Pictorial Warning Labels and Memory for Relative and Absolute Cigarette Health-risk Information Over Time in Teens

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. In this study, teens who have experimented with smoking or are considered vulnerable to smoking are repeatedly exposed to text-only vs. graphic warning labels paired with numeric risk information. This study will allow us to assess the extent to which reactions to warnings remain consistent over time and influence future smoking intentions. We will also assess the impact of graphic images on memory for smoking risk information presented in absolute and (a smokers lifetime risk of getting a smoking related disease), or relative (a smokers risk of getting a smoking related disease, compared to the risk of non-smokers) formats.

Official Title
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Pictorial Warning Labels and Memory for Relative and Absolute Cigarette Health-risk Information Over Time in Teens

Conditions
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Smoking Cessation, Smoking, Cigarette

Intervention / Treatment
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* Behavioral: text-only PWL
* Behavioral: graphic PWL
* Behavioral: absolute risk
* Behavioral: relative risk


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: have ever tried smoking report vulnerability to smoking (i.e., report that they might smoke in the next year or would try a cigarette if a friend offered one) parents give permission to participate Exclusion Criteria: not vulnerable to smoking (i.e., report they will definitely not smoke a cigarette in the next year and definitely would not try a cigarette if one was offered parents do not provide permission to participate

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum 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, absol risk<br>Exposure to FDA-mandated warning labels, without a graphic image, accompanied by risk information about smoker's risk of a smoking-related disease | Behavioral: text-only PWL<br>* control condition (no image)<br>Behavioral: absolute risk<br>* Percentage risk information for smoking-related diseases for smokers<br>|
| Experimental: text-only PWL, relative risk<br>Exposure to FDA-mandated warning labels, without a graphic image, accompanied by risk information about smoker's risk and non-smoker's risk of a smoking-related disease | Behavioral: text-only PWL<br>* control condition (no image)<br>Behavioral: relative risk<br>* Percentage risk information for smoking-related diseases for smokers and non-smokers<br>|
| Experimental: graphic PWL, absol risk<br>Exposure to FDA-mandated warning labels, paired with a graphic image, accompanied by risk information about smoker's risk of a smoking-related disease | Behavioral: graphic PWL<br>* pictorial warning<br>Behavioral: absolute risk<br>* Percentage risk information for smoking-related diseases for smokers<br>|
| Experimental: graphic PWL, relative risk<br>Exposure to FDA-mandated warning labels, paired with a graphic image, accompanied by risk information about smoker's risk and non-smoker's risk of a smoking-related disease | Behavioral: graphic PWL<br>* pictorial warning<br>Behavioral: relative risk<br>* Percentage risk information for smoking-related diseases for smokers and non-smokers<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| numeric risk recognition | Participants answered one multiple choice question about the numeric risk for smokers for each label (e.g., ____% of smokers die before age 85). For each question, there were four decoy responses. | measured immediately following last exposure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| numeric risk recognition | Participants answered one multiple choice question about the numeric risk for smokers for each label (e.g., ____% of smokers die before age 85). For each question, there were four decoy responses. | measured after 6-week delay | 
| relative risk recognition | Participants answered one multiple choice question about the numeric risk for smokers vs. nonsmokers for each health risk (e.g., a smoker is ____ as likely to die from heart disease as a nonsmoker). For each question, there were three decoy responses (e.g., for heart disease, response options were: about as likely, 1.75 times, 4.1 times, 10.4 times). | measured immediately following last exposure | 
| relative risk recognition | Participants answered one multiple choice question about the numeric risk for smokers vs. nonsmokers for each health risk (e.g., a smoker is ____ as likely to die from heart disease as a nonsmoker). For each question, there were three decoy responses (e.g., for heart disease, response options were: about as likely, 1.75 times, 4.1 times, 10.4 times). | measured after 6-week delay | 
| smoking risk perceptions | Participants completed several scale items about how much risk they perceived smoking posed to them (e.g., If a person smokes at your age, how likely are they to get a life-threatening illness from smoking someday ? [1=very unlikely; 5=extremely likely]) | measured immediately following last exposure | 
| smoking risk perceptions | Participants completed several scale items about how much risk they perceived smoking posed to them (e.g., If a person smokes at your age, how likely are they to get a life-threatening illness from smoking someday ? [1=very unlikely; 5=extremely likely]) | measured after 6-week delay | 
| quit intentions (for next 30 days) | Participants intentions to quit smoking; self-reported likelihood of smoking within the next 30 days (-3 = very unlikely, 3 = very likely) (only for those teens who currently smoked) | measured immediately following last exposure | 
| quit intentions (for next 30 days) | Participants intentions to quit smoking; self-reported likelihood of smoking within the next 30 days (-3 = very unlikely, 3 = very likely) (only for those teens who currently smoked) | measured after 6-week delay | 
| quit intentions (for next year) | Participants intentions to quit smoking; self-reported likelihood of smoking within the next year (-3 = very unlikely, 3 = very likely) only for those teens who currently smoked | measured immediately following last exposure | 
| quit intentions (for next year) | Participants intentions to quit smoking; self-reported likelihood of smoking within the next year (-3 = very unlikely, 3 = very likely) only for those teens who currently smoked | measured after 6-week delay | 
| risk recognition | Participants were given a list of 9 warnings and asked to select which ones they'd been previously exposed to | measured immediately following last exposure | 
| risk recognition | Participants were given a list of 9 warnings and asked to select which ones they'd been previously exposed to | measured after 6-week delay | 
| feelings about smoking | Participants completed several scale items about their feelings towards smoking (e.g., How good or bad do you feel about smoking? -2=very bad; +2=very good; How much do you feel confused about the harms vs. benefits of smoking? 0=not at all confused; 4=very confused) | measured immediately following last exposure | 
| feelings about smoking | Participants completed several scale items about their feelings towards smoking (e.g., How good or bad do you feel about smoking? -2=very bad; +2=very good; How much do you feel confused about the harms vs. benefits of smoking? 0=not at all confused; 4=very confused) | measured after 6-week delay | 

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