[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.
[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.
[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.
[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.
[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.
Preview · Article · Jan 2014 · Health Education Research
[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).
No preview · Article · Sep 2013 · American Journal of Public Health
[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.
No preview · Article · Mar 2013 · American Journal of Public Health
[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.