Abstract
Current text-only cigarette warning labels (long-term, loss-framed messages) may not motivate positive changes in smoking behavior. The current project was a cross-sectional study examining the effects of tailored cigarette warnings on perceived message effectiveness (PME) in adult smokers (n = 512) conducted using Amazon Mechanical Turk (M-Turk) in January–February 2020. Participants were an average age of 40.7 (SD = 11.6), with the majority of the sample being female (62.2%) and White (88.9%). Participants reported smoking an average of 14.6 cigarettes/day (SD = 9.2) with an average FTND score of 4.6 (SD = 2.2). Participants were asked to complete a tobacco use history questionnaire, and mixed gambles and delay discounting tasks before random assignment to one of five message groups. The groups were based on a 2 (gain versus loss framing) ×2 (short-term versus long-term framing) between-subject design; a fifth group served as the control group. All experimental messages reported higher PME scores than the control (p values < 0.001, Cohen’s d = 1.88–2.48). Participants with shallower delayed reward discounting and lower loss aversion rates reported higher total PME scores, p values < 0.05. Our findings also suggest that loss aversion rates vary widely among smokers and that individuals are more responsive to messages congruent with their behavioral economic profile. Specifically, smokers who viewed messages congruent with their loss aversion and delay discounting rates reported higher PME scores than those who viewed incongruent messages (p = 0.04, Cohen’s d = 0.24). These preliminary findings suggest that anti-smoking campaigns may best impact smokers by tailoring messages based on individual loss aversion and delay discounting rates versus a one-size-fits-all approach.
Highlights
Greater perceived message effectiveness was observed for messages that described long-term compared to short-term outcomes, regardless of sign
No study has simultaneously tested how loss aversion and delay discounting rates of smokers can influence the perceived effectiveness of cigarette warning messages. We found that these behavioral economic differences influenced perceived message effectiveness (PME), which is a reliable measure of persuasiveness and has been associated with quit intentions and cessation behavior [44,45,46,47]
At the time of writing, the ability of PME to predict behavioral change is debated; PME is a useful tool in determining whether subsequent behavioral studies are necessary [44,47,54,55,56]
Summary
In 1965, Congress passed the Federal Cigarette Labeling and Advertising Act, requiring that cigarette packaging have text warning labels alerting consumers of the potential negative health consequences of smoking. In 1981, additional warnings with more descriptive text were added to the initial caution message. Researchers have examined how the manipulation of text warning label size, color, placement, and congruency with images influences smokers’ decision making [1,2,3,4]. Prospect theory has been used to conceptualize how cigarette-related health messages influence risky decision making. Prospect theory presents two primary changes to previous decision-making theories directly relevant to risk messaging: framing and loss aversion [5]
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