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Kowitt SD, Lazard AJ, Queen TL, Noar SM, Goldstein AO. Adolescents' Aided Recall of Targeted and Non-Targeted Tobacco Communication Campaigns in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2363. [PMID: 30366436 PMCID: PMC6266583 DOI: 10.3390/ijerph15112363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022]
Abstract
We examined whether advertisements from two national tobacco control campaigns targeting adolescents (i.e., The Real Cost, Fresh Empire) and one campaign targeting adults (i.e., Tips from Former Smokers) were reaching adolescents. Data came from a national sample of adolescents aged 13 to 17 years (n = 975) surveyed by phone from August 2016 to May 2017. We assessed recall and attitudes toward five specific advertisements and three campaign slogans and examined differences by sub-groups. Almost all (95%) adolescents recalled seeing at least one campaign advertisement. Aided recall of The Real Cost and Tips from Former Smokers slogans was high (65.5% and 71.6%, respectively), while aided recall of Fresh Empire slogan was lower (15.3%) (χ² p-value: p < 0.001); however, Black adolescents had higher odds of recalling the Fresh Empire ad (aOR: 2.28, 95% CI: 1.39, 3.73) and slogan (aOR: 2.64, 95% CI: 1.06, 6.54) compared to White adolescents. Increased exposure to the advertisements (i.e., recalling more advertisements) was significantly associated with higher odds of reporting negative feelings toward tobacco products in 4/5 models (aORs from 1.34 to 1.61). Large-scale national campaigns can have wide reach among both targeted and non-targeted audiences with added benefits for cumulative cross-campaign exposure to advertisements.
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Lazard AJ, Horrell L, Pikowski J, Cornacchione Ross J, Noar SM, Sutfin EL. Message and Delivery Preferences for Online Tobacco Education among Adolescents and Young Adults. JOURNAL OF HEALTH COMMUNICATION 2018; 23:735-742. [PMID: 30280989 PMCID: PMC6421838 DOI: 10.1080/10810730.2018.1523259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Use of cigarettes and noncigarette tobacco products (NCTPs) among adolescents and young adults remains high. Strategies to communicate the risks of cigarettes and NCTPs are needed. Online tobacco education is one such strategy; however, there is little guidance for message development. We conducted four focus groups (n = 39) with adolescent and young adult to identify message and delivery preferences for online tobacco education. Participants evaluated three existing tobacco education websites. Transcripts were coded for preferred tobacco education message content, delivery, and willingness to use online tobacco education. Participants preferred novel, concise facts, embedded links to credible sources, and an anti-industry tone for website messages. Participants expressed an aversion to message strategies that relied on scare tactics or attempted to simulate youth media trends (e.g., overuse of hashtags). To increase exposure, participants recommended using social media to drive engagement. Results serve as guidelines for what information adolescents and young adults desire, as well as how they want this information communicated with online tobacco education. Our findings - youth prefer new, fact-based information that is conveyed concisely, with sources, without authoritative tones, and delivered via social media - provides guidance for how to develop online tobacco education for this at-risk population.
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Morgan JC, Golden SD, Noar SM, Ribisl KM, Southwell BG, Jeong M, Hall MG, Brewer NT. Conversations about pictorial cigarette pack warnings: Theoretical mechanisms of influence. Soc Sci Med 2018; 218:45-51. [PMID: 30340152 DOI: 10.1016/j.socscimed.2018.09.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/19/2018] [Accepted: 09/30/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Social interactions are a key mechanism through which health communication campaigns influence behavior. Little research has examined how conversations about pictorial warnings motivate behavior. PURPOSE We sought to establish whether and how smokers' conversations explain the effect of pictorial warnings on quit attempts. METHODS US adult smokers (n = 2149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations sparked by pictorial warnings and the theoretical mechanisms cognitive elaboration and social norms at each visit. Analyses used structural equation modeling to test our theorized mediation models. RESULTS The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p < .001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations was associated with greater cognitive elaboration, which in turn was associated with being more likely to make a quit attempt (p < .05). Social norms did not explain the influence of conversations on quit attempts. CONCLUSIONS Pictorial warnings increased conversations about the warnings, which led to greater cognitive elaboration, which led to greater quit attempts. Our findings suggest designing warnings that increase conversations in order to better inform and motivate smokers. Furthermore, these findings improve our understanding of why conversations matter in health communication.
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Noar SM, Barker J, Yzer M. Measurement and Design Heterogeneity in Perceived Message Effectiveness Studies: A Call for Research. THE JOURNAL OF COMMUNICATION 2018; 68:990-993. [PMID: 30479402 PMCID: PMC6241501 DOI: 10.1093/joc/jqy047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Indexed: 06/01/2023]
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Kelley DE, Boynton MH, Noar SM, Morgan JC, Mendel JR, Ribisl KM, Stepanov I, Nylander-French LA, Brewer NT. Effective Message Elements for Disclosures About Chemicals in Cigarette Smoke. Nicotine Tob Res 2018; 20:1047-1054. [PMID: 28521063 PMCID: PMC6093311 DOI: 10.1093/ntr/ntx109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/12/2017] [Indexed: 11/13/2022]
Abstract
Introduction Cigarette smoke contains at least 93 chemicals or "constituents" that the Food and Drug Administration has identified as harmful and potentially harmful constituents to human health. Our study sought to identify which constituent disclosure message elements are most effective in discouraging people from smoking. Methods Three hundred eighty eight current smokers aged 18 and older completed an online survey in February 2015. We randomized participants to respond to one of two sets of 13 toxic products that contain cigarette constituents and 25 health effects associated with cigarette constituents. Results Products that elicited the most discouragement were those with lower chances of exposure (e.g., explosives), followed by products with possible exposure (e.g., rat poison), and products with a high likelihood of exposure (e.g., floor cleaner). Awareness of toxic products that constituents are found in (p < .001) and low exposure products (p < .001) were associated with higher discouragement. Health effects that people had heard are caused by cigarette smoke constituents elicited higher discouragement from smoking cigarettes (p < .001). Cancer was associated with higher discouragement relative to respiratory, cardiovascular, and reproductive health effects (all p < .001). Conclusions Cigarette smoke constituent messages may be more effective at discouraging smoking if they include information about carcinogenic health effects (e.g., mouth cancer and lung tumors) and low exposure toxic products (e.g., explosives and radioactive material) as message elements. Implications Our study identified health effects and toxic products, especially cancers and rarely encountered toxic products, that may discourage smoking when included in disclosure messages. By constructing messages that communicate the harms associated with tobacco use by contextualizing those harms in terms of specific constituents, tobacco education messaging efforts may be increasingly successful.
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Donohew L, DiBartolo M, Zhu X, Benca C, Lorch E, Noar SM, Kelly TH, Joseph JE. Communicating with Sensation Seekers: An fMRI Study of Neural Responses to Antidrug Public Service Announcements. HEALTH COMMUNICATION 2018; 33:1004-1012. [PMID: 28622027 PMCID: PMC6190582 DOI: 10.1080/10410236.2017.1331185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study examined the neural basis of processing high- and low-message sensation value (MSV) antidrug public service announcements (PSAs) in high (HSS) and low sensation seekers (LSS) using fMRI. HSS more strongly engaged the salience network when processing PSAs (versus LSS), suggesting that high-MSV PSAs attracted their attention. HSS and LSS participants who engaged higher level cognitive processing regions reported that the PSAs were more convincing and believable and recalled the PSAs better immediately after testing. In contrast, HSS and LSS participants who strongly engaged visual attention regions for viewing PSAs reported lower personal relevance. These findings provide neurobiological evidence that high-MSV content is salient to HSS, a primary target group for antidrug messages, and additional cognitive processing is associated with higher perceived message effectiveness.
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Hall MG, Mendel JR, Noar SM, Brewer NT. Why smokers avoid cigarette pack risk messages: Two randomized clinical trials in the United States. Soc Sci Med 2018; 213:165-172. [PMID: 30096636 DOI: 10.1016/j.socscimed.2018.07.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/10/2018] [Accepted: 07/29/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Message avoidance (e.g., trying not to look at the message) may be motivated by reactance, a maladaptive rejection of the message. An alternative view is that avoidance indicates that a message is eliciting fear and other negative affect, thereby increasing the likelihood of behavioral change. We sought to identify which psychological mechanism-reactance or fear and other negative affect-explains message avoidance. We also examined whether avoidance was associated with more forgoing or butting out of cigarettes. METHOD Trial 1 randomly assigned 2149 adult U.S. smokers to receive either pictorial warnings (intervention) or text-only warnings (control) on their cigarette packs for four weeks in 2014 and 2015. Trial 2 randomly assigned 719 adult U.S. smokers to receive either messages about toxic chemicals in cigarette smoke (intervention) or messages about not littering cigarette butts (control) for three weeks in 2016 and 2017. Negative affect included fear, anxiety, disgust, sadness, and guilt. Reactance included perceived threat to freedom, anger, and counterarguing. RESULTS Intervention messages led to greater message avoidance in both trials (both p < .001). In Trial 1, intervention messages elicited greater negative affect, which in turn was associated with greater avoidance (mediated effect = 0.21, p < .001). In contrast, reactance explained only a small part of the effect in Trial 1 (mediated effect = 0.03, p < .001). Similarly, in Trial 2, intervention messages elicited greater negative affect, which was associated with more avoidance (mediated effect = 0.12, p < .001); reactance did not explain any of the effect. In both trials, avoidance was associated with more forgoing or butting out of cigarettes (ps < .001). CONCLUSIONS Smokers may avoid cigarette pack risk messages because they evoke aversive types of emotion. These studies add to a growing body of evidence that, in the context of cigarette pack messages, avoidance is not a form of defensive processing but instead a sign of deeper processing.
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Noar SM, Bell T, Kelley D, Barker J, Yzer M. Perceived Message Effectiveness Measures in Tobacco Education Campaigns: A Systematic Review. COMMUNICATION METHODS AND MEASURES 2018; 12:295-313. [PMID: 31428217 PMCID: PMC6699787 DOI: 10.1080/19312458.2018.1483017] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Target audience ratings of the likely impact of persuasive messages, known as perceived message effectiveness (PME), are commonly used during message development and selection. PME is also used to examine receptivity of messages after they are fully developed or deployed. Despite this, we know little about the conceptual and methodological characteristics of extant PME measures used in the literature. We conducted a systematic review of tobacco education video, print, and audio campaign studies to examine conceptual and methodological characteristics of PME measures. One hundred twenty-six PME measures from 75 studies conducted in 21 countries with more than 61,000 participants were reviewed. Results indicated considerable variability in measures' focus on general perceptions of a message (i.e., message perceptions) versus perceptions of expected message effects (i.e., effects perceptions). Considerable variability was also found on underlying persuasive constructs, use of referents, and referencing of behavior in PME items and measures. We conclude with several recommendations for future research on PME measurement and validation.
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Kelley DE, Noar SM, Seidenberg AB. Understanding Misinformation in the Pro-tanning Communication Environment: A Content Analysis. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2018.1473181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Morgan JC, Moracco KE, Mendel JR, Kelley DE, Noar SM, Brewer NT. Increasing Effectiveness of Messages about Chemicals in Cigarette Smoke. TOB REGUL SCI 2018; 4:50-62. [PMID: 34141828 PMCID: PMC8208641 DOI: 10.18001/trs.4.4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Federal law requires informing the public on toxic chemicals in cigarette smoke. We sought the public's advice about communicating information about these chemicals. METHODS Adolescents, young adults, and adults (N = 59), including smokers and non-smokers, participated in 9 focus groups that discussed inclusion of messages about toxic chemicals on cigarette packs, in media campaigns, and on a website. We transcribed, coded, and analyzed focus group audio-recordings. RESULTS Participants had 3 suggestions for message content to increase the impact of messages about cigarette smoke chemicals. First, they wanted to see messages rotated more frequently to increase message novelty. Second, they recommended using stories and pictures to help connect people to the abstract idea of chemicals in smoke. Third, they cautioned against making messages that might seem overblown and could appeal to the rebellious nature of adolescents. Some participants mentioned that chemical information on a website might discourage people from smoking; others mentioned that people might use it to choose which brand to smoke. CONCLUSIONS Legislation provides the impetus to design new chemical disclosure messages for cigarette packs and other media. Our findings can help increase the impact of these messages.
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Morgan JC, Southwell BG, Noar SM, Ribisl KM, Golden SD, Brewer NT. Frequency and Content of Conversations About Pictorial Warnings on Cigarette Packs. Nicotine Tob Res 2018; 20:882-887. [PMID: 29059415 PMCID: PMC5991214 DOI: 10.1093/ntr/ntx180] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 08/11/2017] [Indexed: 11/13/2022]
Abstract
Introduction Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods A controlled trial randomly assigned US adult smokers (n = 2149) to have their cigarette packs labeled with pictorial or text-only warnings for 4 weeks. Smokers completed surveys during the baseline visit and each of the subsequent 4 weekly visits. Results Smokers with pictorial warnings on their packs had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs 5.0, p<.01). The highest number of conversations occurred during the first week. Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking, whether the warnings would make them want to quit and whether the warnings would make others want to quit (all p < .05). Smokers were more likely to describe pictorial warnings as scary, gross, or depressing and gloomy during conversations than text-only warnings (all p < .05). Conclusions Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker and may be one of the processes by which pictorial warnings have impact. Implications Health communication can influence behavior by changing social interactions. Our trial characterized social interactions about pictorial cigarette pack warnings with a large longitudinal sample in a real-world setting. Understanding these conversations can inform the United States and other countries as they improve existing warnings and help tobacco control policy makers and health communication theorists understand how social interactions triggered by warnings affect smoking.
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Garrett Wagner KP, Widman L, Nesi J, Noar SM. Intentions to use emergency contraception: The role of accurate knowledge and information source credibility. AMERICAN JOURNAL OF HEALTH EDUCATION 2018; 49:264-270. [PMID: 30397420 DOI: 10.1080/19325037.2018.1473179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background Emergency contraception (EC) is a highly effective form of birth control that may lower rates of unintended pregnancy among young women. But efforts to disseminate EC to women are hampered by misinformation and inadequate information. Purpose The purpose of this study was to determine the sources from which young women learn about EC (including health care providers, friends/interpersonal sources, media sources, or no information sources), and to examine source credibility with the accuracy of EC knowledge and intentions to use EC. Method Using a computer-based survey, 339 college women (M age = 18.4) reported their EC information sources, knowledge about EC, and behavioral intentions to use EC. Results In total, 97% of participants had heard of EC from at least one source and 49% indicated they were highly likely to use EC in the future if needed. Results demonstrated that EC knowledge mediated the relationship between EC information source credibility and intentions to use EC. Discussion This study contributes important insights to a scarce literature on EC information sources and the factors that predict intentions to use EC. Translation to Health Education Practice Future EC promotion efforts should target health education sources instead of media or interpersonal sources to promote EC knowledge and use among young, sexually at-risk populations.
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Noar SM, Leas E, Althouse BM, Dredze M, Kelley D, Ayers JW. Can a selfie promote public engagement with skin cancer? Prev Med 2018; 111:280-283. [PMID: 29109014 DOI: 10.1016/].ypmed.2017.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 05/24/2023]
Abstract
Social media may provide new opportunities to promote skin cancer prevention, but research to understand this potential is needed. In April of 2015, Kentucky native Tawny Willoughby (TW) shared a graphic skin cancer selfie on Facebook that subsequently went viral. We examined the volume of comments and shares of her original Facebook post; news volume of skin cancer from Google News; and search volume for skin cancer Google queries. We compared these latter metrics after TWs announcement against expected volumes based on forecasts of historical trends. TWs skin cancer story was picked up by the media on May 11, 2015 after the social media post had been shared approximately 50,000 times. All search queries for skin cancer increased 162% (95% CI 102 to 320) and 155% (95% CI 107 to 353) on May 13th and 14th, when news about TW's skin cancer selfie was at its peak, and remained higher through May 17th. Google searches about skin cancer prevention and tanning were also significantly higher than expected volumes. In practical terms, searches reached near-record levels - i.e., May 13th, 14th and 15th were respectively the 6th, 8th, and 40th most searched days for skin cancer since January 1, 2004 when Google began tracking searches. We conclude that an ordinary person's social media post caught the public's imagination and led to significant increases in public engagement with skin cancer prevention. Digital surveillance methods can rapidly detect these events in near real time, allowing public health practitioners to engage and potentially elevate positive effects.
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Hall MG, Marteau TM, Sunstein CR, Ribisl KM, Noar SM, Orlan EN, Brewer NT. Public support for pictorial warnings on cigarette packs: an experimental study of US smokers. J Behav Med 2018; 41:398-405. [PMID: 29411272 PMCID: PMC5924634 DOI: 10.1007/s10865-018-9910-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Understanding factors that influence public support for "nudging" policies, like pictorial cigarette pack warnings, may offer insight about how to increase such support. We sought to examine factors that influence smokers' support for requiring pictorial warnings on cigarette packs. METHODS In 2014 and 2015, we randomly assigned 2149 adult US smokers to receive either pictorial warnings or text-only warnings on their cigarette packs for 4 weeks. The outcome examined in the current study was support for a policy requiring pictorial warnings on cigarette packs in the US. RESULTS Support for pictorial warnings was high at baseline (mean: 3.2 out of 4). Exposure to pictorial warnings increased policy support at week 4 (β = .05, p = .03). This effect was explained by increases in perceived message effectiveness (p < .001) and reported conversations about policy support (p < .001). Message reactance (i.e., an oppositional reaction to the warning) partially diminished the impact of pictorial warnings on policy support (p < .001). CONCLUSIONS Exposing people to a new policy through implementation could increase public support for that policy by increasing perceived effectiveness and by prompting conversations about the policy. Reactance may partially weaken the effect of policy exposure on public support.
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Rohde JA, Noar SM, Horvitz C, Lazard AJ, Cornacchione Ross J, Sutfin EL. The Role of Knowledge and Risk Beliefs in Adolescent E-Cigarette Use: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E830. [PMID: 29690606 PMCID: PMC5923872 DOI: 10.3390/ijerph15040830] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/23/2022]
Abstract
The use of e-cigarettes and other vaping devices among adolescents is an urgent public health problem due to the concern about adolescent exposure to nicotine. This study examined: (1) adolescents’ knowledge and beliefs about e-cigarette risks; and (2) whether knowledge and risk beliefs were associated with e-cigarette use. N = 69 adolescents completed a cross-sectional survey about e-cigarette knowledge, attitudes (i.e., risk beliefs), and behavior (KAB). Nearly half (47%) of the sample reported ever using e-cigarettes. The majority of adolescents knew about many of the risks of e-cigarettes, with no differences between never- and ever-users. However, risk beliefs, such as worrying about health risks of using e-cigarettes, varied across groups. Compared to never-users, e-cigarette ever-users were significantly less likely to worry about e-cigarette health risks, less likely to think that e-cigarettes would cause them negative health consequences, and less likely to believe that e-cigarette use would lead to addiction. In a multivariable logistic regression, prior combustible cigarette use, mother’s education, and addiction risk beliefs about e-cigarettes emerged as significant predictors of adolescents’ e-cigarette use. This study reveals that while knowledge is not associated with adolescent e-cigarette use, risk beliefs do predict use.
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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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Choukas-Bradley S, Nesi J, Widman L, Noar SM. Examining the Roles of Self-Objectification and Appearance Expectations in Young Women’s Indoor Tanning Behavior. SEX ROLES 2018. [DOI: 10.1007/s11199-018-0913-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Francis DB, Noar SM, Fortune DA, Adimora AA. "Be Straight Up and So Will He": Evaluation of a Novel HIV Prevention Condom Distribution and Health Communication Intervention Targeting Young African American Females. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:137-151. [PMID: 29688776 PMCID: PMC6476563 DOI: 10.1521/aeap.2018.30.2.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study evaluated a novel 3-month campus-based HIV prevention condom distribution and health communication intervention for African American females attending a historically Black college in North Carolina. The theoretical framework for study incorporated the integrative model of behavioral prediction and the theory of gender and power. The intervention provided free condoms via condom dispensers with point-of-access messaging on the dispensers. We assessed 195 individuals before and 118 three months after the intervention. Almost 90% of participants were exposed to the intervention. Forty-four percent used the dispensers, 70% of whom reported using the condoms for sexual intercourse. Perceptions of condom availability and accessibility increased significantly after the intervention. In a multiple regression analysis controlling for covariates, dispenser use was significantly associated with greater condom use. These findings show the promise of a low-cost, broad-reach HIV/STI prevention intervention for young African American women.
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Noar SM, Kelley DE, Boynton MH, Morgan JC, Hall MG, Mendel JR, Ribisl KM, Brewer NT. Identifying principles for effective messages about chemicals in cigarette smoke. Prev Med 2018; 106:31-37. [PMID: 28890353 PMCID: PMC5764803 DOI: 10.1016/j.ypmed.2017.09.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/31/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
US law requires the Food and Drug Administration (FDA) to disclose information on harmful and potentially harmful chemicals in cigarette smoke (i.e., constituents) to the public. To inform this effort, we sought to identify principles for creating constituent messages that effectively discourage smoking. Participants were an online convenience sample of 1148 US smokers ages 18+. We developed a library of 76 messages about constituents only and constituents plus contextualizing information (i.e., toxic products that also contain the chemical, health effects, or both). We randomized smokers to receive 1 message from each of 7 message panels in a mixed between-/within-subjects experiment. Participants rated each message on perceived message effectiveness. Results indicated that smokers perceived messages about arsenic, formaldehyde, lead, uranium, and ammonia as more effective than messages about nitrosamines. Messages that contained information on toxic products, health effects, or both received higher effectiveness ratings than constituent-only messages. Among constituent-only messages, those that referenced multiple constituents received higher effectiveness ratings than those with fewer constituents. We conclude that chemical messages may have more impact if they pair known constituents with toxic product or health effect information. These message principles can be used to inform studies examining the impact of constituent messages on smoking beliefs and behavior.
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Jo CL, Golden SD, Noar SM, Rini C, Ribisl KM. Effects of E-cigarette Advertising Messages and Cues on Cessation Outcomes. TOB REGUL SCI 2018; 4:562-572. [PMID: 29242819 PMCID: PMC5725201 DOI: 10.18001/trs.4.1.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We examined effects of e-cigarette ad messages and visual cues on outcomes related to combustible cigarette smoking cessation: smoking cessation intention, smoking urges, and immediate smoking behavior. METHODS US adult smokers (N = 3293) were recruited through Amazon Mechanical Turk and randomized to condition in a 3 (message: e-cigarette use anywhere, harm reduction, control) × 2 (e-cigarette cue presence or absence) between-subjects experiment. Stimuli were print ads for cigarette-like e-cigarettes ("cigalikes") that were manipulated for the experimental conditions. We conducted ANOVA and logistic regression analyses to investigate effects of the manipulations. RESULTS Message effects on cessation intention and smoking urges were not statistically significant. There was no evidence of cue effects or message × cue interactions across outcomes. Contrary to expectations, e-cigarette use anywhere and harm reduction messages were associated with lower odds of immediate smoking than the control message (AOREUA = 0.75, 95%CI = 0.58, 0.97, p = .026; AORHR = 0.72, 95%CI = 0.55, 0.93, p = .013). CONCLUSIONS E-cigarette use anywhere and harm reduction messages may encourage smoking cessation, given the observed reduction in immediate smoking. E-cigarette cues may not influence smoking cessation outcomes. Future studies should investigate whether message effects are a result of smokers believing e-cigarettes to be effective cessation aids.
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Hall MG, Sheeran P, Noar SM, Boynton MH, Ribisl KM, Parada H, Johnson TO, Brewer NT. Negative affect, message reactance and perceived risk: how do pictorial cigarette pack warnings change quit intentions? Tob Control 2017; 27:e136-e142. [PMID: 29248897 DOI: 10.1136/tobaccocontrol-2017-053972] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Pictorial warnings on cigarette packs increase motivation to quit smoking. We sought to examine the potential mediating role of negative affect, message reactance (ie, an oppositional reaction to a message) and perceived risk in shaping quit intentions. METHODS In 2014 and 2015, we randomly assigned 2149 adult US smokers to receive either pictorial warnings or text-only warnings applied to their cigarette packs for 4 weeks. Analyses used structural equation modelling with bootstrapped SEs to test our theorised mediational model. FINDINGS Pictorial warnings increased negative affect, message reactance and quit intentions (all P<0.001), but not perceived risk (ie, perceived likelihood and severity of harms of smoking). Negative affect mediated the impact of pictorial warnings on quit intentions (mediated effect=0.16, P<0.001). Message reactance weakened the impact of pictorial warnings on quit intentions, although the effect was small (mediated effect=-0.04, P<0.001). Although pictorial warnings did not directly influence perceived risk, the model showed additional small mediation effects on quit intentions through negative affect and its positive association with perceived risk (mediated effect=0.02, P<0.001), as well as reactance and its negative association with perceived risk (mediated effect=-0.01, P<0.001). CONCLUSIONS Pictorial cigarette pack warnings increased quit intentions by increasing negative affect. Message reactance partially attenuated this increase in intentions. The opposing associations of negative affect and reactance on perceived risk may explain why pictorial warnings did not lead to observable changes in perceived risk.
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Seidenberg AB, Noar SM, Sontag JM. Is initiating tanning bed use as a minor associated with increased risky tanning behaviors and burning? An exploratory study. Prev Med 2017; 105:15-18. [PMID: 28757448 PMCID: PMC5998669 DOI: 10.1016/j.ypmed.2017.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
Abstract
Tanning bed use is most common among youth and young adults, and is associated with an increased risk of skin cancer. Recently, numerous states have adopted restrictions on minors' access to tanning beds; however, little has been reported on how such policies may impact tanning behaviors and burning. The purpose of this study was to examine the associations between age of indoor tanning initiation and risky tanning behaviors and burning. Female students (n=567) attending a large southeastern public university completed a questionnaire (spring of 2015) assessing tanning bed use history, including age of initiation. The analytic sample was limited to participants reporting past year indoor tanning (n=134). Multivariable logistic regression was used to compare the odds of risky tanning behaviors and burning among those initiating indoor tanning before and after their 18th birthday. Participants initiating indoor tanning as a minor had significantly (ps<0.05) greater odds of using a tanning bed 10 or more times in the previous year, typically indoor tanning for ≥10min, ever indoor tanning without wearing goggles, and ever fallen asleep inside a tanning bed. Further, those that initiated as a minor had significantly greater odds of ever burning from indoor tanning (p<0.05). Indoor tanning initiation as a minor was associated with several risky tanning behaviors and burning. Youth access restrictions may help reduce the harms caused by tanning beds.
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Francis DB, Hall MG, Noar SM, Ribisl KM, Brewer NT. Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments. Nicotine Tob Res 2017; 19:1127-1137. [PMID: 28431080 PMCID: PMC5896543 DOI: 10.1093/ntr/ntx082] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/12/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to describe characteristics and psychometric properties of measures used in pictorial cigarette pack warning experiments and provide recommendations for future studies. METHODS Our systematic review identified 68 pictorial cigarette pack warning experiments conducted between 2000 and 2016 in 22 countries. Two independent coders coded all studies on study features, including sample characteristics, theoretical framework, and constructs assessed. We also coded measurement characteristics, including construct, number of items, source, reliability, and validity. RESULTS We identified 278 measures representing 61 constructs. The most commonly assessed construct categories were warning reactions (62% of studies) and perceived effectiveness (60%). The most commonly used outcomes were affective reactions (35%), perceived likelihood of harm (22%), intention to quit smoking (22%), perceptions that warnings motivate people to quit smoking (18%), and credibility (16%). Only 4 studies assessed smoking behavior. More than half (54%) of all measures were single items. For multi-item measures, studies reported reliability data 68% of the time (mean α = 0.88, range α = 0.68-0.98). Studies reported sources of measures only 33% of the time and rarely reported validity data. Of 68 studies, 37 (54%) mentioned a theory as informing the study. CONCLUSIONS Our review found great variability in constructs and measures used to evaluate the impact of cigarette pack pictorial warnings. Many measures were single items with unknown psychometric properties. Recommendations for future studies include a greater emphasis on theoretical models that inform measurement, use of reliable and validated (preferably multi-item) measures, and better reporting of measure sources. IMPLICATIONS Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the need for standardized, theory-based measures.
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Boynton MH, Agans RP, Michael Bowling J, Brewer NT, Sutfin EL, Goldstein AO, Noar SM, Ribisl KM. Erratum to: understanding how perceptions of tobacco constituents and the FDA relate to effective and credible tobacco risk messaging: a national phone survey of U.S. adults, 2014-2015. BMC Public Health 2017; 17:726. [PMID: 28931386 PMCID: PMC5607607 DOI: 10.1186/s12889-017-4760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022] Open
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