Communicating about chemicals in cigarette smoke: impact on knowledge and misunderstanding

Abstract

BackgroundThe USA must publicly share information about harmful and potentially harmful constituents (chemicals) in tobacco products. We sought to understand whether webpages with chemical information are “understandable and not misleading to a lay person.”MethodsParticipants were a national probability sample of US adults and adolescents (n=1441, 18% smokers). In an online experiment, we randomly assigned participants to view one of the developed webpages (chemical names only, names with quantity ranges, names with visual risk indicators) or no webpage in phase one (between subjects). Participants completed a survey assessing knowledge, misunderstanding, perceived likelihood, perceived severity of health effects from smoking and quit intentions (smokers only). In phase two (within subjects), participants viewed all three webpage formats and reported webpage perceptions (clarity, usability, usefulness) and perceived impact (affect, elaboration, perceived effectiveness).ResultsIn phase one, viewing any webpage led to more knowledge of chemicals (48%–54% vs 28% no webpage, ps<0.001) and health harms (77% vs 67% no webpage, ps<0.001). When exposed to any webpage, 5%–23% endorsed misunderstandings that some cigarettes are safer than others. Webpage format did not affect knowledge or reduce misunderstandings. Viewing any webpage led to higher perceived likelihood of experiencing health effects from smoking (p<0.001) and, among smokers, greater intentions to quit smoking (p=0.04). In phase two, where participants viewed all formats, a visual risk indicator led to the highest perceived impact.ConclusionsKnowledge of chemicals and health effects can increase after viewing a website. Yet, websites may not correct the misunderstanding that some cigarettes are safer.

Social Media Message Designs to Educate Adolescents About E-Cigarettes

“…Cognitive elaboration, or thinking in reaction to each message, was assessed with, "How much did this message make you think about the harmful effects of vaping?" [28]. Response options ranged from "not at all" (coded as 1) to "a great deal" (5).…”

“…Response options ranged from "not at all" (coded as 1) to "a great deal" (5). Affect was assessed with the item, "how did this message make you feel about vaping," with responses ranging from "very bad" (coded as 1) to "very good" (7) [28].…”

Pilot study to inform young adults about the risks of electronic cigarettes through text messaging

“…New text messages should be generated and tested to warn YA about severe lung disease and deaths associated with e-cigarette and vaping devices (Centers for Disease Control & Food and Drug Administration, 2019). Further, other investigators may be interested in incorporating the contents of the messages into other health communication research (e.g., testing e-cigarette product warning labels, educational websites, and national tobacco education campaigns for adolescents and YA) (Dobbs et al, 2019, Duke et al, 2018, Lazard et al, 2019).…”

Numeracy and memory for risk probabilities and risk outcomes depicted on cigarette warning labels.

“…Participants selected the best word from four options to complete the sentence (e.g., “I agree to give correct information to ______ if I can receive Medicaid.”). Because total correct responses were highly skewed (roughly half of participants answered all 20 items correct), we rescored health literacy as a binary variable: 1 = all items correct and 0 = one or more items incorrect (see, e.g., Lazard, Byron, Peters, & Brewer, 2019 for a similar approach). Controlling for health literacy as a continuous variable produced substantially similar results, but the structural equation model (see below) would not converge.…”