This application responds to the """"""""Family Smoking Prevention and Tobacco Control Act,"""""""" which gave the Food and Drug Administration (FDA) regulatory authority over the manufacture and marketing of many tobacco products for the first time. Smoking remains the largest preventable source of mortality in the United States. Although decreasing cigarette use will likely require a range of strategies, one particularly effective way of reaching smokers is through graphic warning labels on cigarette packaging. Recognizing this reality, the Act mandates FDA to require graphic warning labels on cigarette packages by October 2012. FDA will also have continuing authority to revise graphic warning labels to promote public health. Research thus can have an important influence on these rules. This research has four aims designed to identify warning label components that can maximize quit intentions and to determine whether the currently planned program achieves this goal.
Aim 1 : To determine experimentally whether different combinations of graphic label components lead to greater overall quit intentions among adult smokers. To fulfill this aim, we propose (Study 1) a randomized controlled trial of 320 adult smokers at two sites (Columbus, OH and Philadelphia, PA) given their own brand of cigarettes to use with the new warning labels for a period of 28 days. Variations in the components of the labels (no graphic image, the current warning system, elaborative text emphasizing the importance of quitting, and a quitline in combination with elaborative text) will allow us to test predictions regarding two motivations underlying intentions to quit smoking: the motivation to smoke and to quit. We predict that the current warning program will primarily affect the motivation to smoke but that the combination of a quitline and elaborative text will influence both motivations. In Study 2, we will observe reactions to the rollout of the FDA warning-label program among 300 adolescent and 600 adult smokers as well as 300 adolescents vulnerable to smoking over a period of one year. This study will allow us to fulfill three additional aims to determine how well the currently planned warning label program performs with cohorts of (2) adolescent smokers and vulnerable nonsmokers and (3) adult smokers studied prior to and one year during the introduction of the new warning system. In addition, (4) we aim to determine whether the current warning program performs as well for persons lower in health literacy and numeracy as for those who are more able. We hypothesize that the current program will primarily affect the motivation to smoke among smokers and that it may leave adolescents vulnerable to the belief that they can quit at any time without incurring much harm. Nevertheless, the current program is expected to be equally effective across the ability spectrum.

Public Health Relevance

/Relevance Although decreasing smoking use and mortality will likely require a range of strategies, one particularly effective way of reaching cigarette users is through graphic warning labels on cigarette packaging that are mandated to be in place by the FDA in October 2012, with FDA continuing authority to modify and update the labels. This application seeks support for testing the potential effectiveness of different warning label components in studies that aim to identify psychological mechanisms that underlie their effectiveness so that warning-label effectiveness can be maximized and maintained over time.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Risk, Prevention and Intervention for Addictions Study Section (RPIA)
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Blake, Kelly D
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University of Pennsylvania
Other Domestic Higher Education
United States
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Evans, Abigail T; Peters, Ellen; Strasser, Andrew A et al. (2015) Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial. PLoS One 10:e0142879
Emery, Lydia F; Romer, Daniel; Sheerin, Kaitlin M et al. (2014) Affective and cognitive mediators of the impact of cigarette warning labels. Nicotine Tob Res 16:263-9
Romer, Daniel; Peters, Ellen; Strasser, Andrew A et al. (2013) Desire versus efficacy in smokers' paradoxical reactions to pictorial health warnings for cigarettes. PLoS One 8:e54937