PREP advertisement features affect smokers’ beliefs regarding potential harm

Abstract

Background The Institute of Medicine report on potential reduced exposure products (PREPs) recommends that advertising and labelling be regulated to prevent explicitly or implicitly false or misleading claims. Belief that a product is less harmful may increase use or prevent smoking cessation. Objective To determine the effect of altering advertisement features on smokers’ beliefs of the harm exposure from a PREP. Methods A Quest advertisement was digitally altered using computer software and presented to participants using web-based television recruitment contracted through a survey company. 500 current smokers completed demographic and smoking history questions, were randomised to view one of three advertisement conditions, then completed eight items assessing their beliefs of the harmfulness of the product. Advertisement conditions included the original, unaltered advertisement; a “red” condition where the cigarette packages were digitally altered to the colour red, implying increased harm potential; and a “no text” condition where all text was removed to reduce explicit product information. Polytomous logistic regression, using “incorrect,” “unsure” and “correct” as outcomes, and advertisement type and covariates as predictors, was used for analyses. Results Participants randomised to the “no text” advertisement were less likely to be incorrect in their beliefs that Quest cigarettes are lower in tar, less addictive, less likely to cause cancer, have fewer chemicals, healthier and make smoking safer. Conclusions Smokers can form false beliefs about the harmfulness of PREP products based on how the PREPs are marketed. Careful examination must be undertaken to provide empirical evidence to better formulate regulatory principles of PREP advertising.

U.S. adults' addiction and harm beliefs about nicotine and low nicotine cigarettes

“…A nationally representative survey of smokers found that over half believed that LNCs were less dangerous than regular cigarettes (Cummings et al, 2004). Further, an experimental study (Strasser et al, 2008) found that smokers assigned to view ads for one brand of LNCs believed them to be healthier and safer, and believed that switching to them could reduce exposure to tar, carcinogens, and other chemicals. Another study found that smokers believed LNCs to be associated with a lower risk of lung cancer, other cancers, emphysema, bronchitis, heart disease, and stroke (Hatsukami et al, 2013).…”

Characteristics of current and recent former smokers associated with the use of new potential reduced-exposure tobacco products

“…Additionally, we found in another survey that interest in PREPs was associated with non-health-related factors, including favorable attitudes toward technology and a willingness to experiment with new products and trends ( Parascandola, Hurd, & Augustson, 2008 ). Nevertheless, several previous studies have found that advertising messages for PREP-type products can infl uence smokers ' beliefs regarding potential harm ( Hamilton et al, 2004 ;O'Connor et al, 2007 ;O'Hegarty, Richter, & Pederson, 2007 ;Shiffman et al, 2007 ;Strasser, Tang, Tuller, & Cappella, 2008 ). Thus, further study is warranted here to better understand consumers ' expectations and health beliefs about PREP products under different conditions.…”

Reduced nicotine content cigarette advertising: How false beliefs and subjective ratings affect smoking behavior

“…Consistent with previous work (Lochbuehler et al, 2016; Shadel et al, 2006; Strasser et al, 2012; Strasser et al, 2008), participants viewed an unaltered company-created advertisement for 30 seconds (Strasser et al, 2008), deliberately presented five days before randomization to approximate real-world conditions (e.g., viewing novel product advertisement in a magazine/online/etc., then purchasing it the next time at store; i.e., not immediately after viewing advertisement).…”

“…Eight items (Lochbuehler et al, 2016; Shadel et al, 2006; Strasser et al, 2008) rated on a 5-point response scale (1= “definitely untrue”, 5=“definitely true”) assessed participants’ Quest cigarette beliefs only at the initial study visit, before and after viewing the advertisement: “Quest cigarettes:” (a) “are lower in nicotine than regular cigarettes”, (b) “are lower in tar than regular cigarettes”, (c) “are less addictive than regular cigarettes”, (d) “are less likely to cause cancer than regular cigarettes”, (e) “have fewer chemicals than regular cigarettes”, (f) “healthier than regular cigarettes”, (g) “make smoking safer”, (h) “help people quit smoking.” Items b–h were summed to create a cumulative false beliefs variable (Cronbach’s α’s = 0.77 and 0.81 for pre- and post-advertisement variables, respectively); consistent with previous work (Lochbuehler et al, 2016; Shadel et al, 2006), the first item was excluded because it was factually correct.…”

“…Our prior work demonstrated that advertising for a previously commercially-available RNC product that heavily marketed its low nicotine appeal (i.e., Quest®; Vector Tobacco Inc.) affected smokers’ beliefs about the product’s overall health risks (Lochbuehler et al, 2016; Strasser et al, 2008). This work, however, did not consider product use behaviors or subjective ratings.…”