Tailored Cigarette Warning Messages: How Individualized Loss Aversion and Delay Discounting Rates Can Influence Perceived Message Effectiveness

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations.

A multi-method evaluation of tobacco treatment trial recruitment messages for current smokers recently diagnosed with cancer: A pilot factorial randomized control trial (Preprint)

Background

A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited.

Objective

This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer.

Methods

From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors.

Results

Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified.

Conclusions

Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates.

Trial Registration

Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284

The Influence of Episodic Future Thinking and Graphic Warning Labels on Delay Discounting and Cigarette Demand

Delay discounting and operant demand are two behavioral economic constructs that tend to covary, by degree, with cigarette smoking status. Given historically robust associations between adverse health outcomes of smoking, a strong preference for immediate reinforcement (measured with delay discounting), and excessive motivation to smoke cigarettes (measured with operant demand), researchers have made numerous attempts to attenuate the extent to which behaviors corresponding to these constructs acutely appear in smokers. One approach is episodic future thinking, which can reportedly increase the impact of future events on present decision making as well as reduce the reinforcing value of cigarettes. Graphic cigarette pack warning labels may also reduce smoking by increased future orientation. Experiment 1 evaluated the combined effects of episodic future thinking and graphic warning labels on delay discounting; Experiment 2 evaluated solely the effects of episodic future thinking on delay discounting and operant demand. We observed no statistically significant effects of episodic future thinking when combined with graphic warning labels or when assessed on its own. These results serve as a call for further research on the boundary conditions of experimental techniques reported to alter behaviors associated with cigarette smoking.