Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment

Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22−1.62), and intention to quit (OR = 1.30, 95% CI = 1.10−1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities

Steady diet of confusion: Contradictory nutrition messages in the public information environment

Nutrition researchers, clinicians, and communication scholars have assumed that contradictory health and nutrition messages exist in the news media, and that exposure to these messages negatively influences public understanding and health behavior. This dissertation does not take issue with these claims, but rather with the evidence base that supports them. Although there is some evidence that contradictory health and nutrition messages exist, serious empirical studies of these messages and their potential effects are scarce. In addition, the few studies that exist lack a theoretical rationale for why contradictory messages might lead to effects. This dissertation moves beyond assumptions by asking two overarching research questions: (1) To what extent do contradictory nutrition messages exist in the news media, and (2) is exposure to such messages linked to potentially deleterious outcomes—namely, nutrition confusion (defined as perceived ambiguity about nutrition recommendations and research), nutrition backlash (defined as negative beliefs about nutrition recommendations and research), and, ultimately, decreased intentions to engage in recommended nutrition- and health-related behaviors? To address these questions, I conducted four studies. Study 1, a content analysis of news media coverage, focuses on the first research question, and Studies 2, 3, and 4—all of which use cross-sectional survey data—address the second question. Results provide support for the claim that contradictory nutrition information exists in the news media. Perhaps more importantly, there is evidence that people notice this information. Measures of media exposure to contradictory messages were developed and validated for the purposes of this research, and results show that exposure is associated with negative outcomes. Specifically, exposure to conflicting information on the health benefits and risks of, for example, wine, fish, and coffee consumption is associated with confusion about what foods are best to eat and the belief that nutrition scientists keep changing their minds. There is evidence that these beliefs, in turn, may lead people to doubt nutrition and health recommendations more generally—including those that are not rife with contradictory information (e.g., fruit and vegetable consumption, exercise behavior). The implications of these findings for communication theory and research, health journalism, and medical research are discussed

Steady diet of confusion: Contradictory nutrition messages in the public information environment

Nutrition researchers, clinicians, and communication scholars have assumed that contradictory health and nutrition messages exist in the news media, and that exposure to these messages negatively influences public understanding and health behavior. This dissertation does not take issue with these claims, but rather with the evidence base that supports them. Although there is some evidence that contradictory health and nutrition messages exist, serious empirical studies of these messages and their potential effects are scarce. In addition, the few studies that exist lack a theoretical rationale for why contradictory messages might lead to effects. This dissertation moves beyond assumptions by asking two overarching research questions: (1) To what extent do contradictory nutrition messages exist in the news media, and (2) is exposure to such messages linked to potentially deleterious outcomes—namely, nutrition confusion (defined as perceived ambiguity about nutrition recommendations and research), nutrition backlash (defined as negative beliefs about nutrition recommendations and research), and, ultimately, decreased intentions to engage in recommended nutrition- and health-related behaviors? To address these questions, I conducted four studies. Study 1, a content analysis of news media coverage, focuses on the first research question, and Studies 2, 3, and 4—all of which use cross-sectional survey data—address the second question. Results provide support for the claim that contradictory nutrition information exists in the news media. Perhaps more importantly, there is evidence that people notice this information. Measures of media exposure to contradictory messages were developed and validated for the purposes of this research, and results show that exposure is associated with negative outcomes. Specifically, exposure to conflicting information on the health benefits and risks of, for example, wine, fish, and coffee consumption is associated with confusion about what foods are best to eat and the belief that nutrition scientists keep changing their minds. There is evidence that these beliefs, in turn, may lead people to doubt nutrition and health recommendations more generally—including those that are not rife with contradictory information (e.g., fruit and vegetable consumption, exercise behavior). The implications of these findings for communication theory and research, health journalism, and medical research are discussed

Evaluation of graphic messages to promote human papillomavirus vaccination among young adults: A statewide cross-sectional survey

Young adults in the United States 18–26 years of age are eligible for human papillomavirus (HPV) vaccination, yet they rarely attend preventive healthcare visits. In contrast, they have a high prevalence of social media use, which could be leveraged to provide healthcare recommendations. Since graphics attract users, the study's primary objective was to determine the most appealing graphic to promote HPV vaccination to young adults. A cross-sectional survey was conducted at the Minnesota State Fair. Participants 18–26 years of age completed a 36-item survey including information on demographics, HPV vaccination status, eHealth literacy, and assessed the appeal of 8 Instagram graphic mock-ups promoting HPV vaccination to prevent cancer. The graphics represented 4 categories: 1) infographics; 2) disease photos; 3) young adult cancer patient photos; 4) humorous graphics. A total of 1037 eligible young adults participated in the study. Median age was 22 years. A majority were women (63%), white (82%), educated (79% post-secondary education or greater), or privately insured (85%). Although 61% reported receiving at least one dose of HPV vaccine, only 48% reported receiving all three recommended doses. Participants were slightly more drawn to posts with humorous graphics or infographics than disease or patient photos (pairwise p-values <0.0001). There were small but statistically significant differences in response to graphics by gender, race, HPV vaccination status, and eHealth literacy.In conclusion, graphic types tested in this study showed only small differences in response, suggesting that factors other than graphic type need to be explored to improve appeal of HPV vaccine promotional messaging. Keywords: HPV vaccination, Social media, Graphics, Health promotio