View of European cigarette packaging that has shocking images of health problems caused by smoking, photo credit Firn / Shutterstock
Tobacco Center of Regulatory Science

Publications

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Our Publications

This publication is in press with the journal Tobacco Control.

Authors: Melissa Mercincavage, L. Peck, James F. Thrasher, Joseph N. Cappella, Eric Donny, Cristine Delnevo, and Andrew Strasser

In Frank, L., & Falzone, P. (Eds.). Entertainment Education Behind the Scenes: Case Studies for Theory and Practice. Palgrave & MacMillan Publishing, 2021.

Authors: Yotam Ophir, Angeline Sangalang, Joseph N. Cappella

Abstract: This chapter examined the emotional flow hypothesis that suggested that emotional shifts in response to educational narratives promote and sustain message engagement, and that engagement, in turn, can promote story-consistent attitudes and beliefs. We conducted two controlled experimental studies, manipulating emotional flow through discrete emotions or emotional valence. The persuasive messages about the misinformed nature of organic tobacco were embedded within an entertainment-education narrative about a romantic date. Results suggest that, at least in the short narratives often used for health campaigns, emotional shifts may not increase engagement with plots or characters. This finding was further supported by the manipulation checks, showing participants did go through emotional shifts in the appropriate conditions. Theoretical and practical implications are discussed.

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Psychology & Health, 2021.

Authors: Rui Shi, Jiaying Liu, Joseph N. Cappella

Overview: This study examined the effect of online comments on smokers’ attitude toward trying e-cigarettes. It also explored the effect of an unobtrusive forewarning in increasing smokers’ resistance to online review fraud.

Design: 739 adult smokers participated in an experiment with a 2 comment valence (supportive vs. oppositional) x 3 comment deception warning (no warning vs. early warning vs. late warning) + 1 control (no comment) factorial design. Smokers watched two e-cigarette commercials. The control group received only the ads. The treatment groups saw 10 to 12 comments following each ad.

Main Outcome Measure: E-cigarette attitude.

Results: Smokers who read supportive (M = 5.28, SD = 1.37), oppositional (M = 4.96, SD = 1.53), and no comment (M = 5.44, SD = 1.20) showed significant difference on their e-cigarettes attitude, p = .004. When the comment climate was overly in favor of e-cigarettes, warning smokers of review fraud could raise their awareness of comment deception, increase defensive processing, decrease their social identification with commenters, and eventually lower their interest in trying e-cigarettes.

Conclusion: The overall opinion climate in the form of aggregated valence of comments could sway smokers’ e-cigarette attitude. Smokers could benefit from warnings of online review fraud.

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Tobacco Regulatory Science, 2021

Authors: Anupreet K. Sidhu, Melissa Mercincavage, Valentina Souprountchouk, Joseph N. Cappella, Andrew A. Strasser

Objectives: A critique of graphic warning labels has been concerning their potential to elicit avoidance where smokers avoid engaging with tobacco risk messages. To date, there are no studies that objectively measure how smokers visually engage with high versus low avoidance warning labels. Methods: Smokers (N = 360) were randomized to one of 9 warning labels, subsequently categorized as high (ie, depicting images of disease) or low avoidance. Participants attended 4 sessions over 10 days; eye movements were recorded while viewing warning labels to assess differences on attention and recall of specific areas of interest. Results: Latency to the image was not significantly different between groups, however, latency for text was longer in the high versus low avoidance group (p < .01). The total fixation duration on the image for high avoidance labels was longer than low avoidance labels (p < .001). Independent of warning label type, the image recall was high throughout; text and message recall started low and reached 80% correct recall by day 7. Conclusion: Graphic high avoidance images gain attention just as quickly as low avoidance images but tend to hold attention significantly longer than low avoidance images.

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Journal of Health Communication, 2020

Authors: Jennifer C. Morgan, Jazmyne A. Sutton, Sijia Yang, Joseph N. Cappella

Abstract: Graphic cigarette warnings increase quit attempts. Perceived message effectiveness and message avoidance are predictive of later quit attempts. We sought to examine whether randomized exposure to warning messages would inadvertently increase intentions to use alternate tobacco products while enhancing attempts to quit cigarettes. An online survey of 1392 adult smokers in the US asked participants to rate six randomly selected tobacco warnings (from a set of 319) on perceived effectiveness and avoidance intentions. These two indicators of message effectiveness were calculated at the message-level and then at the individual campaign-level to facilitate causal inference. After viewing a message campaign of six warning messages, participants indicated their intentions to use alternate tobacco products. Sixty-eight percent of participants reported some intention to use e-cigarettes and intentions to use other alternate tobacco products ranged from 31% to 40%. Campaigns of messages eliciting higher avoidance increased the odds of intending to use hookah (aOR: 4.32), smokeless tobacco (aOR: 4.88), and snus (aOR: 8.06), but not the intention to use electronic cigarettes. These relationships are mediated by intentions to quit smoking (all p <.05). Viewing campaigns with higher campaign-level perceived effectiveness increased the intentions to quit, which in turn increased intentions to try alternate tobacco products. Our findings increase the tobacco control community’s understanding of unintended consequences of graphic tobacco warnings.

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AJPH, 2020.

Authors: Wen-Ying Silvia Chou, Anna Gaysynsky, Joseph N. Cappella

This is an AJPH Perspectives commentary.

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Communication Monographs, 2020.

Authors: Qinghua Yang, Natalie Herbert, Sijia Yang, Julia Alber, Yotam Ophir, and Joseph N. Cappella

Insufficient scientific evidence about electronic cigarettes (e-cigarettes) has led to conflicting recommendations (CRs) by credible scientific organizations, creating a public health debate that could prove especially difficult to reconcile as current and former smokers make decisions about whether to use e-cigarettes. To investigate how CRs about e-cigarettes may affect intentions to engage in healthy behaviors, 717 former and current smokers were randomly exposed to one of five conditions (varying in the level of conflict in recommendations) in this between-subject experiment. Our results indicated a significant interaction between the message level of conflict and individuals’ information avoidance, employed to maintain hope and deniability. These results suggest the effects of CRs stemming from scientific uncertainty vary with subgroups of people, pointing to several pressing theoretical and practical implications.

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Doctoral Dissertation by Stefanie Gratale, University of Pennsylvania, 2020.

Abstract: Misinformation is a growing concern in the public health realm, as it is persistent and difficult to correct. One strategy recently considered to address misinformation is “inoculation”, which leverages forewarning and refutation to defend against a subsequent persuasive message. Here, I aimed to assess whether inoculation can be harnessed to forestall implicitly arising misinformation such as that from misleading natural cigarette ads, which have been shown to prompt widespread misbeliefs. I conducted three randomized online experiments assessing means of inoculating against misinformation. The first tested inoculation tactics to determine whether particular message formats are more effective (i.e., exemplar, narrative, or exposition), and to assess whether inoculations must refute the exact arguments from the misinformation or can more generally match argument themes. The second study tested an attenuated generic versus a specific refutation, and explored results over time. The final study focused on a particular inoculation strategy–highlighting prior deceptive messaging by the persuasive source. Results indicate that inoculations can successfully defend against misinformation from misleading ads; further, they do not need to match exact arguments or even exact themes from the arguments in order to reduce misbeliefs. In fact, high level, generic refutations successfully reduced misbeliefs both immediately and with a time delay, and, crucially, so too did inoculations that included an explicit forewarning but only an implicit refutation. Furthermore, multiple inoculation message formats were successful, and the effectiveness of inoculations was enhanced, to a limited degree, by identifying prior deceptive messaging by the persuasive source. Finally, findings supported counterarguing as a potential mediator of effects of inoculation messages on misbeliefs. The significance of the results here lies in their support for key inoculation components–forewarning and refutation–as well as the much-hypothesized mechanism of counterarguing, when attempting to combat misinformation. The core contribution of these studies is the consistent finding that we can successfully inoculate against implicit misinformation without directly addressing the exact misinformation claims, which is particularly important with implicitly arising, often difficult-to-anticipate misbeliefs from misleading advertising.

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Tobacco Control, 2019.

Authors: Stefanie Gratale, Erin Moloney, Joseph N. Cappella

Objective: This study sought to demonstrate causal effects of exposure to Natural American Spirit (NAS) advertising content on misinformed beliefs of current and former smokers, and to empirically establish these beliefs as a mechanism driving intentions to use NAS.

Methods: Our study employed a randomised experimental design with 1128 adult daily, intermittent and former smokers. We compared participants who were exposed to NAS advertisements or claims made in the advertisements with those in a no-message control group to test the effects of NAS advertising content on inaccurate beliefs about NAS and attitudes and intentions towards the product.

Results: One-way analysis of variance revealed that exposure to NAS advertisements produced inaccurate beliefs about the composition of NAS cigarettes among current and former smokers (p<0.05). Planned contrasts indicated a compilation of arguments taken directly from NAS advertisements resulted in significantly greater beliefs that NAS cigarettes are healthier/safer than other cigarettes (for former smokers, t(472)=3.63, p<0.001; for current smokers, t(644)=2.86, p=0.004), demonstrating that suggestive claims used in the brand’s marketing have effects on beliefs not directly addressed in the advertisements. Regression and mediation analyses showed that health-related beliefs predict attitudes towards NAS for current and former smokers, and mediate intentions to use NAS.

Conclusions: The findings of this study provide causal support for the need for further regulatory action to address the potentially harmful ramifications of claims used in NAS advertising.

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International Journal of Environmental Research and Public Health, 2019.

Authors: Stefanie Gratale, Angeline Sangalang, Erin K. Maloney, Joseph N. Cappella

Abstract: This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely and erroneously perceived as safer than their traditional counterparts because of their marketed “natural” composition. Yet regulatory action regarding natural cigarette marketing has been limited in scope, and little research has examined whether misleading product advertising affects support for related policy, an important component of the policy process. Here, we administered a large-scale randomized experiment (n = 1128), assigning current and former smokers in the United States to an NAS advertising condition or a control group and assessing their support for tobacco industry regulation. Results show that exposure to NAS advertising reduces support for policies to ban potentially misleading terminology from cigarette advertising, and these effects are stronger for daily smokers. Further, misinformed beliefs about the healthy composition of NAS partially mediate effects on policy support. Yet interestingly, exposure to NAS marketing does not reduce support for policies to establish standards for when certain terms are permissible in cigarette advertising. The results of this analysis indicate potential spillover effects from exposure to NAS advertising in the realm of support for regulatory action pertaining to tobacco industry marketing.

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Tobacco Control, 2018.

Authors: Stefanie Gratale, Erin K. Maloney, Angeline Sangalang, Joseph N. Cappella

Objective: This study sought to demonstrate causal effects of exposure to Natural American Spirit (NAS) advertising content on misinformed beliefs of current and former smokers, and to empirically establish these beliefs as a mechanism driving intentions to use NAS.

Methods: Our study employed a randomised experimental design with 1128 adult daily, intermittent and former smokers. We compared participants who were exposed to NAS advertisements or claims made in the advertisements with those in a no-message control group to test the effects of NAS advertising content on inaccurate beliefs about NAS and attitudes and intentions towards the product.

Results: One-way analysis of variance revealed that exposure to NAS advertisements produced inaccurate beliefs about the composition of NAS cigarettes among current and former smokers (p<0.05). Planned contrasts indicated a compilation of arguments taken directly from NAS advertisements resulted in significantly greater beliefs that NAS cigarettes are healthier/safer than other cigarettes (for former smokers, t(472)=3.63, p<0.001; for current smokers, t(644)=2.86, p=0.004), demonstrating that suggestive claims used in the brand’s marketing have effects on beliefs not directly addressed in the advertisements. Regression and mediation analyses showed that health-related beliefs predict attitudes towards NAS for current and former smokers, and mediate intentions to use NAS.

Conclusions: The findings of this study provide causal support for the need for further regulatory action to address the potentially harmful ramifications of claims used in NAS advertising.

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