Message-Elicited Brain Response Moderates the Relationship Between Opportunities for Exposure to Anti-Smoking Messages and Message Recall

A mixed-method study of perceptions of cigarette pack inserts among adult smokers from New York and South Carolina exposed as part of a randomized controlled trial

While many countries require prominent pictorial health warning labels (PHWLs) on the outside of cigarette packs to communicate the harms of smoking, there is evidence that cigarette pack inserts that contain efficacy messages may enhance the effectiveness of PHWLs. The US Food and Drug Administration (FDA) has regulatory authority to communicate with smokers through inserts. While current labeling regulations do not require inclusion of inserts, the FDA could implement them in the future. This study assesses US smokers' perceptions of cigarette package inserts at the conclusion of a two-week randomized trial on cigarette labeling where half of participants were exposed to insert messages (two response-efficacy messages and two self-efficacy messages) in their packs. Participants (n = 359) completed a 30- to 60-min interview with both quantitative and qualitative assessments, including measures of recall and perceived message effectiveness (PME) for specific inserts. Correlates of recall and PME were estimated using mixed-effects regression models. Qualitative responses to PME items were analyzed using thematic analysis. Response-efficacy messages had higher PME and recall than self-efficacy messages. People had diverse responses to the inserts, including that they were positive, thought-provoking, and helpful. Reactions to and perceptions of the inserts indicate potential benefits of integrating efficacy messages into labeling policies.

Face Value: Remote facial expression analysis adds predictive power to perceived effectiveness for selecting anti-tobacco PSAs

Perceived effectiveness (PE) is a validated tool for predicting the potential impact of anti-tobacco public service announcements (PSAs). We set out to evaluate the added predictive value of facial expression analysis when combined with PE in a remote (online) survey. Each of 302 tobacco users watched 3 PSAs and allowed transmission of webcam videos from which metrics for "attention" (head position) and "facial action units" (FAU) were computed. The participants completed scales for their subjective emotions, willingness to share on social media, and intention to quit smoking using the Tobacco Free Florida website. Based on PE, both ready to quit (RTQ) and not ready (NR) respondents favored the same PSAs but RTQs assigned higher PE scores. Negative PSAs ("sad" or "frightening") were more compelling overall but RTQs also favored surprising ads and were more willing to share them on social media. Logistic regression showed that the combination of Attention + FAU+ PE (AUC = .816, p < .0001) outperformed single factors or factor combinations in distinguishing RTQ from NR. This study demonstrates that on-line assessment of facial expressions enhances the predictive value of PE and can be deployed on large remote samples.

Neural activity in self-related brain regions in response to tailored nutritional messages predicts dietary change

Overweight and obesity have become international public health problems, so there is an urgent need to implement effective interventions that prevent these concerning health issues. Designing personalized (tailored) dietary communications has become one of the most effective tools in reducing unhealthy eating behavior, when compared with one-size-fits-all messages (untailored). However, more research is required to gain a complete understanding of the underlying mechanisms by which tailored nutritional messages elicit reductions in unhealthy dietary behavior. To the best of our knowledge, our study may be the first to use neuroimaging, namely functional magnetic resonance imaging (fMRI), aiming to evaluate the neural basis of tailored and untailored nutritional messages and assess how these neural responses predict unhealthy food intake reduction after a month receiving tailored nutritional messages. To that goal, 30 participants were scanned while reading tailored and untailored nutritional messages. Subsequently, for a month, they received tailored interventions encouraging healthy food intake. The neural findings reveal that when compared to untailored communications, tailored messages elicit brain networks associated with self-relevance, such as the precuneus, the middle temporal gyrus, the hippocampus, the inferior orbitofrontal cortex (OBC), the dorsomedial prefrontal cortex (dMPFC), and the angular gyrus. Interestingly, among these self-related brain areas, the dMPFC, OFC, angular gyrus, and hippocampus forecast reductions in unhealthy food intake after a one-month tailored intervention for the cessation of unhealthy eating. These results may offer implications for clinicians, practitioners, and/or policymakers who should implement substantial efforts in creating individualized campaigns focused on their target's perceived needs, goals, and drivers in relation to eating healthy to reduce overweight issues. This research therefore constitutes a step forward in showing a direct association between the neural responses to tailored nutritional messages and changes in real-life healthy eating behavior.