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Reynolds RM, Trasher JF, Yang B, Henderson KC, Ashley DL, Hackworth EE, Ntansah CA, Pei D, Popova L. Perceptions of a reduced nicotine policy and predictors of policy support: A nationally representative U.S. survey. Prev Med 2024; 184:107952. [PMID: 38657684 DOI: 10.1016/j.ypmed.2024.107952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The U.S. Food and Drug Administration is considering a policy to reduce nicotine in cigarettes to non-addictive levels. Although current evidence supports the public-health benefits of a reduced-nicotine policy, almost half of people who smoke (∼ 40%) do not support the policy. This study estimates the factors most strongly associated with support or opposition toward the policy, including tobacco use status, perceived effects of a reduced nicotine policy, trust in the FDA, and psychological distress. The study aims to inform messaging campaigns and policy makers. METHODS Data were collected in 2021 with nationally representative samples of U.S. adults (n = 1763). After receiving information about the reduced nicotine policy, participants indicated their beliefs and support for or opposition to the policy, along with other individual difference characteristics. Univariate population parameters and multinomial logistic regression coefficients were estimated. RESULTS In adjusted models, people who formerly or never smoked were less likely to oppose the policy compared to those who currently smoke; people with higher psychological distress and those who believe the policy will promote switching to e-cigarettes were more likely to oppose the policy. In addition, people were more likely to support the policy if they believed it would make quitting easier or that the FDA is trustworthy. CONCLUSIONS Educational campaigns about reduced nicotine policy should expect higher impact by targeting prevalent perceptions and those more strongly associated with policy sentiment. In anticipation of the policy rollout, there may be a critical window to shape public opinion.
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Affiliation(s)
- Reed M Reynolds
- Communication Department, University of Massachusetts, Boston, MA, USA.
| | - James F Trasher
- Department of Health Promotion, Education & Behavior, University of South Carolina, Columbia, SC, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ, USA
| | | | | | - Emily E Hackworth
- Department of Health Promotion, Education & Behavior, University of South Carolina, Columbia, SC, USA
| | - Charity A Ntansah
- Department of Health Promotion, Education & Behavior, University of South Carolina, Columbia, SC, USA
| | - Di Pei
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Reynolds RM, Popova L, Ashley DL, Henderson KC, Ntansah CA, Yang B, Hackworth EE, Hardin J, Thrasher J. Messaging about very low nicotine cigarettes (VLNCs) to influence policy attitudes, harm perceptions and smoking motivations: a discrete choice experiment. Tob Control 2024; 33:325-332. [PMID: 36171147 PMCID: PMC10043050 DOI: 10.1136/tc-2022-057577] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND To reduce smoking and the harms it causes, countries, including the USA, are considering policies to reduce nicotine in combustible tobacco to minimally addictive levels. Effective messages about very low nicotine cigarettes (VLNCs) and this policy are crucial in combating misperceptions threatening the policy's effectiveness. DATA AND METHODS A discrete choice experiment assessed messages about VLNCs. Participants were 590 adults who smoked exclusively, 379 adults who both smoked and used e-cigarettes, 443 adults who formerly smoked and 351 young adults who never smoked (total n=1763). Seven message attributes were varied systematically (source, harm, chemicals, nicotine, satisfaction, addictiveness and quitting efficacy). Outcomes were selection of messages that generated the most positive attitude towards reduced nicotine policy, the greatest perceived harmfulness of VLNCs, and most strongly motivated quitting and initiating behaviour for VLNCs. RESULTS Information about specific harms and chemicals of VLNCs had the largest effects on selection of messages as eliciting more negative attitudes towards VLNCs policy, increasing perceived VLNC harmfulness, increasing motivation to quit VLNCs and decreasing motivation to try VLNCs. Messages with information about quitting efficacy were selected as more motivating to quit among those who smoke, but also more motivating to try VLNCs among those who do not smoke. CONCLUSION Harm and chemical information can be prioritised to ensure VLNCs are not misperceived as less harmful than regular cigarettes. Messages about increased quitting efficacy and reduced addictiveness associated with VLNCs may backfire if presented to those who do not smoke.
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Affiliation(s)
- Reed M Reynolds
- Communication Department, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Charity A Ntansah
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, Arizona, USA
| | - Emily E Hackworth
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Hardin
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Sagna MB, Rosemeyer MC, Ba O, Diouf F, Walter K, Camara Bityeki B, Carmona MG, Sebrie EM. Monitoring compliance with Senegal's tobacco products packaging and labelling requirements 6 months after implementation of the law. Tob Control 2023; 32:661-663. [PMID: 34987080 DOI: 10.1136/tobaccocontrol-2021-056973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION As of December 2021, 22 countries and one jurisdiction in WHO African Region (AFRO) have adopted pictorial health warning labels on tobacco packaging, but only 13 have implemented them. In 2014, Senegal enacted a comprehensive tobacco control law, which requires strong provisions on tobacco packaging and labelling. The objective of this study was to assess the level of compliance with these provisions in Senegal 6 months after implementation. METHODS Data collection took place in Senegal's capital city of Dakar across 12 districts in February 2018, following the Tobacco Pack Surveillance System Field Protocol developed by the Institute for Global Tobacco Control at Johns Hopkins Bloomberg School of Public Health. Unique tobacco packs were purchased from a total of 48 tobacco vendors, and compliance with new packaging and labelling provisions was assessed. RESULTS In total, seven unique cigarette packs were confirmed to be legally available for sale in Dakar, Senegal. All packs complied with all health warning provisions (type, size, location, language and quitline information) as well as bans on quantitative emissions yields. However, no pack complied with the descriptive constituents and emissions statement required on the lateral side, and four of the seven packs violated the ban on misleading brand descriptors. CONCLUSIONS AFRO countries have made substantial progress in adopting comprehensive tobacco control laws that bring them closer into alignment with the Framework Convention on Tobacco Control. This study found areas of effective implementation of FCTC recommended packaging and labelling requirements, as well as areas in need of stronger enforcement.
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Affiliation(s)
| | - Mary Clare Rosemeyer
- Department of International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Oumar Ba
- National Tobacco Control Program, Government of Senegal Ministry of Health and Social Action, Dakar, Senegal
| | - Fatou Diouf
- Framework Convention Alliance, Dakar, Senegal
| | - Karoline Walter
- Department of International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Bintou Camara Bityeki
- Department of International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Maria G Carmona
- Department of International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Ernesto Marcelo Sebrie
- Department of International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
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Demeshko A, Buckley L, Morphett K, Adams J, Meany R, Cullerton K. Characterising trusted spokespeople in noncommunicable disease prevention: A systematic scoping review. Prev Med Rep 2022; 29:101934. [PMID: 35942296 PMCID: PMC9356185 DOI: 10.1016/j.pmedr.2022.101934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Noncommunicable diseases (NCD) are an increasing global threat. Utilising public policy to address NCDs can reduce incidence and prevalence. However, NCD-relevant public policy action is minimal in many countries as changing public policy is difficult and multifactorial. Two factors that may influence this process is the message people receive and the messenger delivering it. To date, much health communication research has focused on message content, with limited research on messengers that are trusted by policymakers and the public to communicate NCD matters. We aimed to review the literature to characterise who the public and policymakers consider to be trustworthy and/or credible for NCD messaging, and why this might be the case. Arksey and O'Malley's scoping review methodology guided the review. A systematic search of three databases up to June 2021 combined with hand searching of review reference lists was undertaken. Nineteen articles were included. Data extraction focused on study design, issue being influenced, spokesperson studied, and measures of trust. Results showed health professionals were the most-frequently trusted sources of information. Other spokespeople, such as government sources or religious leaders, were only trustworthy in some contexts, and even distrusted in others. Reasons why spokespeople were trusted included technical expertise, strategic engagement with stakeholders, and reputation. However, we also found the nature of trust and credibility of spokespeople is dependent on the studied population and context. Overall, characteristics of influential messengers were nonspecific. Thus, trusted messengers and their characteristics in NCD-messaging must be better understood to develop and maintain the trust of the public and policymakers.
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Affiliation(s)
- Anastassia Demeshko
- School of Public Health, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
| | - Lisa Buckley
- School of Public Health, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge CB2 0QQ, United Kingdom
| | - Roger Meany
- Health and Wellbeing Queensland, Ground Floor, 139 Coronation Drive, Milton Green, Milton, QLD 4064, Australia
| | - Katherine Cullerton
- School of Public Health, The University of Queensland, 266 Herston Rd, Herston, QLD 4006, Australia
- Corresponding author.
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Van Dessel P, Tibboel H. Assessing the influence of warnings with testimonies from former smokers on smoking and quitting behaviour. Br J Health Psychol 2021; 26:917-934. [PMID: 33554386 DOI: 10.1111/bjhp.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cigarette pack warnings are widely used internationally for reducing smoking behaviour. Current warnings typically consist of a textual or graphic warning that smoking can lead to negative (health) outcomes. Though these warnings have proven benefits, they also have important limitations. Most notably, they do not produce beneficial changes in important cognitive determinants of smoking cessation such as self-efficacy to refrain from smoking and they do not reduce smoking for specific subsets of the target population. Recent studies provide evidence for the effectiveness of health warnings that include health-related testimonies from former smokers. METHODS We designed cigarette pack warnings that consist of more general testimonial statements from former smokers, selected in a pilot study for their potential impact on two important cognitive determinants of smoking (i.e., self-efficacy beliefs and outcome expectancies). In the main study, online participants were either exposed to the new testimonial warnings, to graphic health warnings, or to text-only health warnings on four separate occasions during a 24-h window. RESULTS In a sample of 416 daily smokers, we observed beneficial changes in self-reported cigarette smoking, craving, quit intentions, evaluations of smoking, self-efficacy, and outcome expectancies, immediately after viewing the warnings a first time and after multiple exposures. These effects were comparable for participants in the three warning type groups, with some (small) differences for changes in outcome expectancies and craving. CONCLUSIONS Warnings with general testimonies from former smokers might provide a useful evidence-based addition to currently used cigarette pack health warnings.
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Affiliation(s)
- Pieter Van Dessel
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Helen Tibboel
- Erasmus School of Social and Behavior Sciences, Erasmus University Rotterdam, The Netherlands
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Goldstein AO, Jarman KL, Kowitt SD, Queen TL, Kim KS, Shook-Sa BE, Sheeran P, Noar SM, Ranney LM. Effect of Cigarette Constituent Messages With Engagement Text on Intention to Quit Smoking Among Adults Who Smoke Cigarettes: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e210045. [PMID: 33625509 PMCID: PMC7905497 DOI: 10.1001/jamanetworkopen.2021.0045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The US Food and Drug Administration (FDA) is required to communicate the risks of tobacco constituents to the public. Few studies have addressed how FDA media campaigns can effectively communicate about cigarette smoke constituents. OBJECTIVE To examine whether messages about cigarette smoke constituents are effective in reducing smoking intentions and behaviors among adults who smoke. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial enrolled participants who were aged between 18 and 65 years, were English speakers, were living in the United States, and who smoked at least 100 cigarettes during their lifetime and now smoked every day or some days. Participants received daily messages via email for 15 days. Participants were randomized to 1 of 2 message conditions or a control group and reported their previous-day smoking behaviors daily. Follow-up surveys were conducted on days 16 and 32. Data were collected from June 2017 to April 2018 and analyzed from April to September 2018. INTERVENTIONS The 3 groups were (1) constituent plus engagement messages (eg, "Cigarette smoke contains arsenic. This causes heart damage.") that included the FDA as the source and engagement text (eg, "Within 3 months of quitting, your heart and lungs work better. Ready to be tobacco free? You can quit. For free nicotine replacement, call 1-800-QUIT-NOW"); (2) constituent-only messages that did not list the FDA as the source or include engagement text; and (3) a control condition with messages about littering cigarette butts. MAIN OUTCOMES AND MEASURES The primary outcome was the change in quit intentions (range, 1-4, with higher scores indicating stronger intentions) from pretest to day 16. Secondary outcome measures included daily smoking behaviors and quit attempts. RESULTS A total of 789 participants (mean [SD] age, 43.4 [12.9] years; 483 [61.2%] women; 578 [73.3%] White; 717 [90.9%] non-Hispanic) were included in the study. The mean (SD) quit intention score was 2.5 (0.9) at pretest. Mean (SE) change in quit intention score from pretest to day 16 was 0.19 (0.07) points higher in the constituent plus engagement condition than in the control condition (P = .005) and 0.23 (0.07) points higher in the constituent-only condition compared with the control condition (P = .001). Participant reports of cigarettes smoked, forgone, and butted out were similar across study conditions at baseline and did not differ significantly at days 16 and 32 across study conditions. Viewing more messages was associated with an estimated decrease of 0.15 (SE, 0.01) cigarettes smoked per day per message viewed overall across conditions. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first longitudinal test of cigarette constituent campaign messages in a national sample of adults who currently smoke. Messages about cigarette smoke constituents, with or without engagement text and source information, increased participants' intentions to quit, lending support to FDA efforts to educate consumers about such constituents. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03339206.
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Affiliation(s)
- Adam O. Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Kristen L. Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Sarah D. Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Tara L. Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Kyung Su Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Bonnie E. Shook-Sa
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Seth M. Noar
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
- Hussman School of Journalism and Media, Chapel Hill, North Carolina
| | - Leah M. Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill
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Jovanova M, Skurka C, Byrne S, Kalaji M, Greiner Safi A, Porticella N, Mathios AD, Avery RJ, Dorf MC, Niederdeppe J. Should Graphic Warning Labels Proposed for Cigarette Packages Sold in the United States Mention the Food and Drug Administration? Nicotine Tob Res 2021; 23:402-406. [PMID: 32770222 DOI: 10.1093/ntr/ntaa142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/29/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Under the US Family Smoking Prevention and Tobacco Control Act, the US Food and Drug Administration (FDA) has the authority to implement graphic warning labels (GWLs) on cigarette packages. Neither the original labels proposed by the FDA nor the revised labels include a source to indicate sponsorship of the warnings. This study tests the potential impact of adding a sponsor to the content of GWLs. METHODS We recruited adult smokers (N = 245) and middle-school youth (N = 242) from low-income areas in the Northeastern US. We randomly assigned participants to view one of three versions of the original FDA-proposed warning labels in a between-subjects experiment: no sponsor, "US Food and Drug Administration," or "American Cancer Society" sponsor. We tested the effect of varying sponsorship on source attribution and source credibility. RESULTS Compared to unsponsored labels, FDA sponsorship increased source attributions that the FDA sponsored the labels among both middle-school, largely nonsmoking youth and adult smokers. However, sponsorship had no effect on source credibility among either population. CONCLUSIONS We found no evidence that adding FDA as the source is likely to boost source credibility judgments, at least in the short term; though doing so would not appear to have adverse effects on credibility judgments. As such, our data are largely consistent with the Tobacco Control Act's provisions that allow, but do not require, FDA sponsorship on the labels. IMPLICATIONS This study addresses the FDA's regulatory efforts by informing the possible design and content of future cigarette warning labels. Our results do not offer compelling evidence that adding the FDA name on GWLs will directly increase source credibility. Future work may test more explicit FDA source labeling and continue to examine the credibility of tobacco message content among high-priority populations.
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Affiliation(s)
- Mia Jovanova
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Chris Skurka
- Department of Film/Video and Media Studies, Donald P. Bellisario College of Communications, Penn State University, University Park, PA
| | - Sahara Byrne
- Department of Communication, Cornell University, Ithaca, NY
| | - Motasem Kalaji
- Department of Communication, Cornell University, Ithaca, NY
| | - Amelia Greiner Safi
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY
| | | | - Alan D Mathios
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
| | - Rosemary J Avery
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY
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Development and Pretesting of Hookah Tobacco Public Education Messages for Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238752. [PMID: 33255675 PMCID: PMC7728075 DOI: 10.3390/ijerph17238752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/16/2020] [Accepted: 11/22/2020] [Indexed: 12/23/2022]
Abstract
Young adults’ hookah tobacco use is fueled by misperceptions about risks, appealing flavors, and social use. We developed and pretested public education messages to prevent and reduce hookah tobacco smoking among young adults. We used a two (user status: current hookah user, susceptible never user) by two (risk content: health harms or addiction) by three (message theme: harms/addiction risk alone, harms/addiction risk flavors, or harms/addiction risk social use) design with two messages/condition (n = 12 total messages). Young adults aged 18–30 (N = 713) were randomized to 1 of 12 messages and completed measures assessing message receptivity, attitudes, and negative emotional response. Harms messages were associated with greater receptivity (p < 0.001), positive attitudes (p < 0.001), and negative emotional response (p < 0.001) than addiction messages. Messages with harm or addiction content alone were associated with greater receptivity than social use-themed messages (p = 0.058). Flavor-themed messages did not differ in receptivity from harm or addiction content alone or social use-themed messages. Messages about the health harms of hookah tobacco use resonate more with young adults than addiction risk messages. Social use-themed messages produce the lowest receptivity. These findings can guide population-based approaches to communicate hookah tobacco risks to young adults.
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Mays D, Johnson AC, Phan L, Tercyak KP, Rehberg K, Lipkus I. Effect of risk messages on risk appraisals, attitudes, ambivalence, and willingness to smoke hookah in young adults. Health Psychol Behav Med 2020; 8:96-109. [PMID: 33033657 PMCID: PMC7540838 DOI: 10.1080/21642850.2020.1730844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: We examined effects of hookah tobacco risk messages on risk appraisals, attitudes towards hookah, ambivalence about hookah use, and willingness to smoke in young adults aged 18–30 years (n = 234). Design: In an online experiment, participants completed pre-exposure measures and were randomized to hookah tobacco risk messages or to a no message control condition. Main Outcome Measures: Risk appraisals, attitudes, ambivalence, and willingness to smoke hookah. Results: Those who viewed risk messages reported greater risk appraisals (M 4.50, SD 1.17 vs. M 3.87, SD 1.16, p < .001), less positive attitudes (M −0.56, SD 1.24, vs. M 0.39, SD 1.35, p < .001), greater ambivalence (M 3.86, SD 1.26, vs. M 3.08, SD 1.32, p < .001), and less willingness to smoke than controls (M 4.48, SD 1.27, vs. M 4.85, SD 1.37, p = .034). Structural equation modeling demonstrated messages reduced willingness to smoke by evoking less positive attitudes (b = −0.15, 95% CI −0.32, −0.05) and by the effect of heightened risk appraisals on less positive attitudes (b = −0.14, 95% CI −0.30, −0.07). Conclusions: Honing messages and understanding their mechanisms of action are necessary to produce more effective interventions to address hookah and other tobacco use in young adults.
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Affiliation(s)
- Darren Mays
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Andrea C Johnson
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lilianna Phan
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kenneth P Tercyak
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn Rehberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, NC, USA
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Ranney LM, Kowitt SD, Queen TL, Jarman KL, Goldstein AO. An Eye Tracking Study of Anti-Smoking Messages on Toxic Chemicals in Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4435. [PMID: 31726727 PMCID: PMC6888389 DOI: 10.3390/ijerph16224435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/28/2019] [Accepted: 11/07/2019] [Indexed: 12/04/2022]
Abstract
The US Food and Drug Administration is tasked with communicating information to the public about the harmful chemicals in cigarette smoke. Our study used eye tracking method to test the effectiveness of messages about the harmful chemicals in cigarettes smoke among adult smokers. A sample size of 211 current cigarette smokers viewed four communication messages that included: Health effects of a chemical in cigarette smoke and an image depicting the health effect. The messages focused on arsenic, formaldehyde, uranium, and general health. Eye tracking recorded the length of time participants viewed the text and the image. After each message, the participants were asked about the messages' effectiveness in changing attitudes towards smoking. We analyzed the data using multilevel modeling, and of the 211 smokers, 59.7% were female, 36.5% were Black, and 21.3% had a high school degree or less. Compared to the general message, the messages about formaldehyde and uranium were more discouraging to smoking (p < 0.05). Messages about formaldehyde were more believable and made participants want to quit more than the general messages. Increasing message dose was significantly associated with discouraging participants from smoking and made participants want to quit (p < 0.05). Our findings suggest that anti-smoking messages, containing chemical information, can successfully increase negative attitudes toward smoking cigarettes and potentially encourage quitting.
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Affiliation(s)
- Leah M. Ranney
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB# 7595, Chapel Hill, NC 27599, USA; (S.D.K.); (A.O.G.)
| | - Sarah D. Kowitt
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB# 7595, Chapel Hill, NC 27599, USA; (S.D.K.); (A.O.G.)
| | - Tara L. Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Drive, CB# 7295, Chapel Hill, NC 27599, USA; (T.L.Q.); (K.L.J.)
| | - Kristen L. Jarman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Drive, CB# 7295, Chapel Hill, NC 27599, USA; (T.L.Q.); (K.L.J.)
| | - Adam O. Goldstein
- Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB# 7595, Chapel Hill, NC 27599, USA; (S.D.K.); (A.O.G.)
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 101 Manning Drive, CB# 7295, Chapel Hill, NC 27599, USA; (T.L.Q.); (K.L.J.)
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Testing a Brief Web-based Intervention to Increase Recognition of Tobacco Constituents. TOB REGUL SCI 2019; 4:83-94. [PMID: 31363490 DOI: 10.18001/trs.4.6.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective We examined website formats to increase smokers' recognition of harmful and potentially harmful constituents (HPHCs) in cigarettes. Methods Adult, daily smokers (N = 279) were randomized to view a brief, single-page study website showing HPHC names and uses. The intervention site was tailored + interactive, labeled by cigarette brand/subbrand showing color imagery and pop-up boxes; the generic + static website (control) was unbranded in greyscale. Eye tracking equipment measured attention (dwell time) to precise website features. Linear regression analyses compared attention to HPHC descriptions and the correct recognition of 15 HPHC chemicals. A randomly selected sub-sample (N = 30) of participants qualitatively rated website usability. Results Despite spending less dwell time on the HPHC text and entire website, adult smokers who viewed the generic + static website had greater improvement in HPHC recognition compared to the tailored + interactive website (4.6 vs 3.6; p = .02); this finding contrasts with current literature on tailoring and interactivity. Both websites were rated highly on ease-of-use and readability. Conclusions Basic formats and narrative HPHC Web-based content attracted less visual attention, yet increased recognition of these chemicals in cigarettes, compared to brand-tailored, interactive web-based content.
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Jarman KL, Kowitt SD, Queen TL, Ranney LM, Kim K, Jones EE, Donovan E, Goldstein AO. Do Smokers Recall Source or Quitline on Cigarette Constituent Messages? TOB REGUL SCI 2018; 4:66-82. [PMID: 31414036 PMCID: PMC6693861 DOI: 10.18001/trs.4.6.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Food and Drug Administration (FDA) is required under the Family Smoking Prevention and Tobacco Control Act to communicate the risks of tobacco use to the public. Little research exists about methods to communicate the constituents of tobacco in a media campaign. This research examines specific strategies to increase effectiveness of a media campaign for cigarette smoking adults about tobacco constituents by including engagement text about smoking cessation and FDA as the source of the campaign. METHODS In an eye tracking study of 211 current cigarette smokers, participants randomly viewed 4 cigarette constituent messages that varied engagement text for quitting (benefits of quitting and quitline number, presence, absence) and by FDA source (presence, absence). After the eye tracking session, participants were asked about recall of the national quitline number and the source of message. RESULTS Participants in conditions with engagement text were significantly more likely than those in the no engagement conditions to recall the national quitline number. Few participants saw or recalled the FDA source. CONCLUSIONS Engagement text for smoking cessation on constituent communication campaign messages significantly increases recall of the quitline, an important resource for smokers.
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Affiliation(s)
- Kristen L Jarman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - KyungSu Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ellen E Jones
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily Donovan
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam O Goldstein
- Director of Departmental Advancement, Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Langdridge D, Davis M, Gozdzielewska L, McParland J, Williams L, Young M, Smith F, MacDonald J, Price L, Flowers P. A visual affective analysis of mass media interventions to increase antimicrobial stewardship amongst the public. Br J Health Psychol 2018; 24:66-87. [PMID: 30221433 PMCID: PMC6585774 DOI: 10.1111/bjhp.12339] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/08/2018] [Indexed: 11/26/2022]
Abstract
Objectives In an innovative approach to improve the contribution of health psychology to public health we have analysed the presence and nature of affect within the visual materials deployed in antimicrobial stewardship interventions targeting the public identified through systematic review. Design A qualitative analysis focused on the affective content of visual materials garnered from a systematic review of antibiotic stewardship (k = 20). Methods A novel method was devised drawing on concepts from semiotics to analyse the affective elements within intervention materials. Results Whilst all studies examined tacitly rely on affect, only one sought to explicitly deploy affect. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed: (1) monsters, bugs, and superheroes; (2) responsibility, threat, and the misuse/abuse of antibiotics; (3) the figure of the child. Conclusions The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not – to date – been adequately theorized or explicitly considered in the intervention design process. Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation. We argue that further research is needed to systematically illuminate and capitalize upon the use of affect to effect behaviour change concerning antimicrobial stewardship. Statement of contribution What is already known on this subject? The (mis)use of antibiotics and consequent risk of antimicrobial resistance is a critical public health problem. If sufficient action is not taken, global society will face the ‘post‐antibiotic’ era, in which common infections will lead to death for many millions. Key desirable behavioural changes are decreased patient demands for antibiotics, use of them for targeted purposes alone, and compliance with prescribed dosing. There is a growth of interest in the role of affect in mass media interventions designed to engage publics and produce health‐related behavioural change.
What does this study add? This article presents a novel analytic approach to understanding and intervening within behaviour change in public health that may complement other types of analysis. We present findings specifically from an ‘affective’ analysis based on semiotics in which we critically interrogated the visual imagery being deployed in mass media public health interventions concerning antimicrobial stewardship. Three thematic categories of affect are identified within the materials in which specific ideological machinery is deployed and that demonstrate some association with intervention effectiveness worthy of further investigation and testing.
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Affiliation(s)
- Darren Langdridge
- Faculty of Arts & Social Sciences, Open University, Milton Keynes, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lucyna Gozdzielewska
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Joanna McParland
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lynn Williams
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Mairi Young
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Fraser Smith
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Jennifer MacDonald
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lesley Price
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Paul Flowers
- Safeguarding Health through Infection Prevention (SHIP), School of Health and Life Sciences, Glasgow Caledonian University, UK
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Brewer NT, Jeong M, Mendel JR, Hall MG, Zhang D, Parada H, Boynton MH, Noar SM, Baig SA, Morgan JC, Ribisl KM. Cigarette pack messages about toxic chemicals: a randomised clinical trial. Tob Control 2018; 28:74-80. [PMID: 29654122 PMCID: PMC6186198 DOI: 10.1136/tobaccocontrol-2017-054112] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/22/2018] [Accepted: 02/20/2018] [Indexed: 11/07/2022]
Abstract
Background The USA can require tobacco companies to disclose information about harmful and potentially harmful chemicals in cigarette smoke, but the impact of these messages is uncertain. We sought to assess the effect of placing messages about toxic chemicals on smokers’ cigarette packs. Methods Participants were 719 adult cigarette smokers from California, USA, recruited from September 2016 through March 2017. We randomly assigned smokers to receive either factual messages about chemicals in cigarette smoke and their health harms (intervention) or messages about not littering cigarette butts (control) on the side of their cigarette packs for 3 weeks. The primary trial outcome was intention to quit smoking. Results In intent-to-treat analyses, smokers whose packs had chemical messages did not have higher intentions to quit smoking at the end of the trial than those whose packs had control messages (P=0.56). Compared with control messages, chemical messages led to higher awareness of the chemicals (28% vs 15%, P<0.001) and health harms (60% vs 52%, P=0.02) featured in the messages. In addition, chemical messages led to greater negative affect, thinking about the chemicals in cigarettes and the harms of smoking, conversations about the messages and forgoing a cigarette (all P<0.05). Discussion Chemical messages on cigarette packs did not lead to higher intentions to quit among smokers in our trial. However, chemical messages informed smokers of chemicals in cigarettes and harms of smoking, which directly supports their implementation and would be critical to defending the messages against cigarette company legal challenges. Trial registration number NCT02785484.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michelle Jeong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer R Mendel
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dongyu Zhang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Marcella H Boynton
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sabeeh A Baig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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