[Show abstract][Hide abstract] ABSTRACT: Introduction
Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing anti-smoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing anti-smoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees.
In a pretest-posttest experiment, 782 Airmen were randomized to view anti-smoking advertisements in one of six conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry, or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes (e-cigarettes), smokeless tobacco, hookah and cigarillos from pretest to posttest with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions).
Anti-smoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions.
Anti-smoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing anti-smoking advertising may be a cost-effective tool to educate young adults in the military.
Tobacco Control 10/2015; DOI:10.1136/tobaccocontrol-2015-052477 · 5.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior.
We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014.
The Apple and Google Play app stores were searched using the terms "cannabis" and "marijuana." Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers.
Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated "17+" years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated "high maturity" (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment.
Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations.
[Show abstract][Hide abstract] ABSTRACT: Background: Perceived risk is central to initiation and cessation of tobacco, and warning labels on cigarettes promote cessation and effectively communicate risk, but research on smokeless tobacco and electronic cigarette warning labels is nascent. Tobacco companies have proposed alternative smokeless tobacco warning labels that endorse smokeless tobacco as safer than cigarettes.
Methods: Online experiment with a national sample of 455 adult non-users of tobacco randomized to view print advertisements for snus, e-cigarettes, and moist snuff with either warning labels (current warning label, graphic warning label), or endorsements (“FDA-approved” or the label proposed by one of the large tobacco companies “Warning: No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes”), or control. Perceived harm of each product was measured at pretest and post-test.
Results: Warning labels increased perceived harm of e-cigarettes. Endorsements decreased perceived harm of moist snuff and snus, and the large tobacco company proposed endorsement had an effect similar to the prohibited “FDA Approved” endorsement. Almost 16% of non-users were interested in a free sample of an alternative tobacco product, mostly e-cigarettes (the most requested brand was blu, even if blu was not the brand of e-cigarette ad shown in the experiment). Those interested in a free sample had significantly lower perceived harm of all tobacco products than those not interested in a free sample.
Conclusions: Regulatory agencies should not allow endorsements of alternative tobacco products and should implement graphic warning labels for smokeless tobacco products and warning labels for e-cigarettes.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Background: We examined whether different groups of social smokers (based on self-identification and behavior as social smokers) differed in smoking cessation attempts and how these groups and cessation attempts predicted use of alternative tobacco products.
Methods: Online cross-sectional survey of a nationally representative sample of 1,813 current or recently former (quit within last two years) smokers. Social smoking was measured as self-identified (SI) or behavioral (smoking mainly or only with others). Chi-square tests and regression were used to analyze associations between groups and tobacco use.
Results: Participants were classified into four groups: consistent social smokers (SI and behavior, 13% of participants), deniers (SI but not behavior, 33%), established smokers (not SI and not behavior, 52%), and behavior only (behavior but not SI, 3%). Consistent social smokers were significantly younger, had the lowest cigarette consumption, highest intentions to quit, and were more likely to report a quit attempt in the past year. Deniers had lower education, lower income, similar cigarette consumption as established smokers, and were most open to using alternative tobacco products. Making a cessation attempt predicted ever and 30 day use of e-cigarettes. Social smoking identification predicted ever use of snus and hookah and 30 day use of smokeless tobacco and hookah.
Conclusions: Social smokers who identify and behave as such were the most inclined to quit smoking. Use of e-cigarettes (which are promoted as cessation devices) was predicted by making a cessation attempt, while use of “social” alternative tobacco products (like hookah) was predicted by social smoker identification.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: In three experiments with U.S. undergraduates, effects of three levels of naturally mapped control interfaces were compared on a player's sense of presence, interactivity, realism, and enjoyment in video games. The three levels of naturally mapped control interfaces were: kinesic natural mapping (using the player's body as a game controller), incomplete tangible mapping (using a controller in a way similar to a real object), and realistic tangible mapping (using a controller or an object that directly relates to the real-life activity the game simulates). The results show that levels of interactivity, realism, spatial presence, and enjoyment were consistent across all conditions. However, when performing activities such as table tennis or lightsaber dueling with objects in-hand (incomplete tangible or realistic tangible conditions), perceived reality was a more important predictor of spatial presence. When performing the same activities with empty hands, interactivity emerged as the more important direct predictor of spatial presence. Control interface, therefore, matters greatly to the route by which cognitive processing of games takes place and how enjoyment is produced.
[Show abstract][Hide abstract] ABSTRACT: Background
Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. However, smokeless tobacco products are not required to carry graphic warning labels, and as of September 2014, electronic cigarettes in the US carry no warning labels and are aggressively marketed, including with “reduced harm” or “FDA Approved” messages.
In this online experiment, 483 US adult non-users of tobacco were randomized to view print advertisements for moist snuff, snus, and e-cigarettes with either warning labels (current warning label, graphic warning label) or “endorsements” (a “lower risk” label proposed by a tobacco company, an “FDA Approved” label) or control (tobacco advertisement with no label, advertisement for a non-tobacco consumer products). Main outcome measures included changes in perceived harm, positive attitudes towards, openness to using, and interest in a free sample of moist snuff, snus, and e-cigarettes.
The graphic warning label increased perceived harm of moist snuff and e-cigarettes. “Lower risk” and “FDA Approved” labels decreased perceived harm of moist snuff and snus respectively. Current warning label and graphic warning label significantly lowered positive attitudes towards e-cigarettes. In this sample of non-users of tobacco, 15% were interested in a free sample of alternative tobacco products (predominantly e-cigarettes). Proportion of participants interested in a free sample did not differ significantly across the conditions, but those interested in a free sample had significantly lower perceptions of harm of corresponding tobacco products.
Regulatory agencies should not allow “lower risk” warning labels, which have similar effects to the “FDA Approved” label, which is prohibited, and should consider implementing graphic warning labels for smokeless tobacco products and e-cigarettes.
BMC Public Health 09/2014; 14(1):997. DOI:10.1186/1471-2458-14-997 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cigarette companies increasingly promote novel smokeless tobacco products to smokers, encouraging them to use smokeless tobacco in smoke-free environments. New messages may counteract this promotion. We developed 12 initial anti-smokeless message ideas and tested them in eight online focus groups with 75 US smokers. Those smokers who never tried smokeless tobacco were unaware of health risks of novel smokeless tobacco products, perceived scary messages as effective and acknowledged the addictive nature of nicotine. Smokers who had tried smokeless tobacco shared their personal (mainly negative) experiences with smokeless tobacco, were aware of health risks of novel smokeless tobacco products, but denied personal addiction, and misinterpreted or disregarded more threatening messages. Portraying women as smokeless tobacco users was perceived as unbelievable, and emphasizing the lack of appeal of novel smokeless tobacco products was perceived as encouraging continued smoking. Future ads should educate smokers about risks of novel smokeless tobacco products, but past users and never users may require different message strategies.
Health Education Research 01/2014; 29(2). DOI:10.1093/her/cyt150 · 1.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Novel smokeless tobacco products (such as snus) are aggressively promoted to smokers by the tobacco companies. The Extended Parallel Process Model (EPPM; Witte, 1992 )was used to evaluate the current perceptions of threat, efficacy, attitudes, and behavioral intentions regarding snus in a nationally representative sample of 1,836 smokers. Participants were then exposed to messages designed to discourage smokers from trying snus. On average, smokers perceived health threat of snus as somewhat serious, but believed they can effectively avert this threat. Support was found for the EPPM's proposition that when efficacy is high, greater perceived threat is associated with greater desired outcomes (less favorable attitudes toward snus and lower behavioral intentions to try snus in the future). No support was found for the proposition that when perceived efficacy is low, greater threat is associated with greater message rejection. Instead, message rejection was explained by fear felt while exposed to the anti-smokeless ads. This finding indicates the need to more clearly distinguish between cognitive (danger control) and affective (fear control) responses posited by the EPPM.
Health Communication 12/2013; 29(9). DOI:10.1080/10410236.2013.824063 · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a survey of 1836 adult US smokers, when using a direct comparison measure, 22.1% reported snus was less harmful than were cigarettes. When asked indirectly (estimating the health risk of snus and cigarettes in 2 separate questions and comparing the answers to each other), 51.6% rated snus as less risky. The Food and Drug Administration should consider both direct and indirect measures when perceived risk data are presented as evidence for tobacco regulation. (Am J Public Health. Published online ahead of print September 12, 2013: e1-e3. doi:10.2105/AJPH.2013.301547).
American Journal of Public Health 09/2013; 103(11). DOI:10.2105/AJPH.2013.301547 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions.
A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors.
Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes.
Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation. Unsubstantiated overt and implied claims that alternative tobacco products aid smoking cessation should be prohibited.
American Journal of Public Health 03/2013; 103(5). DOI:10.2105/AJPH.2012.301070 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Tobacco manufacturers' aggressive promotion of new smokeless tobacco products such as snus warrants a timely and effective public health response. This study tested potential countermarketing messages to discourage current and former smokers from becoming dual users of smokeless tobacco and cigarettes.
In a pretest-post-test experiment, 1836 adult current and recently former smokers from a national sample were randomised to view one of six antismokeless tobacco ads followed by a snus ad, to view a control ad followed by a snus ad; or to view two control ads. Perceived effectiveness of ads and actual changes in attitudes and openness to snus were compared across groups using analyses of variance.
Some ads that were perceived as most effective did not change attitudes or openness to trying snus, and conversely, some ads not perceived as effective changed attitudes and openness to snus. Ads portraying the negative health effects of smokeless tobacco were perceived as most effective, but ads with antitobacco industry themes significantly decreased favourable attitudes toward snus. Responses to ads were different for smokers who had ever used smokeless tobacco: for this group health effects and humorous/testimonial ads were effective.
Measures of perceived effectiveness of antitobacco ads need to be augmented with measures of actual effectiveness to assess countermarketing messages. Some of the developed ads, such as ads with anti-industry themes, were effective for the overall population of smokers whereas humorous/testimonial and health effects ads were particularly effective in changing attitudes of past users of smokeless tobacco.
Tobacco control 03/2013; 23(4). DOI:10.1136/tobaccocontrol-2012-050723 · 5.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although equivalence testing is preferred when a researcher's goal is to support the null hypothesis (i.e., no substantial effect), equivalence tests are virtually unknown and unused in the communication field. This article provides the rationale for and theoretical background of equivalence testing and offers examples of equivalence tests for the independent and dependent groups t-test and tests of association using Pearson's coefficient or correlation. From a review of meta-analyses, we provide tables of commonly observed effect-sizes across subdisciplines and topic areas in communication and offer these as a guideline for choosing minimum substantial effects (Δ) in equivalence testing when no other information source is available. To facilitate the adoption of equivalence tests in future research, we provide easy-to-use custom dialogs for SPSS which greatly simplify their computation and application.
Communication Methods and Measures 07/2012; 6(3):190-213. DOI:10.1080/19312458.2012.703834
[Show abstract][Hide abstract] ABSTRACT: This study investigated the impact of new motion-based video game control systems on spatial presence, perceived reality, and enjoyment of video games. In two experiments, university students played video games on either new motion-based (Sony's Move, Microsoft's Kinect, and Nintendo's Wii), or standard video game systems (PS3 and XBOX 360 with gamepads). The results indicate that, in the context of golf, racing, and boxing games, the higher technological interactivity of motion-based systems (particularly Kinect) increases feelings of spatial presence, perceived reality, and enjoyment. Perceived reality predicted spatial presence; and spatial presence, in turn, was a significant predictor of enjoyment. Moving toward a more natural user interface (NUI) between the player and the game world can create a more immersive, realistic, and fun experience for the player. A new model for enjoyment of motion-based video games is proposed.
[Show abstract][Hide abstract] ABSTRACT: This article examines constructs, propositions, and assumptions of the extended parallel process model (EPPM). Review of the EPPM literature reveals that its theoretical concepts are thoroughly developed, but the theory lacks consistency in operational definitions of some of its constructs. Out of the 12 propositions of the EPPM, a few have not been tested explicitly and not a single one received unequivocal empirical support. This article proposes alternative operationalization for some of the constructs and examines some assumptions of this theory, such as additive relationship between the constructs, the role of time and issue of thresholds, and disregard for the existing state of the audience. Finally, the role of the EPPM as a potential foundation for a general theory of negative emotional appeals is addressed.