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Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. Summer 2017 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication; Interpersonal Communication; Social interactions; Tobacco; Warnings eng Doctor of Public Health Dissertation Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication, Interpersonal Communication, Social interactions, Tobacco, Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Jennifer Morgan Creator Department of Health Behavior Gillings School of Global Public Health SOCIAL INTERACTIONS ABOUT PICTORIAL CIGARETTE PACK WARNINGS Introduction. Social interactions are a key mechanism through which health communication efforts, including pictorial cigarette pack warnings, may exert their effects. We sought to better understand social interactions elicited by pictorial cigarette pack warnings. Methods. US adult smokers (n=2,149) participated in a controlled trial that randomly assigned them to have their cigarette packs labeled with pictorial or text-only warnings for four weeks. Surveys assessed the number of conversations, theoretical mechanisms, and conversational content during the baseline visit and each of the subsequent four weekly visits. Results. Smokers with pictorial warnings had more conversations throughout the trial compared to those with text-only warnings (8.2 conversations vs. 5.0, p<.01). Smokers with pictorial warnings were more likely than those with text-only warnings to discuss the health effects of smoking and whether the warnings would make them want to quit (both p<.05). The number of conversations about the warnings mediated the relationship between exposure to pictorial warnings and quit attempts (p<.001). In serial mediation analysis examining possible theoretical mechanisms, the number of conversations increased cognitive elaboration, which in turn increased quit attempts (p<.001). Conversations during the first week were more common among smokers who were younger, white, low-income, had greater perceived message effectiveness, and had stronger negative emotional reactions to the warnings (all p <.05). Conversations declined during the second week, but these declines were more gradual for minority and older smokers, leading to more conversations throughout the study. Conclusions. Pictorial warnings sparked more conversations about the warnings, the health effects of smoking, and quitting smoking than text-only warnings. These social interactions may extend the reach of pictorial warnings beyond the targeted smoker. These results indicate that cognitive elaboration is a possible theoretical mechanism that explains why conversations about pictorial warnings influence quit attempts. Conversations about cigarette pack warnings decreased over time. Greater perceived message effectiveness of the warnings and stronger negative emotional reactions to the warnings were associated with more conversations during the first week of smoking from packs with pictorial warnings. These results support designing warnings to increase conversations about the warnings. 2017-08 2017 Public health Communication; Interpersonal Communication; Social interactions; Tobacco; Warnings eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Noel T. Brewer Thesis advisor Shelley Golden Thesis advisor Seth Noar Thesis advisor Kurt Ribisl Thesis advisor Brian Southwell Thesis advisor text Morgan_unc_0153D_17344.pdf uuid:090717ba-2a42-464e-8718-d25db617d2ad 2019-12-31T00:00:00 2017-09-12T13:53:14Z proquest application/pdf 2375515