1
|
Clark SA, Kowitt SD, Jarman KL, Lazard AJ, Queen TL, Ranney LM, Cornacchione Ross J, Sheeran P, Thrasher JF, Goldstein AO. The Role of Harm Visibility for Pictorial Health Warning Labels on Cigars. Nicotine Tob Res 2024:ntae113. [PMID: 38918001 DOI: 10.1093/ntr/ntae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Pictorial health warning labels (HWLs) can communicate the harms of tobacco product use, yet little research exists for cigars. We sought to identify the most effective types of images to pair with newly developed cigar HWLs. AIMS AND METHODS In September 2021, we conducted an online survey experiment with US adults who reported using little cigars, cigarillos, or large cigars in the past 30 days (n = 753). After developing nine statements about health effects of cigar use, we randomized participants to view one of three levels of harm visibility paired with each statement, either: (1) an image depicting internal harm not visible outside the body, (2) an image depicting external harm visible outside of the body, or (3) two images depicting both internal and external harm. After viewing each image, participants answered questions on perceived message effectiveness (PME), negative affect, and visual-verbal redundancy (VVR). We used linear mixed models to examine the effect of harm visibility on each outcome, controlling for warning statement. RESULTS Warnings with both and external harm depictions performed significantly better than the internal harm depictions across all outcomes, including PME (B = 0.21 and B = 0.17), negative affect (B = 0.26 and B = 0.25), and VVR (B = 0.24 and B = 0.17), respectively (all p < .001). Compared to both, the external depiction of harm did not significantly change PME or negative affect but did significantly lower VVR (B = -0.07, p = .01). CONCLUSIONS Future cigar pictorial HWLs may benefit from including images depicting both or external harm depictions. Future research should examine harm visibility's effect for other tobacco pictorial HWLs. IMPLICATIONS The cigar health warning labels (HWLs) proposed by the US Food and Drug Administration are text-only. We conducted an online survey experiment among people who use cigars to examine the effectiveness of warnings with images depicting different levels of harm visibility. We found HWLs with images depicting both an internal and external depiction of cigar harm, or an external depiction of harm alone, performed better overall than images portraying internal depictions of harm. These findings provide important regulatory evidence regarding what type of images may increase warning effectiveness and offer a promising route for future cigar HWL development.
Collapse
Affiliation(s)
- Sonia A Clark
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tara L Queen
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Paschal Sheeran
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
2
|
Johnson AC, Mercincavage M, Tan ASL, Villanti AC, Delnevo CD, Strasser AA. Effects of reduced nicotine content cigarette advertising with warning labels and social media features on product perceptions among young adults. J Behav Med 2023; 46:948-959. [PMID: 37605036 PMCID: PMC10591832 DOI: 10.1007/s10865-023-00441-7] [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: 11/16/2022] [Accepted: 07/24/2023] [Indexed: 08/23/2023]
Abstract
This study sought to understand reactions to very low nicotine (VLN) cigarette advertising compared with conventional cigarette advertising with consideration of warning labels and social media context. The online experimental study recruited young adult cigarette smokers and nonsmokers (N = 1,608). Participants completed a discrete choice task with a 2 × 2 × 3 mixed design: brand, (VLN, Marlboro), context (Ad only, Ad on social media), and warning (Text-only, Well-known risk pictorial, or Lesser-known risk pictorial). Participants made choices about attention, appeal, harm, buying, and quitting intentions. Social media context increased attention and appeal. A well-known risk pictorial warning outperformed a text-only warning. Smokers had increased odds of quit intentions for VLN ads, yet nonsmokers had increased intentions to buy cigarettes on social media with a text-only warning. Results indicate differences in how young adults react to cigarette ads on social media, especially with the warnings they portray.
Collapse
Affiliation(s)
- Andrea C Johnson
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA.
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA.
| | - Melissa Mercincavage
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Villanti
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104-3309, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
3
|
Cornacchione Ross J, Lazard AJ, King JL, Noar SM, Reboussin BA, Jenson D, Sutfin EL. Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults. Tob Control 2023; 32:211-217. [PMID: 34330882 PMCID: PMC8985738 DOI: 10.1136/tobaccocontrol-2020-056288] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The US Food and Drug Administration requires six text-only warnings for cigar products, including cigarillos. Research has demonstrated the superiority of pictorial over text-only cigarette warnings, yet the relative effectiveness of pictorial warnings for cigarillos has not been examined. We examined the impact of pictorial cigarillo warnings compared with text-only warnings. METHODS Data were collected from a nationally representative sample of US young adult (18-29) cigarillo users and susceptible non-users. Participants were randomised to one of three experimental conditions: text-only or one of two pictorial conditions (combined for analyses). For each warning, we assessed negative emotional reactions, cognitive elaboration (ie, thinking about cigarillo risks) and perceived message effectiveness (PME). RESULTS Participants (N=661) were 46.5% female, 64.7% white and 21.9% Hispanic; 34.1% reported past 30-day cigarillo use; 41.4% were lifetime users (excluding past 30-day use); and 24.4% were susceptible non-users. Pictorial warnings elicited more negative emotional reactions and higher PME than text-only warnings (p values<0.01), with interactions showing the largest effects for past 30-day users (emotional reactions: d=0.99, PME: d=0.63). For cognitive elaboration, there was no main effect of warning type, but an interaction revealed effects for past 30-day users (p<0.05, d=0.46). CONCLUSIONS Pictorial cigarillo warnings elicited greater negative emotional reactions and PME compared with text-only warnings. These effects and the effects on cognitive elaboration were strongest for past 30-day users. Our findings extend research on cigarette warnings to cigarillos, demonstrating that pictorial warnings are superior to text-only warnings for cigarillos in eliciting beneficial responses.
Collapse
Affiliation(s)
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica L King
- Department of Health & Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Beth A Reboussin
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, Minnesota, USA
| | - Erin L Sutfin
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
4
|
Baxter K, Czarnecka B, Schivinski B, Massaro MR. Masculine men do not like feminine wording: The effectiveness of gendered wording in health promotion leaflets in the UK. PLoS One 2022; 17:e0273927. [PMID: 36301843 PMCID: PMC9612536 DOI: 10.1371/journal.pone.0273927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/17/2022] [Indexed: 11/07/2022] Open
Abstract
Following mixed-methods sequential design and drawing on the message-audience congruence concept and homophily theory, across three studies in the UK, we examined the effect of gendered wording and endorser’s gender on the effectiveness of leaflets promoting walking. In Study 1, a mall-intercept study achieved 247 completed questionnaires. Results demonstrated that men and women indicated the highest behavioural intentions for communal wording presented by a male endorser. However, pairwise comparisons revealed that when the wording of the advert was agentic and the endorser was male, males indicated significantly higher scores of behavioural intentions compared with females. Attitude towards the ad for women was highest for communal wording/female endorser; for men it was for agentic wording/male endorser. In Study 2, consumers’ views towards the gendered content were explored in 20 semi-structured interviews. In study 3 we examined the impact of the respondent’s gender role identity on gendered content effectiveness. Overall, when controlled for level of gender role identity, only masculine males evaluated leaflets featuring communal wording negatively which suggests that wording matters only for masculine males, but not for other men and women. Theoretically, we identified that gender-based message-respondent congruence is not a necessary aspect of communications to be effective, except for one group: masculine males. Our study identified dominant gender role identity as a factor that explained respondents’ preferences for presented stimuli. Specifically, males who display masculine gender role identity differ in evaluations of communal wording from all other groups. Social and commercial marketers who target men and women with exercise-related services should consider the use of agentic wording endorsed by a male endorser when targeting masculine men to increase the likelihood of eliciting positive attitudes towards the communication. However, such distinctions should not be associated with differences in women’s evaluations or men who do not report masculine gender role identity.
Collapse
Affiliation(s)
- Katherine Baxter
- Department of Business Management and Marketing, Liverpool Hope University, Liverpool, United Kingdom
| | - Barbara Czarnecka
- Division of Management, Marketing and People, London South Bank University, London, United Kingdom
- * E-mail:
| | - Bruno Schivinski
- School of Media and Communication, RMIT University, Melbourne, Australia
| | | |
Collapse
|
5
|
Chen-Sankey J, Elhabashy M, Gratale S, Geller J, Mercincavage M, Strasser AA, Delnevo CD, Jeong M, Wackowski OA. Examining Visual Attention to Tobacco Marketing Materials among Young Adult Smokers: A Protocol for a Remote Webcam-based Eye-Tracking Experiment (Preprint). JMIR Res Protoc 2022; 12:e43512. [PMID: 37052989 PMCID: PMC10141307 DOI: 10.2196/43512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Eye tracking provides an objective way to measure attention, which can advance researchers' and policy makers' understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. OBJECTIVE This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. METHODS A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment-specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants' sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. RESULTS Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28%) initiated the experiment, and 777 (38.41%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95% CI 3.05-8.52) were more likely to generate usable eye-tracking data. CONCLUSIONS Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/43512.
Collapse
Affiliation(s)
- Julia Chen-Sankey
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Maryam Elhabashy
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Stefanie Gratale
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Jason Geller
- Department of Psychology, Princeton University, Princeton, NJ, United States
| | | | - Andrew A Strasser
- School of Medicine, University of Pennsylvania, Philadelphia, NJ, United States
| | - Cristine D Delnevo
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Michelle Jeong
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, United States
| |
Collapse
|
6
|
Ma Z. The Role of Narrative Pictorial Warning Labels in Communicating Alcohol-Related Cancer Risks. HEALTH COMMUNICATION 2022; 37:1345-1353. [PMID: 33601986 DOI: 10.1080/10410236.2021.1888456] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study examined the role of pictorial warning labels (PWLs) featuring narrative content in communicating alcohol-related cancer risks. In an online experiment, 169 adult alcohol consumers were randomly assigned to view two narrative PWLs, two non-narrative PWLs, or control. Results showed that exposure to narrative PWLs significantly increased participants' worry about, feelings of risk of, and perceived severity of harm of getting alcohol-related cancer, but did not affect their comparative likelihood of getting alcohol-related cancer or intentions to reduce alcohol use. Exposure to narrative PWLs also indirectly influenced intentions through increased worry. Moreover, participants' risk perceptions and intentions in non-narrative PWLs condition did not differ from those in narrative PWLs and control conditions. Therefore, these findings suggest that narrative PWLs are a promising strategy in informing consumers about the cancer risks of alcohol.
Collapse
Affiliation(s)
- Zexin Ma
- Department of Communication, Journalism, and Public Relations, Oakland University
| |
Collapse
|
7
|
Kilijanek A, Ozga WK. Impact of various types of provocative advertisements on brand recall and attention engagement. Pilot study report. APPLIED COGNITIVE PSYCHOLOGY 2022. [DOI: 10.1002/acp.3956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Wioletta Karina Ozga
- Department of Experimental Psychology The John Paul II Catholic University of Lublin
| |
Collapse
|
8
|
Ma Z, Yang G. Show Me a Photo of the Character: Exploring the Interaction between Text and Visuals in Narrative Persuasion. JOURNAL OF HEALTH COMMUNICATION 2022; 27:125-133. [PMID: 35422202 DOI: 10.1080/10810730.2022.2065387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The use of narrative text in health messaging has been ubiquitous. With the popularity of promoting public health on social media, it becomes critical to investigate what visual images should be used to maximize the impact of narrative health-related posts. This study focused on messages designed to communicate the breast cancer risk associated with alcohol use. We conducted a 2 (text: narrative vs. non-narrative) x 2 (visuals: exemplar vs. non-exemplar) between-subjects online experiment (N = 299). Our results showed that narrative (vs. non-narrative) text led to greater attention, stronger negative emotions, and higher intentions to seek information about alcohol use and cancer among female drinkers. The visual exemplar (vs. non-exemplar) also produced higher intentions to seek information and reduce alcohol use. More importantly, including a visual exemplar (vs. non-exemplar) significantly increased negative emotions and subsequently behavioral intentions when the text was a narrative, but the visual content did not make a difference when the text was a non-narrative. The results of this study show the importance of adding a relevant visual exemplar to narrative text, such as a photo of the character, to improve message effectiveness.
Collapse
Affiliation(s)
- Zexin Ma
- Department of Communication, Journalism, and Public Relations, Oakland University, Rochester, Michigan, USA
| | - Guolan Yang
- Department of Communication, Journalism, and Public Relations, Oakland University, Rochester, Michigan, USA
| |
Collapse
|
9
|
Valsecchi M, Codispoti M. Eye tracking applied to tobacco smoking: current directions and future perspectives. J Eye Mov Res 2022; 15:10.16910/jemr.15.1.2. [PMID: 35440972 PMCID: PMC9014256 DOI: 10.16910/jemr.15.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Over the years the general awareness of the health costs associated with tobacco smoking has motivated scientists to apply the measurement of eye movements to this form of addiction. On one hand they have investigated whether smokers attend and look preferentially at smoking related scenes and objects. In parallel, on the other hand eye tracking has been used to test how smokers and nonsmokers interact with the different types of health warning that policymakers have mandated in tobacco advertisements and packages. Here we provide an overview of the main findings from the different lines of research, such as the evidence related to the attentional bias for smoking cues in smokers and the evidence that graphic warning labels and plain packages measurably increase the salience of the warning labels. We point to some open questions, such as the conditions that determine whether heavy smokers exhibit a tendency to actively avoid looking at graphic warning labels. Finally we argue that the research applied to gaze exploration of warning labels would benefit from a more widespread use of the more naturalistic testing conditions (e.g. mobile eye tracking or virtual reality) that have been introduced to study the smokers' attentional bias for tobacco-related objects when freely exploring the surrounding environment.
Collapse
|
10
|
Yoon J, Syn SY. The effects of visual formats on Facebook health-related posts: evidence from eye movement analysis. LIBRARY HI TECH 2022. [DOI: 10.1108/lht-10-2021-0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aimed to provide user-centered evidence for health professionals to make optimal use of images for the effective dissemination of health information on Facebook (FB).Design/methodology/approachUsing an eye-tracking experiment and a survey method, this study examined 42 participants' reading patterns as well as recall and recognition outcomes with 36 FB health information posts having various FB post features.FindingsThe findings demonstrated that FB posts with text-embedded images received more attention and resulted in the highest recall and recognition. Meanwhile, compared to text-embedded images, visual only images yielded less effective recall of information, but they caught the viewers' attention; graphics tended to attract more attention than photos. For effective communication, the text features in FB posts should align with the formats of the images.Practical implicationsThe findings of this study provide practical implications for health information disseminators by suggesting that text-embedded images should be used for effective health communication.Originality/valueThis study provided evidence of users' different viewing patterns for FB health information posts and the relationship between FB post types and recall and recognition outcomes.
Collapse
|
11
|
Pang B, Saleme P, Seydel T, Kim J, Knox K, Rundle-Thiele S. The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions. BMC Public Health 2021; 21:884. [PMID: 34011338 PMCID: PMC8135180 DOI: 10.1186/s12889-021-10810-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Examination of the format and framing of the graphic health warnings (GHWs) on tobacco products and their impact on tobacco cessation has received increasing attention. This review focused on systematically identifying and synthesizing evidence of longitudinal studies that evaluate different GHW formats and specifically considered GHW influence on perceived risk of tobacco use and quit intentions. METHODS Ten databases were systematically searched for relevant records in December 2017 and again in September 2019. Thirty-five longitudinal studies were identified and analyzed in terms of the formatting of GHWs and the outcomes of perceived risk and quit intentions. Quality assessment of all studies was conducted. RESULTS This review found graphics exceeding 50% of packs were the most common ratio for GHWs, and identified an ongoing reliance on negatively framed messages and limited source attribution. Perceived harms and quit intentions were increased by GHWs. However, wear-out effects were observed regardless of GHW format indicating the length of time warnings are present in market warrants ongoing research attention to identify wear out points. Quit intentions and perceived harm were also combined into a cognitive response measure, limiting the evaluation of the effects of each GHW format variables in those cases. In addition, alternative GHW package inserts were found to be a complimentary approach to traditional GHWs. CONCLUSIONS This review demonstrated the role of GHWs on increasing quit intentions and perceptions of health risks by evaluating quality-assessed longitudinal research designs. The findings of this study recommend testing alternate GHW formats that communicate quit benefits and objective methodologies to extend beyond self-report.
Collapse
Affiliation(s)
- Bo Pang
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| | - Pamela Saleme
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| | - Tori Seydel
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| | - Jeawon Kim
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| | - Kathy Knox
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| | - Sharyn Rundle-Thiele
- Social marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, QLD 4111 Australia
| |
Collapse
|
12
|
Cornacchione Ross J, King JL, Lazard AJ, Noar SM, Reboussin BA, Jenson D, Sutfin EL. Developing Pictorial Cigarillo Warnings: Insights From Focus Groups. Nicotine Tob Res 2021; 23:383-389. [PMID: 32766683 DOI: 10.1093/ntr/ntaa130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/06/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The Food and Drug Administration (FDA) selected six text-only warnings for cigarillos to be implemented on packaging and advertising. Pictorial warnings are more effective at discouraging cigarette use than text-only warnings, yet no research exists for cigarillos. We sought to understand what types of images might be most effectively paired with the cigarillo text warnings to inform broad principles for developing pictorial warnings, with a focus on young adults, who have the highest rate of cigarillo use. METHODS We conducted five focus groups with a total of N = 30 young adult cigarillo users and susceptible nonusers (53% female, 50% White, and 33% Black). Participants were shown four to eight unique images for each of the six text statements and were asked about visual-verbal congruency, emotional and cognitive reactions, and perceived effectiveness of each image. Sessions were recorded and transcribed; two investigators independently coded transcripts for emergent themes. RESULTS Participants reported images that were graphic or "gross" would best grab attention and discourage use of cigarillos. Participants preferred images that were a direct illustration of the information in the warning text, rather than abstract images that required more cognitive effort to understand. Participants also highlighted that including people in the images, especially youth and young adults making eye contact, helped them relate to the warnings, garner their attention, and positively influence their reactions. CONCLUSIONS We identified several principles to inform the selection of images to pair with the FDA-required cigarillo text statements. These insights may also apply to pictorial warnings for other tobacco products. IMPLICATIONS This focus group study identified principles for selecting images to develop pictorial warnings for the six FDA text-only cigarillo warnings. We found that young adult cigarillo users and susceptible nonusers preferred images that were graphic and gross, believable, congruent to the warning text, and included people. Images that match young adults' visual expectations of a disease and are emotion-provoking may be most effective in pictorial warnings and highlight challenges for developing pictorial warnings for health effects that do not have a visible health consequence.
Collapse
Affiliation(s)
| | - Jessica L King
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT
| | - Allison J Lazard
- Hussman School of Media and Journalism, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Seth M Noar
- Hussman School of Media and Journalism, University of North Carolina, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, St. Paul, MN
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| |
Collapse
|
13
|
Syn SY, Yoon J. Investigation on reading behaviors and cognitive outcomes of Facebook health information. ONLINE INFORMATION REVIEW 2021. [DOI: 10.1108/oir-05-2020-0177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aims to understand how college students' personal and health-related characteristics are related to their reading behaviors and cognitive outcomes of Facebook health information through eye tracking data and cognitive outcomes.Design/methodology/approachThis study analyzed users' gaze movement data and results of recall and recognition tests to investigate users' reading patterns and their consequences with cognitive outcomes. The gaze movements are analyzed with eye tracking data including the average fixation count and time to first fixation.FindingsThe results of reading patterns show that Texts and Images are highly viewed and viewed immediately by participants when the posts were presented. There was no clear pattern with fixation counts to determine cognitive outcomes. However, the findings of study suggest that there is a clear pattern of reading Facebook posts with areas of interest (AOIs). Among five AOIs observed, participants viewed Images first and then Texts when a Facebook post is presented. On the other hand, they read Texts more carefully than Images. The findings of this study suggest that while images contribute to gaining users' attention, a clear and precise message needs to be delivered in text message to ensure readers' correct understanding and application of health information.Originality/valueThe user-centered evidence on reading behaviors and cognitive outcomes will make contributions to how health professionals and health organizations can make optimal use of Facebook for effective health information communication.Peer reviewThe peer-review history for this article is available at: https://publons.com/publon/10.1108/OIR-05-2020-0177
Collapse
|
14
|
Wang Y, Hao H, Platt LS. Examining risk and crisis communications of government agencies and stakeholders during early-stages of COVID-19 on Twitter. COMPUTERS IN HUMAN BEHAVIOR 2021; 114:106568. [PMID: 32982038 PMCID: PMC7508681 DOI: 10.1016/j.chb.2020.106568] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022]
Abstract
During COVID-19, social media has played an important role for public health agencies and government stakeholders (i.e. actors) to disseminate information regarding situations, risks, and personal protective action inhibiting disease spread. However, there have been notable insufficient, incongruent, and inconsistent communications regarding the pandemic and its risks, which was especially salient at the early stages of the outbreak. Sufficiency, congruence and consistency in health risk communication have important implications for effective health safety instruction as well as critical content interpretability and recall. It also impacts individual- and community-level responses to information. This research employs text mining techniques and dynamic network analysis to investigate the actors' risk and crisis communication on Twitter regarding message types, communication sufficiency, timeliness, congruence, consistency and coordination. We studied 13,598 pandemic-relevant tweets posted over January to April from 67 federal and state-level agencies and stakeholders in the U.S. The study annotates 16 categories of message types, analyzes their appearances and evolutions. The research then identifies inconsistencies and incongruencies on four critical topics and examines spatial disparities, timeliness, and sufficiency across actors and message types in communicating COVID-19. The network analysis also reveals increased communication coordination over time. The findings provide unprecedented insight of Twitter COVID-19 information dissemination which may help to inform public health agencies and governmental stakeholders future risk and crisis communication strategies related to global hazards in digital environments.
Collapse
Affiliation(s)
- Yan Wang
- Department of Urban and Regional Planning and Florida Institute for Built Environment Resilience, University of Florida, P.O. Box 115706, Gainesville, FL, 32611, USA
| | - Haiyan Hao
- Department of Urban and Regional Planning and Florida Institute for Built Environment Resilience, College of Design, Construction and Planning, University of Florida, 1480 Inner Road, Gainesville, FL, 32601, USA
| | - Lisa Sundahl Platt
- Department of Interior Design and Florida Institute for Built Environment Resilience, University of Florida, P.O. Box 115701, Gainesville, FL, 32611, USA
| |
Collapse
|
15
|
Noar SM, Rohde JA, Barker JO, Hall MG, Brewer NT. Pictorial Cigarette Pack Warnings Increase Some Risk Appraisals But Not Risk Beliefs: A Meta-Analysis. HUMAN COMMUNICATION RESEARCH 2020; 46:250-272. [PMID: 32565612 PMCID: PMC7291919 DOI: 10.1093/hcr/hqz016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 05/28/2023]
Abstract
Pictorial warnings on cigarette packs motivate smokers to quit, and yet the warnings' theoretical mechanisms are not clearly understood. To clarify the role that risk appraisals play in pictorial warnings' impacts, we conducted a meta-analysis of the experimental literature. We meta-analyzed 57 studies, conducted in 13 countries, with a cumulative N of 42,854. Pictorial warnings elicited greater cognitive elaboration (e.g., thinking about the risks of smoking; d = 1.27; p < .001) than text-only warnings. Pictorial warnings also elicited more fear and other negative affect (d = .60; p < .001). In contrast, pictorial warnings had no impact on perceived likelihood of harm (d = .03; p = .064), perceived severity (d = .16; p = .244), or experiential risk (d = .06; p = .449). Thus, while pictorial warnings increase affective and some cognitive risk appraisals, they do not increase beliefs about disease risk. We discuss the role of negative affect in warning effectiveness and the implications for image selection and warning implementation.
Collapse
Affiliation(s)
- Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jacob A Rohde
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Joshua O Barker
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
16
|
Guillory J, Kim AE, Fiacco L, Cress M, Pepper J, Nonnemaker J. An Experimental Study of Nicotine Warning Statements in E-cigarette Tweets. Nicotine Tob Res 2020; 22:814-821. [PMID: 30820571 PMCID: PMC7171270 DOI: 10.1093/ntr/ntz029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 02/23/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION It is unclear whether warnings on electronic cigarette (e-cigarette) advertisements required by the US Food and Drug Administration (FDA) will apply to social media. Given the key role of social media in marketing e-cigarettes, we seek to inform FDA decision making by exploring how warnings on various tweet content influence perceived healthiness, nicotine harm, likelihood to try e-cigarettes, and warning recall. METHODS In this 2 × 4 between-subjects experiment participants viewed a tweet from a fictitious e-cigarette brand. Four tweet content versions (e-cigarette product, e-cigarette use, e-cigarette in social context, unrelated content) were crossed with two warning versions (absent, present). Adult e-cigarette users (N = 994) were recruited via social media ads to complete a survey and randomized to view one of eight tweets. Multivariable regressions explored effects of tweet content and warning on perceived healthiness, perceived harm, and likelihood to try e-cigarettes, and tweet content on warning recall. Covariates were tobacco and social media use and demographics. RESULTS Tweets with warnings elicited more negative health perceptions of the e-cigarette brand than tweets without warnings (p < .05). Tweets featuring e-cigarette products (p < .05) or use (p < .001) elicited higher warning recall than tweets featuring unrelated content. CONCLUSIONS This is the first study to examine warning effects on perceptions of e-cigarette social media marketing. Warnings led to more negative e-cigarette health perceptions, but no effect on perceived nicotine harm or likelihood to try e-cigarettes. There were differences in warning recall by tweet content. Research should explore how varying warning content (text, size, placement) on tweets from e-cigarette brands influences health risk perceptions. IMPLICATIONS FDA's 2016 ruling requires warnings on advertisements for nicotine-containing e-cigarettes, but does not specify whether this applies to social media. This study is the first to examine how e-cigarette warnings in tweets influence perceived healthiness and harm of e-cigarettes, which is important because e-cigarette brands are voluntarily including warnings on Twitter and Instagram. Warnings influenced perceived healthiness of the e-cigarette brand, but not perceived nicotine harm or likelihood to try e-cigarettes. We also saw higher recall of warning statements for tweets featuring e-cigarettes. Findings suggest that expanding warning requirements to e-cigarette social media marketing warrants further exploration and FDA consideration.
Collapse
Affiliation(s)
| | - Annice E Kim
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Leah Fiacco
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Margaret Cress
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - Jessica Pepper
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | - James Nonnemaker
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| |
Collapse
|
17
|
Stevens EM, Johnson AL, Leshner G, Sun F, Kim S, Leavens ELS, Tackett AP, Hébert ET, Wagener TL. People in E-Cigarette Ads Attract More Attention: An Eye-Tracking Study. TOB REGUL SCI 2020; 6:105-117. [PMID: 33816715 PMCID: PMC8018674 DOI: 10.18001/trs.6.2.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Minimally regulated electronic cigarettes (e-cigarette) advertising may be one potential factor driving the increasing prevalence of young adult e-cigarette use. Using eye-tracking, the current study examined which e-cigarette advertising features were the most appealing to young adults as a first step to examine how e-cigarette advertising may be regulated. METHODS Using a within-subjects design, 30 young adults (M age = 20.0 years) viewed e-cigarette ads in a laboratory. Ad features or areas of interest (AOIs) included: 1) brand logo, 2) product descriptor, and 3) people. During ad viewing, eye-tracking measured participants' dwell time and time to first fixation for each AOI as well as each ad brand. Harm perceptions pre- and post-viewing were measured. RESULTS Participants spent the longest dwell time on people (M = 2701 ms), then product descriptors (M = 924 ms), then brand logos (M = 672 ms; ps < .001). They also fixated fastest on AOIs in that order. Participant sex significantly impacted dwell time of ad brand, and harm perceptions decreased after viewing the ads (ps < .05). CONCLUSIONS This study provides initial evidence about which e-cigarette ad features may appeal most to young adults and may be useful when designing evidence-based policy.
Collapse
Affiliation(s)
- Elise M Stevens
- Harvard T.H. Chan School of Public Health, Dana-Farber Cancer Institute, Harvard University, Boston, MA
| | - Amanda L Johnson
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Glenn Leshner
- Edward L. and Thelma Gaylord Chair in journalism, Gaylord College of Journalism and Mass Communication, University of Oklahoma, Norman, OK
| | - FuWei Sun
- Department of Journalism, Fu Hsing Kang College, National Defense University, Taiwan
| | - Seunghyun Kim
- Department of Marketing and Advertising, College of Business, University of Arkansas at Little Rock, Little Rock, AK
| | - Eleanor L S Leavens
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | - Alayna P Tackett
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Emily T Hébert
- Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Theodore L Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, Columbus, OH
| |
Collapse
|
18
|
Brennan E, Maloney E, Ophir Y, Cappella JN. Designing Effective Testimonial Pictorial Warning Labels for Tobacco Products. HEALTH COMMUNICATION 2019; 34:1383-1394. [PMID: 29985636 PMCID: PMC6326893 DOI: 10.1080/10410236.2018.1493417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Warning labels on tobacco products sometimes feature images and stories of real people whose health has been affected by smoking. We examined effects of some of the design elements that may contribute to the effectiveness of these testimonial pictorial warning labels (PWLs). Beginning with a testimonial PWL that contained an image of a person and a basic warning statement (e.g., "Smoking can kill you"), we examined the impact of adding: (a) text detailing the person's name, age and health status (identifiers); and (b) explanatory statements that elaborated on the basic warning using a testimonial or non-testimonial message. In an online experiment, 1255 adult smokers in the United States were randomly assigned to one of six experimental conditions (2 [identifier: none/identifier] × 3 [explanatory statement: none/non-testimonial/testimonial]), or a control condition (text only warning labels that currently appear on packs in the United States). In each condition, participants were exposed to multiple labels each focused on a different health effect. Effectiveness was assessed using emotional responses, engagement and behavioral intentions measured immediately post-exposure, and quit attempts measured at five-week follow up. Testimonial PWLs were more effective than the text only labels. However, there was little evidence that adding identifiers or the explanatory statements enhanced effectiveness; rather, there was some evidence that testimonial explanatory statements reduced effectiveness. These findings suggest that the most effective design for testimonial PWLs may be to combine a basic warning statement with an image of a real person, without any additional textual components.
Collapse
Affiliation(s)
- Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria
| | - Erin Maloney
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
| | - Yotam Ophir
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
| | - Joseph N Cappella
- Penn Tobacco Center of Regulatory Science, Annenberg School for Communication, University of Pennsylvania
| |
Collapse
|
19
|
Lochbuehler K, Wileyto EP, Mercincavage M, Souprountchouk V, Burdge JZ, Tang KZ, Cappella JN, Strasser AA. Temporal Effects of Message Congruency on Attention to and Recall of Pictorial Health Warning Labels on Cigarette Packages. Nicotine Tob Res 2019; 21:879-886. [PMID: 29917125 DOI: 10.1093/ntr/nty124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/14/2018] [Indexed: 11/14/2022]
Abstract
OBJECTIVES Recent research has shown that message congruency is beneficial to recall of pictorial health warning label (PWL) content after initial exposure. Despite less attention to the text warning, smokers exposed to congruent PWLs were more likely to recall the text and the message. This study aimed to replicate these findings and to examine whether congruency also affects recall after multiple exposures over time. METHODS A total of 320 daily smokers (39.7% female; cigarettes/day: M = 15.31, SD = 7.15) were randomized to one congruent or incongruent PWL and attended 4 laboratory sessions over 10 days. During each session, eye movements were recorded while viewing the PWL and open-ended recall of label content was assessed after exposure. RESULTS Smokers who were exposed to a congruent PWL were more likely to recall the text (p = .01) and the message (p = .02) and less likely to recall the image (p = .003) of the PWL after initial exposure. By day 4, incongruent PWLs were recalled equally well as congruent PWLs. Independent of condition, image recall was initially high and remained high whereas text and message recall was relatively low initially but increased over time. It was not until day 7 that about 80% of text and message recall was observed. CONCLUSIONS Even when exposed to the same PWL over time, smokers require multiple exposures to recall the text and the message of a PWL. More research on the effects of congruency in the natural environment, where smokers are exposed to multiple PWLs, is needed. IMPLICATIONS The findings of this study, and of previous work showing that message congruency in PWLs is beneficial to initial recall of PWL content, could potentially help to address legal challenges regarding the implementation of PWLs in the United States. Factually correct text warnings have been uncontested on US cigarettes packages since 1966. Congruent PWLs simply provide a means to visually support the same information as the existing text using a medium that better garners attention to the health information. Investigating and understanding longer-term effects of congruency are important and can empirically inform future warning label development, both in the United States via the Family Smoking Prevention and Tobacco Control Act, and via other governing bodies.
Collapse
Affiliation(s)
- Kirsten Lochbuehler
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Melissa Mercincavage
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordan Z Burdge
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kathy Z Tang
- Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph N Cappella
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Andrew A Strasser
- Tobacco Center of Regulatory Science (TCORS), University of Pennsylvania, Philadelphia, PA.,Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
20
|
Thrasher JF, Brewer NT, Niederdeppe J, Peters E, Strasser AA, Grana R, Kaufman AR. Advancing Tobacco Product Warning Labels Research Methods and Theory: A Summary of a Grantee Meeting Held by the US National Cancer Institute. Nicotine Tob Res 2019; 21:855-862. [PMID: 29444268 PMCID: PMC6775856 DOI: 10.1093/ntr/nty017] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/31/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The World Health Organization's Framework Convention on Tobacco Control recommends prominent pictorial health warnings on tobacco products. To advance research methods, theory and understanding of how tobacco product warning labels (TPWLs) work, the US National Cancer Institute convened a grantee meeting. Our article describes the key insights that emerged from the meeting, situated within the context of the scientific literature. RESULTS & RECOMMENDATIONS First, presentations confirmed that large, pictorial TPWLs motivate people to try to quit and encourage smoking cessation. Second, pictorial TPWLs increase attention, knowledge, negative affect, and thinking about the warning. Third, TPWL studies have primarily used brief-exposure laboratory studies and observational studies of sustained exposure through national policy implementation, with a few randomized trials involving several weeks of exposure-with generally consistent results found across study designs. Fourth, novel assessment methods include brain imaging, eye tracking and "best-worst" discrete choice experiments. To make TPWL even more effective, research is needed to confirm the mechanisms of their influence, their impact across vulnerable populations, and their effect on social media posts about tobacco products. Research is also needed on the effect of trial design choices, the predictive validity of new measurement approaches, and warning labels for non-cigarette tobacco products. IMPLICATIONS To improve scientific understanding of TPWL effects, this grantee meeting summary describes emerging research methods, theory and study results. Directions for future research include examination of the mechanisms of how warning labels work across diverse tobacco products and across different populations and contexts.
Collapse
Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Ellen Peters
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel Grana
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| |
Collapse
|
21
|
Maynard OM, McClernon FJ, Oliver JA, Munafò MR. Using Neuroscience to Inform Tobacco Control Policy. Nicotine Tob Res 2019; 21:739-746. [PMID: 29590482 PMCID: PMC6528159 DOI: 10.1093/ntr/nty057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 03/23/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Techniques employed in the field of neuroscience, such as eye tracking, electroencephalography, and functional magnetic resonance imaging, have been important in informing our understanding of the cognitive mechanisms underlying tobacco smoking. These techniques are now increasingly being used to investigate the likely impact of tobacco control policies. AIMS AND METHODS In this narrative review, we outline the value of these methodological approaches in answering policy-relevant tobacco control research questions, with a particular focus on their use in examining the impact of standardized cigarette packaging and health warnings. We also examine the limitations of these methodologies and provide examples of how they can be used to answer other policy-relevant questions. RESULTS We argue that neuroscience techniques can provide more objective evidence of the impacts of policy measures, allow investigation where it is not possible to conduct behavioral manipulations, and facilitate a deeper understanding of the cognitive mechanisms underlying the impacts of tobacco control policies such as standardized packaging, health warnings, point-of-sale displays, and mass media campaigns. CONCLUSIONS Rather than replacing more traditional methods of examining tobacco control measures, such as observational experiments, surveys, and questionnaires, neuroscience techniques can complement and extend these methods. IMPLICATIONS Neuroscience techniques facilitate objective examination of the mechanisms underlying the impacts of tobacco control measures. These techniques can therefore complement and extend other methodologies typically used in this field, such as observational experiments, surveys, and questionnaires.
Collapse
Affiliation(s)
- Olivia M Maynard
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jason A Oliver
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Marcus R Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit (IEU), School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
22
|
Cao B, Saha PT, Leuba SI, Lu H, Tang W, Wu D, Ong J, Liu C, Fu R, Wei C, Tucker JD. Recalling, Sharing and Participating in a Social Media Intervention Promoting HIV Testing: A Longitudinal Analysis of HIV Testing Among MSM in China. AIDS Behav 2019; 23:1240-1249. [PMID: 30632008 DOI: 10.1007/s10461-019-02392-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Social media interventions may enhance HIV services among key populations, including men who have sex with men (MSM). This longitudinal analysis examined the effect of recalling, sharing, and participating in different components of a social media intervention on HIV testing among MSM. The social media intervention included six images/texts and information about an online local community contest to promote testing. Of the 1033 men, they recalled a mean of 2.7 out of six images and shared an average of one image online. 34.5% of men recalled information on the online local community contest and engaged in a mean of 1.3 contest. Recalling images/texts (aOR = 1.13, 95% CI 1.02-1.25) and recalling a local contest (aOR = 1.59, 95% CI 1.13-1.24) were associated with facility-based HIV testing. This study has implications for the development and evaluation of social media interventions to promote HIV testing.
Collapse
|
23
|
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
|
24
|
Mercincavage M, Burdge J, Lochbuehler K, Souprountchouk V, McCullough AA, Strasser AA. Visual Attention Patterns Differ by Pictorial Health Warning Label Features. TOB REGUL SCI 2018; 4:8-17. [PMID: 30775412 PMCID: PMC6374036 DOI: 10.18001/trs.4.6.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we sought to determine how smokers allocate their attention when viewing the 9 cigarette pictorial warning labels (PWLs) proposed by the Food and Drug Administration (FDA), and identify PWL attributes associated with increased attention. METHODS Using eye-tracking data from an exploratory within-subject study, we examined smokers' attention (latency, latency duration, and dwell time) to areas of interest (image vs textual warning) for each PWL among 95 daily, non-treatment-seeking smokers (62.1% male, 48.4% white, mean [SD] age = 32.98 [10.14], mean [SD] cigarettes/day = 15.51 [8.43]). We also compared attention measures by PWL message congruency, textual warning location, and participant rankings of effectiveness. RESULTS Attention measures differed significantly among PWLs (p s < .001) and by features and self-reported effectiveness rankings (p s < .001 - .039). Congruent PWLs, those displaying text across the warning label, and those ranked most effective were associated with sustained attention to image, whereas incongruent PWLs, those displaying left text, and those ranked least effective, were associated with faster and sustained attention to text. CONCLUSIONS Smokers allocated their attention differently across PWLs. Formats and participant effectiveness rankings of PWLs were associated with visual attention patterns, suggesting the importance of these features to the design of potential future PWLs.
Collapse
Affiliation(s)
- Melissa Mercincavage
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and Center for Interdisciplinary Research on Nicotine Addiction [CIRNA], University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jordan Burdge
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Kirsten Lochbuehler
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Valentina Souprountchouk
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Alexandra A McCullough
- Department of Psychiatry, CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Tobacco Center of Regulatory Science and CIRNA, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
25
|
Hwang JE, Yang YS, Oh YM, Lee SY, Lee JE, Cho SI. Differences in visual fixation duration according to the position of graphic health warning labels: An eye-tracking approach. Tob Induc Dis 2018; 16:39. [PMID: 31516438 PMCID: PMC6659495 DOI: 10.18332/tid/94327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Framework Convention on Tobacco Control (FCTC) recommends that graphic health warning labels (GHWLs) be positioned at the top of the principal area of cigarette packs, rather than at the bottom, to increase visibility. However, during the legislative process of introducing GHWLs in South Korea, the position of GHWLs has become a contested issue. The pro-tobacco industry group argued that the warnings should be placed at the bottom of cigarette packs because evidence for the effectiveness of the upper position was insufficient. Therefore, this study investigated whether the position of the GHWL affects eye movement. METHODS Participants (30 daily smokers and 24 non-smokers) were shown six cigarette packs in random order with different position combinations (top, middle, bottom) and image concepts (skin aging, toxic constituents). Participants’ eye movements were recorded using eye-tracking equipment to measure visual fixation duration in milliseconds (ms) RESULTS Participants visually fixated longer on the health warning area than on the tobacco branding area (p<0.05). Mean fixation duration on the health warning area was significantly longer at the top or middle positions compared to the bottom, by 28% (mean difference=340 ms, p=0.006) and by 30% (mean difference=368 ms, p=0.002), respectively. By contrast, mean fixation duration on the branding area was longer with the warning at the bottom compared to top or middle positions by 25% and 33%, with mean differences of 157 ms (p=0.100) and 212 ms (p=0.026), respectively. No significant difference in fixation time was observed between the top and middle positions (p>0.05) CONCLUSIONS The duration of visual fixation on GHWLs was longer when they were displayed at the top and middle, rather than at the bottom. Therefore, GHWLs should be positioned from the top to the middle of the tobacco package.
Collapse
Affiliation(s)
- Ji-Eun Hwang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yu-Seon Yang
- Korea Health Promotion Institute, Seoul, Republic of Korea
| | - Yu-Mi Oh
- Korea Health Promotion Institute, Seoul, Republic of Korea
| | - Seon-Young Lee
- Gyeonggi Infectious Disease Control Center, Seongnam, Republic of Korea
| | - Joung-Eun Lee
- Korea Health Promotion Institute, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
26
|
Yang S, Maloney EK, Tan ASL, Cappella JN. When Visual Cues Activate Moral Foundations: Unintended Effects of Visual Portrayals of Vaping within Electronic Cigarette Video Advertisements. HUMAN COMMUNICATION RESEARCH 2018; 44:223-246. [PMID: 30013288 PMCID: PMC6037301 DOI: 10.1093/hcr/hqy004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Within multimodal persuasive messages, the roles of visual cues in producing unintended effects have been understudied. In an experiment on a sample of former and current smokers (N = 991), we manipulated the presence of visual vaping cues within electronic cigarette video advertisements (N = 25) to evaluate opinions towards vape-free policies. Such cues diminished the effects of pro-vaping arguments to increase support for vape-free policies, inadvertently benefiting public health. Consistent with the moral foundations theory (MFT), endorsement of the care/harm moral foundation strengthened message effects. Furthermore, cognitions and emotions related to moral intuitions mediated the effects of visual vaping cues. These findings suggest that MFT can help explain unintended effects of visual cues when outcomes are related to morality.
Collapse
Affiliation(s)
- Sijia Yang
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Erin K Maloney
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Center for Community-Based Research, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
27
|
Dewhirst T, Lee WB. Who is the target? Package health warnings and the role of market segmentation. Tob Control 2018; 27:243-244. [DOI: 10.1136/tobaccocontrol-2018-054277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Effects of E-Cigarette Health Warnings and Modified Risk Ad Claims on Adolescent E-Cigarette Craving and Susceptibility. Nicotine Tob Res 2018; 21:792-798. [DOI: 10.1093/ntr/nty076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/13/2018] [Indexed: 12/26/2022]
|
29
|
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
|