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 on tobacco packaging • Current and enhanced tobacco industry correctives • Challenges and future research directions • Discussion
Communication Regulatory Science Noar and Cappella (2017): Communication Communication research that uses validated techniques, tools, and models to inform regulatory actions that promote optimal communication Regulatory Tobacco Science Disparities outcomes and benefit the public.
Objectives 1. Advance understanding of communication practices in the marketplace that may mislead consumers. Sanders-Jackson et al. (2017); Lee Moran et al. (forthcoming) et al. (2018)
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 on public health outcomes and mechanisms. Jeong et. al. (2015) Tan et al. (2015)
Informing Federal Regulations and Interventions The Tobacco Control Act: Federal • Restricts tobacco marketing and sales to youth • Requires cigarette and State smokeless tobacco product warning labels • Ensures “modified risk” claims are supported by scientific evidence Local • Requires disclosure of ingredients in tobacco products • National counter-marketing campaigns
Informing State and Local Regulations and Interventions State and local laws and Federal ordinances: • Restricting tobacco advertising and marketing State • State-wide campaigns • Clean Indoor Air Laws – Smoke- free workplaces, enclosed public places, restaurants, and bars • Restricting youth access and Local 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 Random assignment Baseline Post-test to 1 of 7 cigarette/ questions questions e-cigarette packs • Attitude toward the cig/e-cig • Smoking • 3 packs used health brand • Vaping behaviors oriented descriptors, • Perception of packaging • General attitudes • 3 packs used traditional information questions marketing language, • Comparative harm versus • 1 pack is the no- other brands language control • Intention to purchase cig/e-cig • Non-US brand brand
Health-Oriented Labels Absolute India. TPackSS: Tobacco Pack Surveillance System. https://globaltobaccocontrol.org/tpackss/pack- search/pack/6803/absolute-india-w1-01.
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 options 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 outcome 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
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