The Effect of E-Cigarette Print Advertisements on Smoking Cessation Public Deposited

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  • March 19, 2019
  • Jo, Catherine
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
  • Introduction. Electronic cigarette (“e-cigarette”) print advertisements often feature e-cigarette devices that physically resemble combustible cigarettes (“cigalikes”) and messages suggesting e-cigarettes can be used when cigarette smoking is not allowed. These images and messages may undermine combustible cigarette smoking cessation and encourage dual use of e-cigarettes and combustible cigarettes. This dissertation examined the effects of e-cigarette visual cues and ad messages on factors related to combustible cigarette smoking cessation, namely, smoking cessation intention, smoking urges, and immediate smoking behavior. Methods. A U.S. convenience sample of 4,390 established cigarette smokers (ages 18+) completed an online survey in which two between-subjects randomized controlled experiments were embedded. Study 1 (n=3,293) investigated the effects of message content (e-cigarette use anywhere, harm reduction, generic/control message) and e-cigarette cue presence on study outcomes. Study 2 (n=2,201) examined message form (implicit e-cigarette use anywhere vs. explicit e-cigarette use anywhere) and e-cigarette cue presence effects. Mediation analysis was also performed to investigate mechanisms of the message form effect. Stimuli were print ads for cigalikes that were manipulated for the experimental conditions. Results. Message content affected immediate smoking behavior but not in the hypothesized direction. Both the e-cigarette use anywhere and harm reduction messages were associated with lower odds of smoking during the experiment than the control message. Message form directly affected smoking urges and indirectly affected cessation intention through descriptive normative beliefs about smoking. Compared to its explicit counterpart, the implicit e-cigarette use anywhere message evoked greater smoking urges. Participants exposed to the implicit message also perceived cigarette smoking to be more prevalent and, in turn, reported greater cessation intention. There was no evidence in either study of e-cigarette cue or message × cue interaction effects. Conclusion. E-cigarette cues and explicit harm reduction and e-cigarette use anywhere messages may either have no effect on combustible cigarette smoking cessation or may actually encourage it. Implicit e-cigarette use anywhere messages may create a predisposition towards smoking compared to their explicitly written counterparts, but it is unclear whether this effect will ultimately undermine cessation. Future studies should examine additional message variations and cue presentations and consider using implicit measures.
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Rights statement
  • In Copyright
  • Ribisl, Kurt
  • Southwell, Brian
  • Golden, Shelley
  • Noar, Seth
  • Rini, Christine
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016

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