Integrating Communication Research and Tobacco Regulatory Science - - PowerPoint PPT Presentation

Integrating Communication Research and Tobacco Regulatory Science – Implications for Policy and Practice

Andy Tan Assistant Professor in Social and Behavioral Sciences Dana-Farber Cancer Institute & Harvard T.H. Chan School of Public Health andy_tan@dfci.harvard.edu Johns Hopkins Bloomberg School of Public Health Center on Mental Health and Addiction Policy Lecture Series October 17, 2018

Outline

• Overview of Communication Regulatory Science
• Recent research:
• ‘Natural’, ‘organic’, and ‘additive-free’ labels
• n tobacco packaging
• Current and enhanced tobacco industry

correctives

• Challenges and future research directions
• Discussion

Communication Regulatory Science

Communication Tobacco Disparities Regulatory Science

Noar and Cappella (2017): Communication research that uses validated techniques, tools, and models to inform regulatory actions that promote

• ptimal communication
• utcomes and benefit the

public.

Objectives

• 1. Advance understanding of communication practices in

the marketplace that may mislead consumers.

Sanders-Jackson et al. (2017); Lee et al. (2018) Moran et al. (forthcoming)

Objectives

• 2. Identify most effective communications for population

as a whole and diverse subpopulations, and ensure communications have intended effects (and no iatrogenic effects).

Tan et al. (2017); Hayashi et al. (2018) Tan et al. (2018)

Objectives

• 3. Provide evidence base to help federal, state, or local

authorities withstand legal challenges to regulatory actions from the industry.

Tan et al. (2015); Bigman et al. (2018) Lee et al. (under review)

Objectives

• 4. Advance theory and science of communication effects
• n public health outcomes and mechanisms.

Tan et al. (2015) Jeong et. al. (2015)

Informing Federal Regulations and Interventions

Federal State Local The Tobacco Control Act:

• Restricts tobacco marketing and

sales to youth

• Requires cigarette and

smokeless tobacco product warning labels

• Ensures “modified risk” claims

are supported by scientific evidence

• Requires disclosure of

ingredients in tobacco products

• National counter-marketing

campaigns

Informing State and Local Regulations and Interventions

Federal State Local State and local laws and

• rdinances:
• Restricting tobacco advertising

and marketing

• State-wide campaigns
• Clean Indoor Air Laws – Smoke-

free workplaces, enclosed public places, restaurants, and bars

• Restricting youth access and

exposure to tobacco and nicotine delivery products

• School-based health education

interventions

Effects of ‘Natural’, ‘Organic’, and ‘Additive-free’ Labels on Combustible Cigarette and Electronic Cigarette Packaging

Background

Background

• NAS continued to use this type of

language in their marketing and packaging (Moran et al., 2017).

• Cigarette packaging labelled as ‘natural’

perceived as more appealing and less harmful among Canadian youth (Czoli et al., 2014).

• NAS packs or ads that used ‘Organic’,

‘Additive-free’, and ‘Natural’ are associated with reduced harm perceptions of NAS cigarettes (Pearson et al., 2017) and increases interest to switch to NAS among adults (Baig et al., 2018).

Research Gaps

• Most research conducted using NAS cigarette packs and ads

– unable to disentangle the effect of familiarity with the brand and the descriptors.

• Use of health-oriented descriptors on other tobacco products

such as e-cigarette packaging and impact on consumer perceptions and behaviors is lacking.

Research Questions

What effects do health-oriented descriptors (’100% organic,’ ’all natural’ or ’no additives’) on cigarette and e-cigarette packaging have on: a. Smokers’ attitude toward the cigarette/e-cigarette brand b. Perception of packaging information c. Comparative harm versus other brands d. Intention to purchase cigarette/e-cigarette brand

Methods

• Design: Two online randomized controlled experiments

(Nov 2016)

• Sample: US adult daily smokers 18+ (Qualtrics panel)
• Study 1 (Cigarette package) N=405; Study 2 (E-

cigarette package) N=396

• Completion rate ~48%

Study Procedure

• Smoking
• Vaping behaviors
• General attitudes

questions

• 3 packs used health
• riented descriptors,
• 3 packs used traditional

marketing language,

• 1 pack is the no-

language control

• Non-US brand

Baseline questions Random assignment to 1 of 7 cigarette/ e-cigarette packs Post-test questions

• Attitude toward the cig/e-cig

brand

• Perception of packaging

information

• Comparative harm versus
• ther brands
• Intention to purchase cig/e-cig

brand

Absolute India. TPackSS: Tobacco Pack Surveillance System. https://globaltobaccocontrol.org/tpackss/pack- search/pack/6803/absolute-india-w1-01.

Health-Oriented Labels

Traditional Marketing Labels

Absolute India. TPackSS: Tobacco Pack Surveillance System. https://globaltobaccocontrol.org/tpackss/pack- search/pack/6803/absolute-india-w1-01.

Measures

• Attitude toward the Absolute brand of cigarettes (or e-

cigarettes)

• 6-item scale (Cronbach’s alpha=0.93 for cigarettes and 0.91 for

e-cigarettes)

• Perception of information on packaging
• 5-item scale (Cronbach’s alpha=0.87 for cigarettes and 0.88 for

e-cigarettes)

• Comparative harm of Absolute brand vs. other brands
• Single-item (less harmful, no different, or more harmful)
• Intention to purchase Absolute cigarettes/e-cigarettes
• Juster scale - How probable were participants to purchase

cigarettes in the next 3 months on an 11-point scale. Answer

• ptions ranged from 0 (No chance, almost no chance) to 10

(Certain, practically certain)

Analysis

• Participants who viewed the three different labels in the

health-oriented language condition were analyzed as one group.

• Similarly, those who viewed the three labels in the traditional

language conditions were analyzed as one group.

• Unadjusted and adjusted regression models predicting
• utcome measures with condition, controlling for age, gender,

race, ethnicity and level of education.

Study 1 Results – Cigarette Packaging

• Health-oriented vs. no-language:
• More favorable perceptions

toward the package information, lower comparative harm and higher intention to purchase combustible cigarettes.

• Health-oriented vs. traditional

marketing:

• More positive attitude toward

the brand and lower comparative harm.

Study 2 Results – E-cigarette Packaging

• Health-oriented vs. traditional

marketing:

• Increased intention to purchase

Absolute e-cigarettes.

Discussion

• Single brief exposure to subtle words and phrases on

unfamiliar brand of cigarette/e-cigarette result in “health halo” effect.

• These descriptors influence consumers’ perceptions and

behavioral intentions toward tobacco products.

• Effects of descriptors more pronounced for cigarette vs. e-

cigarette packs although stimuli were identical.

• Results support banning the use of these descriptors on

cigarette and e-cigarette packaging and promotional materials.

Postscript: NAS Marketing

• January 2017: Agreement with

FDA to remove ‘Additive-free’ and ’Natural’ from labels and marketing within 7 months.

• Retain the use of ‘Natural’ in the

brand name and trademarks.

• Use of ‘Organic’ label is currently

not restricted.

• Recently used ‘Tobacco & Water’

slogan.

Limitations

• Convenience online sample; self-selection bias.
• Single brief exposure to one brand of cigarette/e-

cigarette pack.

• Potentially underestimate effects of repeated exposures

to health-oriented language in print advertising, coupons, internet and social media.

Future Research

• Surveillance of effects of potentially misleading tobacco

marketing messages implying reduced harm.

• Longitudinal study designs across multiple marketing

media involving nationally representative samples needed.

• Examine effects of remedies – use of disclaimers,

corrective statements, and plain packaging to inform regulatory interventions.

Effects of Current and Enhanced Tobacco Corrective Messages on Intention to Quit Smoking, Emotions and Beliefs about Tobacco Companies

Background

Original Court-Ordered Correctives

A Federal Court has ruled that the tobacco companies deliberately deceived the American public about the addictiveness of smoking and nicotine, and has ordered those companies to make this statement. Here is the truth: Smoking is highly addictive. Nicotine is the addictive drug in tobacco. Cigarette companies intentionally designed cigarettes with enough nicotine to create and sustain addiction. It’s not easy to quit. When you smoke, the nicotine actually changes the brain – that’s why quitting is so hard.

Current Court-Ordered Correctives

https://vimeo.com/239872238

Current Court-Ordered Correctives

Current Court-Ordered Correctives

Background

• Assessed adult smokers’ ratings of the original court-ordered

corrective messages on characteristics such as novelty and relevance (Kollath-Cattano et al. 2014)

• Original versions of corrective messages were successful in

changing beliefs and knowledge related to the five topics (e.g., addiction, light and low-tar cigarettes) (Smith et al., 2011)

• Original versions of corrective messages influenced tobacco-related

beliefs (Tangari et al., 2010)

• Emotions indirectly influence behavioral intentions through beliefs

(Hall et al., 2018)

Research Gaps

• Final corrective messages that are disseminated have not

been evaluated (vs. original corrective statements).

• Behavioral outcomes such as intention to quit smoking have

not been examined (vs. knowledge and beliefs).

• Effects of enhancing the current correctives e.g., using

narratives and potential differences across subgroups.

• Mechanisms of effects of correctives through influencing

emotions and beliefs.

Research Questions

1. Do the current correctives increase smokers’ intention to quit smoking compared to baseline (no-message control)? 2. Are enhanced correctives that include industry deception statements (Deception) or industry deception statements and testimonial (Deception + Testimonial) more effective than current correctives (Current)? 3. Do the effects of enhanced correctives differ across different social groups? 4. Do discrete emotions and beliefs about tobacco companies mediate the effects of enhanced correctives?

Methods

• Design: Online randomized experiment
• Sample: US adults 18+ who are current established

smokers (Survey Sampling International), N=803

Procedures

• Smoking
• Intention to quit
• 2 current correctives

(health effects of smoking and secondhand smoke)

• 2 enhanced correctives

with deception statement

• 2 enhanced correctives

with deception + testimonial statement

Baseline questions Random assignment to 1 of 3 conditions Post-test questions

• Intentions to quit
• Intention to purchase

cigarettes

• Demographics

Measures

• Intention to quit smoking (pre- and post):
• Willingness to 1) try to quit smoking; 2) reduce the number
• f cigarettes smoked per day; 3) quit smoking completely

in the next 30 days on a scale from 1 (definitely will not) to 4 (definitely will) (Cronbach’s alpha=.83).

• Intention to purchase cigarettes (Juster scale):
• Single item - How probable were participants to purchase

cigarettes in the next 30 days on an 11-point scale. Answer

• ptions ranged from 0 (No chance, almost no chance) to

10 (Certain, practically certain).

Measures

• Beliefs about tobacco companies (Tangari et al., 2010):
• Average of 6 items (e.g., “Tobacco companies mislead

consumers on the effects of smoking on their health and

• thers around them”, “Tobacco companies have used

deceptive practices to get people hooked on smoking”) on a scale from 1 (Strongly disagree) to 7 (Strongly agree) (Cronbach’s alpha=.94).

• Emotions toward tobacco companies (Harmon-Jones et
• al. 2016):
• Single items – Extent to which participants felt angry,

scared, and disgusted when thinking about tobacco companies on a scale from 1(Not at all) to 7 (An extreme amount).

Demographic and Smoking Variables

• Age
• Income
• Sex (male, female)
• Education (high school or below, some college, college and

higher)

• Ethnicity (Hispanic, non-Hispanic)
• Race (White, Black, Other)
• Smoking behavior (number of days they smoked, number of

cigarettes smoked daily)

• Nicotine dependence (Fagerström test)

Analysis

• RQ1 – Paired t-test
• RQ2 – Linear regression
• RQ3 - Included interaction terms between the condition

variable and subgroup variables (gender, race, ethnicity, education, income, and smoking status)

• RQ4 – Structural equation modeling

• RQ1. Do the current correctives increase smokers’

intention to quit smoking compared to baseline (no- message control)?

• Participants’ intention to quit smoking (M= 2.90, SD=

0.83) increased significantly after being exposed to the Current correctives compared to their baseline intention to quit smoking (M= 2.81, SD= 0.81); t(284) = -3.14, p < .01.

• RQ2. Are enhanced correctives that include industry

deception statements (Deception) or industry deception statements and testimonial (Deception + Testimonial) more effective than current correctives (Current)?

• Participants exposed to the Deception + Testimonial

correctives had significantly greater intention to quit smoking vs. Current and Deception correctives.

• Intention to purchase cigarettes did not differ between

participants across conditions

• RQ3. Do the effects of Deception and Deception +

Testimonial vs. Current correctives differ across different social groups?

• There were no differences in effects for subgroups based on

age, sex, education, race, income, and smoking status (daily

• vs. non-daily).
• Hispanic participants who viewed the Industry Deception +

Testimonial corrective messages (vs. Current correctives) had higher intention to quit and lower intention to purchase cigarettes compared to non-Hispanics.

2.87 2.85 2.82 2.85 3.24 2.91 1.0 1.5 2.0 2.5 3.0 3.5 4.0 Hispanic Non-Hispanic

Intention to quit smoking

Current Industry deception Industry deception + testimonial

7.46 7.60 7.85 7.88 5.65 7.62 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 Hispanic Non-Hispanic

Intention to purchase cigarettes

Current Industry deception Industry deception + testimonial

• RQ4. Do discrete emotions and beliefs about tobacco

companies mediate the effects of enhanced correctives?

.05*** .03* .31*** .09* .58*** .35* .37* Industry Deception + Testimonial

• vs. Current

Angry Disgusted Tobacco industry beliefs Intention to quit smoking Scared Industry Deception

• vs. Current
• Notes. Maximum-likelihood unstandardized coefficients are presented. Significance

levels are *p < .05 and ***p < .001. The final model included correlated errors among emotions angry, scared, and disgusted and controlled for baseline intention to quit

• smoking. RMSEA<0.001, CFI=1.000, TLI=1.000, SRMR=0.006

Discussion

• Current correctives were effective in increasing smokers’

intention to quit smoking vs. baseline (no message control).

• Adding industry deception statement alone may not improve

effects on intention to quit smoking beyond the current correctives but adding testimonials could further increase effectiveness.

• Anger and disgust toward tobacco companies and beliefs

about tobacco companies mediated the effects of Deception + Testimonial on quit intentions.

• Inform future iterations of court-ordered corrective

statements.

Limitations

• Non-representative sample, lack of racial diversity.
• Brief exposure to only two corrective message topics.
• Static plain print format.

Future Research

• Evaluate effects of enhanced corrective statements in

cigarette onserts and other formats e.g., on social media and utilizing video content to increase exposure among priority populations (youth, young adults, LGBTQ, racial minorities).

• Longitudinal study designs testing effects of multiple

exposures and involving nationally representative samples.

Communication Regulatory Science

1. Advance understanding of communication practices in the marketplace that may mislead consumers. 2. Identify most effective communications for population as a whole and diverse subpopulations, and ensure communications have intended effects (and no iatrogenic effects). 3. Provide evidence base to help federal, state, or local authorities withstand legal challenges to regulatory actions from the industry. 4. Advance theory and science of communication effects on public health outcomes and mechanisms.

Challenge #1 – Tobacco Marketplace

Challenge #2 – Mis/Disinformation

Clark et al. (2016)

Challenge #3 – Influencer Marketing

Future Research Directions

• Surveillance and evidence-based

remedies for correcting misinformation.

• Effects of modified-risk tobacco products

health claims and disclaimers.

Discussion

Integrating Communication Research and Tobacco Regulatory Science – Implications for Policy and Practice

Andy Tan Assistant Professor in Social and Behavioral Sciences Dana-Farber Cancer Institute & Harvard T.H. Chan School of Public Health andy_tan@dfci.harvard.edu Johns Hopkins Bloomberg School of Public Health Center on Mental Health and Addiction Policy Lecture Series October 17, 2018