For over 90 million adults - nearly half of all adults in the United States - difficulty with health literacy interferes with the capacity to obtain, process, and understand health information. Moreover, these individuals have an increased risk of disease. Because tobacco smoking is the leading behavioral risk factor that contributes to social disparities in the incidence and mortality of disease, effectively providing low-literate smokers with information concerning the health consequences of smoking is critical. Therefore, the primary aim of the proposed study is to examine how health literacy influences responses to smoking risk messages manipulated in terms of message framing and emotionality. In addition to traditional questionnaires, outcomes will be assessed using """"""""implicit"""""""" cognitive psychological measures. Thus, the proposed study examines the immediate effects of different types of smoking risk messages on cognition in a laboratory setting. Findings will have important implications for the future development of smoking cessation interventions targeted at low literacy populations. Smokers with varying levels of health literacy (i.e., inadequate, marginal, adequate) will listen to one of four different types of smoking risk messages recorded on a computer in the form of audio scripts (i.e., a human voice pre-recorded on a computer will read each message) and concurrently presented in written form via a computer monitor. They will be written at a fifth- to sixth-grade reading level and manipulated in terms of 1) framing (i.e., gain-framed messages that highlight the benefits of quitting vs. loss-framed messages that emphasize the costs of failing to quit), and 2) emotionality (i.e., primarily fact-based vs. primarily emotion-based). Framing and emotionality will be completely crossed to create four different types of messages, 1) factual gain-framed, 2) factual loss-framed, 3) emotional gain-framed, and 4) emotional loss-framed. The primary specific aims are to examine: 1) whether main effects emerge for health literacy (inadequate, marginal, adequate) and the different message types (fact-based vs. emotion-based and gain-framed vs. loss-framed) on the primary explicit and implicit outcome measures: a) intention to quit smoking, and b) implicit and explicit attitudes toward smoking, and 2) whether health literacy interacts with the different message types (fact- vs. emotion-based and gain- vs. loss- framed) to influence the primary explicit and implicit outcome measures: a) intention to quit smoking, and b) implicit and explicit attitudes toward smoking. A secondary, exploratory aim is to examine potential associations between explicit and implicit outcomes. Findings will shed light on important cognitive mechanisms that may influence the potency of smoking risk messages across the health literacy spectrum. Moreover, findings will be directly relevant to translation of the basic behavioral science underlying smoking risk communications into enhanced smoking cessation treatment approaches. ? ? ?
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