Testing Cessation Messages for Cigarette Package Inserts: Findings from a Best/Worst Discrete Choice Experiment

Abstract

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed models regressed choices on insert and smoker characteristics. For DCE 1, the most motivating messages involved novel disease topics and imagery of younger women. For DCE 2, topics of social support, stress reduction and nicotine replacement therapy were selected as most helpful, with no differences by imagery type. For DCE 3, imagery influenced choices more than topic, with imagery of a family or a mom and baby selected as most motivating. Statistically significant interactions for all three experiments indicated that the influence of imagery type on choices depended on the message topic. Messages to promote smoking cessation through cigarette pack inserts should consider specific combinations of message topic and imagery.

Exploring the impact of efficacy messages on cessation-related outcomes using Ecological Momentary Assessment

“…Observational studies suggest that these inserts increase smokers’ self-efficacy to quit 1 and promote quit attempts and sustained smoking cessation 1,2 . Further, experimental studies indicate that smokers perceive inserts with Canadian-style efficacy messages to be motivating and useful for quitting 3,4 . The current study assessed the real-world effects of inserts on cessation-related variables among a sample of smokers from the United States.…”

“…As suggested by fear-appeal research and theories 6,7 , a combination of self-efficacy and response efficacy messages can enhance fear-appeal messages and promote desirable attitudinal and behavioral change independent of fear arousal. However, the effects of inserts with efficacy messages have not been assessed in experiments outside brief, one-time exposures to messages online 3,4 . Further research is needed to determine if these supportive messages are effective.…”

Why Are New Tobacco Control Interventions Needed?

“…While FCTC Article 4 [ 3 ] called for political commitment to socially and culturally appropriate tobacco control programs for Indigenous populations, this seems important for a range of vulnerable groups. Two other publications in this special issue examined the differences in perceptions of product and packaging policies between low socioeconomic status (SES) and high SES individuals [ 8 , 9 ]. Although smoking rates among low SES groups are generally not as high as in the vulnerable populations discussed above [ 10 ], an increasingly large share of the total smoking population is of low SES [ 11 ].…”

“…Although smoking rates among low SES groups are generally not as high as in the vulnerable populations discussed above [ 10 ], an increasingly large share of the total smoking population is of low SES [ 11 ]. In this special issue, low SES groups showed more positive attitudes towards further tobacco product legislation (e.g., restricting flavored cigarettes) [ 8 ], while they were less likely to find quitting tips messages on cigarette package inserts helpful [ 9 ] than their high-SES counterparts.…”

“…Scheffers-van Schayck et al [ 18 ] describe a protocol for a randomized controlled trial and an implementation study aimed at proactive smoking cessation counseling for smoking parents. Several studies gave indications for the effectiveness of the various interventions, such as extending smokefree policies in schools to include outdoor spaces in the Netherlands [ 19 ], cigarette package inserts in Canada [ 9 ], and health warnings in electronic cigarette ads in the U.S. [ 20 ]. For example, the study by Thrasher et al [ 9 ] found that about eight in ten smokers identified at least one general cessation benefit message on a cigarette package insert to be motivating or a quitting tip message to be helpful.…”