cognitive processing of the health recommendation, while loss and non-gain messages mainly activated emotional shortcuts toward attitude and intention. Overall, these results advance our comprehension of the effects of message framing on receivers' attitudes and intentions.
Collapse
Affiliation(s)
- Valentina Carfora
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Massimiliano Pastore
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Patrizia Catellani
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| |
Collapse
|
8
|
Chen M, Chen L. Promoting Smoking Cessation in China: Using an Expansion of the EPPM with Other-oriented Threat. JOURNAL OF HEALTH COMMUNICATION 2021; 26:174-183. [PMID: 33821769 DOI: 10.1080/10810730.2021.1906360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study explored strategies to increase Chinese smokers' cessation intentions, using the extended parallel processing model, or EPPM. A 2 × 2 × 2 factorial experiment was designed to examine the effects of self-oriented threat (present vs. absent), other-oriented threat (present vs. absent), and efficacy (present vs. absent) on smoking cessation intention. A total of 324 Chinese smokers aged 18-64 years participated in this study. The results revealed significant main effects of self-oriented threat, other-oriented threat, and efficacy on cessation intentions. Moreover, the presence of other-oriented threat was important, and the combination of presence of other-oriented threat and the presence of efficacy led to the greatest willingness to quit smoking, regardless of the presence of a self-oriented threat.
Collapse
Affiliation(s)
- Minyi Chen
- Wee Kim Wee School of Communication and Information,Nanyang Technological University, Singapore
| | - Liang Chen
- School of Journalism and Communication, Tsinghua University, China
| |
Collapse
|
9
|
The Effects of Fear Appeals and Message Format on Promoting Skin Cancer Prevention Behaviors among College Students. SOCIETIES 2020. [DOI: 10.3390/soc10010021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study tested the Extended Parallel Process Model (EPPM) by examining how fear mediated the effects of threat on individuals’ assessment of risk, which was neglected in many fear appeal studies. Second, this study treated efficacy as an existing perception, and explored the effects of varying levels of threat and efficacy on individuals’ behavioral intention. Furthermore, this study examined whether message format, such as narratives, played a role on individuals’ behavioral intention. Implications for the EPPM and health message development were discussed.
Collapse
|
10
|
Cornacchione Ross J, Noar SM, Sutfin EL. Systematic Review of Health Communication for Non-Cigarette Tobacco Products. HEALTH COMMUNICATION 2019; 34:361-369. [PMID: 29236542 PMCID: PMC5999530 DOI: 10.1080/10410236.2017.1407274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Food and Drug Administration, which now has regulatory authority over all tobacco products meeting the statutory definition, is tasked with communicating the risks of these products to the public through health warnings and public education. However, there have been no attempts to summarize what is known about non-cigarette tobacco product (NCTP) health messaging. We conducted a systematic review to examine the existing literature on health communication for NCTPs and identify key research gaps. A total of 45 unique studies were retrieved and coded, with the majority focused on messaging for smokeless tobacco (SLT, k = 32, 71.1%), followed by waterpipe tobacco (WT, k = 9, 20%), electronic nicotine delivery systems (ENDS, k = 2, 4.4%), cigars (k = 2, 4.4%), and a potentially reduced exposure product (k = 1, 2.2%). Studies most commonly examined tobacco product warnings (k = 26, 57.8%) and public education (k = 19, 42.2%), which included mass media campaigns. Most studies examined knowledge, attitudes, and beliefs as outcomes (k = 27, 60%), while behavior was an outcome in the minority of studies (k = 8, 17.8%). Pictorial warnings and public education about NCTPs demonstrated positive impact in some studies, although the literature is nascent. Given the increasing use of NCTPs such as ENDS, WT, and cigars, particularly among adolescents and young adults, more research is needed on effective ways to communicate product risk to those audiences most at risk.
Collapse
Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| | - Seth M. Noar
- School of Media and Journalism, University of North Carolina, Chapel Hill
| | - Erin L. Sutfin
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine
| |
Collapse
|
11
|
Owusu D, So J, Popova L. Reactions to tobacco warning labels: predictors and outcomes of adaptive and maladaptive responses. ADDICTION RESEARCH & THEORY 2019; 27:383-393. [PMID: 31511769 PMCID: PMC6738943 DOI: 10.1080/16066359.2018.1531127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The Extended Parallel Process Model (EPPM) responses have not been evaluated from verbal reactions to cigarette warning labels. We identified the EPPM responses in reactions to cigarette warning labels and evaluated their predictors and relationship with warning perceptions. METHODS U.S. adult current smokers, transitioning smokers (quit in the past two years or currently quitting) and never smokers (n=1,838) saw nine of 81 cigarette warning labels. Participants freely wrote their thoughts after viewing the first label and reported perceived informativeness, negative emotions, and denial for this label. Responses were coded for the presence of the EPPM response categories. Multivariable logistic regression models described adaptive and maladaptive respondent characteristics, and linear regression models assessed the relationship between the response categories and label perceptions. RESULTS Participants' responses contained adaptive (65.4%), maladaptive (16.5%), no response (14.7%), and mixed responses (both adaptive and maladaptive; 3.4%). Current smokers had decreased odds of adaptive response compared to never and transitioning smokers. Compared to text warnings, pictorial warnings were associated with increased odds of adaptive and decreased odds of maladaptive responses. Adaptive response was associated with increased odds of intentions to quit smoking. Adaptive respondents reported the highest levels of informativeness and negative emotions among the four response categories. CONCLUSIONS The finding demonstrating predominantly adaptive (and few maladaptive) responses to warning labels supports the continued use of fear appeals in warning label design. The greater adaptive and lower maladaptive responses to pictorial warnings could serve as additional evidence for FDA to implement pictorial warning labels.
Collapse
Affiliation(s)
- Daniel Owusu
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Jiyeon So
- Department of Communication Studies, University of Georgia, Athens, GA, USA
| | - Lucy Popova
- Tobacco Center of Regulatory Science, School of Public Health, Georgia State University, Atlanta, GA, USA
- Corresponding author: P.O. Box 3995, Atlanta, GA 30302.
| |
Collapse
|
12
|
Alwall Svennefelt C, Hunter E, Lundqvist P. Evaluating The Swedish Approach to Motivating Improved Work Safety Conditions on Farms: Insights from Fear Appeals and the Extended Parallel Processing Model. J Agromedicine 2018; 23:355-373. [DOI: 10.1080/1059924x.2018.1501454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Catharina Alwall Svennefelt
- Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - Erik Hunter
- Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, Alnarp, Sweden
| | - Peter Lundqvist
- Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, Alnarp, Sweden
| |
Collapse
|
13
|
Blondé J, Girandola F. Self-Relevant Threatening Messages Promote Vigilance Toward Coping Information: Evidence of Positive Processing at Attentional Level. SOCIAL COGNITION 2018. [DOI: 10.1521/soco.2018.36.4.411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Abstract
Objectives Our aim was to identify message characteristics for cigarette pack inserts that aim to help smokers quit. Methods US adult smokers from an online consumer panel (N = 665) participated in a discrete choice experiment with a 2x2x2x2x4 within-subjects balanced incomplete block design, manipulating: image (vs no image), text type (testimonial vs informational), cessation resource information (vs none), call to action (vs none), and message topic (well-being, financial benefit, cravings, social support). Participants evaluated 9 choice sets, each with 4 inserts, selecting: (1) the most and least helpful for quitting; and (2) the most and least motivating to quit. Linear models regressed choices on insert characteristics, controlling for sociodemographics and smoking-related variables. We assessed interactions between insert characteristics and smoker attributes (ie, education, quit intention, self-efficacy). Results Inserts were most helpful and motivating when they included an image, provided cessation resource information, or referenced well-being and financial benefits. Significant interactions indicated that inserts with cessation resource information were relatively more helpful and motivating among smokers with low self-efficacy, an intention to quit, or lower education. Conclusion Cigarette pack inserts with imagery and cessation resource information may be particularly effective in promoting smoking cessation.
Collapse
|
15
|
Thrasher JF, Islam F, Davis RE, Popova L, Lambert V, Cho YJ, Salloum RG, Louviere J, Hammond D. Testing Cessation Messages for Cigarette Package Inserts: Findings from a Best/Worst Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E282. [PMID: 29415523 PMCID: PMC5858351 DOI: 10.3390/ijerph15020282] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/20/2018] [Accepted: 02/01/2018] [Indexed: 11/16/2022]
Abstract
This study assessed smokers' responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed models regressed choices on insert and smoker characteristics. For DCE 1, the most motivating messages involved novel disease topics and imagery of younger women. For DCE 2, topics of social support, stress reduction and nicotine replacement therapy were selected as most helpful, with no differences by imagery type. For DCE 3, imagery influenced choices more than topic, with imagery of a family or a mom and baby selected as most motivating. Statistically significant interactions for all three experiments indicated that the influence of imagery type on choices depended on the message topic. Messages to promote smoking cessation through cigarette pack inserts should consider specific combinations of message topic and imagery.
Collapse
Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Farahnaz Islam
- Department of Biostatistics and Epidemiology, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Lucy Popova
- Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA 30302, USA.
| | - Victoria Lambert
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Yoo Jin Cho
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes & Policy, College of Medicine, University of Florida, Gainesville, FL 32610, USA.
| | - Jordan Louviere
- Institute for Choice and School of Marketing, University of South Australia, Adelaide, SA 5001, Australia.
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON N2L3G1, Canada.
| |
Collapse
|
16
|
Klein EG, Quisenberry AJ, Shoben AB, Cooper S, Ferketich AK, Berman M, Peters E, Wewers ME. Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving. Nicotine Tob Res 2018; 19:1172-1177. [PMID: 28339596 DOI: 10.1093/ntr/ntx021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022]
Abstract
Introduction Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products. Methods A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall. Results Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08). Conclusions GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users. Implications Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.
Collapse
Affiliation(s)
| | | | | | - Sarah Cooper
- College of Public Health, Ohio State University, Columbus, OH
| | - Amy K Ferketich
- College of Public Health, Ohio State University, Columbus, OH
| | - Micah Berman
- College of Public Health, Ohio State University, Columbus, OH.,College of Law, Ohio State University, Columbus, OH
| | - Ellen Peters
- College of Arts and Sciences, Ohio State University, Columbus, OH
| | | |
Collapse
|
17
|
The influence of graphic warning labels on efficacy beliefs and risk perceptions: a qualitative study with low-income, urban smokers. Tob Induc Dis 2016; 14:25. [PMID: 27471440 PMCID: PMC4964038 DOI: 10.1186/s12971-016-0088-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 07/01/2016] [Indexed: 11/22/2022] Open
Abstract
Background Health communication theories indicate that messages depicting efficacy and threat might promote behavior change by enhancing individuals’ efficacy beliefs and risk perceptions, but this has received little attention in graphic warning label research. We explored low socioeconomic status (SES) smokers’ perceptions of theory-based graphic warning labels to inform the development of labels to promote smoking cessation. Methods Twelve graphic warning labels were developed with self-efficacy and response efficacy messages paired with messages portraying high, low, or no threat from smoking. Self-efficacy messages were designed to promote confidence in ability to quit, while response efficacy messages were designed to promote confidence in the ability of the Quitline to aid cessation. From January – February 2014, we conducted in-depth interviews with 25 low SES adult men and women smokers in Baltimore, Maryland, U.S. Participants discussed the labels’ role in their self-efficacy beliefs, response efficacy beliefs about the Quitline, and risk perceptions (including perceived severity of and susceptibility to disease). Data were analyzed through framework analysis, a type of thematic analysis. Results Efficacy messages in which participants vicariously experienced the characters’ quit successes were reported as most influential to self-efficacy beliefs. Labels portraying a high threat were reported as most influential to participants’ perceived severity of and susceptibility to smoking risks. Self-efficacy messages alone and paired with high threat were seen as most influential on self-efficacy beliefs. Labels portraying the threat from smoking were most motivational for calling the Quitline, followed by labels showing healthy role models who had successfully quit using the Quitline. Conclusions Role model-based efficacy messages might enhance the effectiveness of labels by making smokers’ self-efficacy beliefs about quitting most salient and enhancing the perceived efficacy of the Quitline. Threatening messages play an important role in enhancing risk perceptions, but findings suggest that efficacy messages are also important in the impact of labels on beliefs and motivation. Our findings could aid in the development of labels to address smoking disparities among low SES populations in the U.S.
Collapse
|