Pictorial Warning Labels, Numeracy, and Memory for Numeric Cigarette Health-risk Information Over Time

Study Overview
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Brief Summary
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Pictorial cigarette warning labels (PWLs) are thought to increase risk knowledge, but experimental research has not examined PWLs' longer term effects on memory for health risks, or for numeric risks (e.g., percentage risk for developing lung cancer). This trial tests memory for numeric health risks immediately or after a six-week delay for US adult smokers. In addition, the trial tests the effects of different warning label components (e.g., whether the numeric risks are percentage or frequency), participants' level of numeric ability, and the consequences of memory for numeric risks on participant risk perceptions and quit intentions.

Official Title
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Pictorial Warning Labels, Numeracy, and Memory for Numeric Cigarette Health-risk Information Over Time

Conditions
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Smoking, Cigarette, Smoking Cessation

Intervention / Treatment
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* Behavioral: text-only PWL
* Behavioral: low-emot PWL
* Behavioral: high-emot PWL
* Behavioral: immed posttest
* Behavioral: delay posttest


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: at least 18 years old have smoked 100+ lifetime cigarettes currently smoke every day or some days. US resident Exclusion Criteria: have not ever smoked a cigarette

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Text-only PWL, immediate post<br>Exposure to 4 FDA-mandated warning labels and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered immediately following last exposure to warning labels | Behavioral: text-only PWL<br> <br> Behavioral: immed posttest<br> <br> |
| Experimental: Text-only PWL, delay posttest<br>Exposure to 4 FDA-mandated warning labels and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered 6 weeks following last exposure to warning labels | Behavioral: text-only PWL<br> <br> Behavioral: delay posttest<br> <br> |
| Experimental: Low-emot PWL, immed post<br>Exposure to 4 FDA-mandated warning labels paired with images that elicit little emotion and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered immediately following last exposure to warning labels | Behavioral: low-emot PWL<br> <br> Behavioral: immed posttest<br> <br> |
| Experimental: Low-emot PWL, delay posttest<br>Exposure to 4 FDA-mandated warning labels paired with images that elicit little emotion and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered 6 weeks following last exposure to warning labels | Behavioral: low-emot PWL<br> <br> Behavioral: delay posttest<br> <br> |
| Experimental: High-emot PWL, immed posttest<br>Exposure to 4 FDA-mandated warning labels paired with images that elicit high emotion and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered immediately following last exposure to warning labels | Behavioral: high-emot PWL<br> <br> Behavioral: immed posttest<br> <br> |
| Experimental: High-emot PWL, delay posttest<br>Exposure to 4 FDA-mandated warning labels paired with images that elicit high emotion and numeric risk information for 8 outcomes related to those warnings (2 outcomes for each PWL; half as percentage, half as frequency) Posttest measures (e.g., memory, risk perceptions, quit intentions) administered 6 weeks following last exposure to warning labels | Behavioral: high-emot PWL<br> <br> Behavioral: delay posttest<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| numeric risk recall | free recall for numeric risks presented in labels (e.g., ____% of smokers die before age 85), both for smokers and nonsmokers | immediately following last exposure or after 6-week delay | 
| numeric risk recognition | Participants answered one multiple choice question about the numeric risk for smokers and nonsmokers (combined in one question) for each of the 8 outcomes that had been paired with the PWLs. For each question, there were four decoy responses. | immediately following last exposure or after 6-week delay | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| smoking risk perceptions | Participants completed several scale items about how much risk they perceived smoking posed to them (e.g., Compared to the average nonsmoker your age, gender, and race, how would you rate your chances of: 1) getting a life threatening illness because of smoking, 2) getting lung cancer, and 3) dying at a younger age than average (-3 = Much lower, +3 = Much higher)) They also gave verbal likelihood ratings for each of the 8 outcomes of smoking that had been paired with the labels (e.g., Thinking of risks that you were shown in the warnings, what is the likelihood of a smoker [non-smoker] dying from heart disease?, 0=impossible, 11=certain) | immediately following last exposure or after 6-week delay | 
| smoking risk knowledge | Participants listed as many risks of smoking as they could think of. | immediately following last exposure or after 6-week delay | 
| quit intentions | Participants intentions to quit smoking, Likelihood of smoking within next 30 days, next year (-3 = very unlikely, 3 = very likely) | immediately following last exposure or after 6-week delay | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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emotion, pictorial warning labels, risk knowledge, memory, risk perceptions, quit intentions, numeracy