Warnings of tobacco addiction considered believable

In the journal Nicotine & Tobacco Research, UNC Lineberger researcher Adam Goldstein, MD, MPH, and Allison Lazard, PhD, compared how believable adults and adolescents found different warnings on addiction and tobacco.

Warnings of tobacco addiction considered believable click to enlarge Adam O. Goldstein, MD, MPH, is a UNC Lineberger member and professor in the UNC School of Medicine’s Department of Family Medicine.
Warnings of tobacco addiction considered believable click to enlarge Allison Lazard, PhD, is an assistant professor in the UNC School of Media and Journalism.

Media Contact: Laura Oleniacz, 919-445-4219, laura_oleniacz@med.unc.edu

A national survey of adolescents and adults found warnings about the addictiveness of tobacco products were “very believable,” report University of North Carolina Lineberger Comprehensive Cancer Center researchers.

“Believability is the first step to buying into information that can ultimately change behavior,” said the study’s lead author Allison Lazard, PhD, an assistant professor in the UNC School of Media and Journalism. “We found several new warnings on cigarette addiction are believable for the majority of both adolescents and adults in the U.S., which should help prevent cigarette initiation and encourage cessation.”

For their study, published in the journal Nicotine & Tobacco Research, researchers compared how believable adults and adolescents found different warnings on addiction and tobacco. They also evaluated whether the source of information – the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, the U.S. Surgeon General, or no source – impacted how believable the warnings were perceived to be. They drew their findings from phone surveys of more than 6,000 adults and adolescents in the United States by the Carolina Survey Research Laboratory.

They found that 69.4 percent of adolescents and 65.6 percent of adults reported the three cigarette addiction warnings were very believable, and the information source didn’t significantly impact believability.

In both groups, respondents reported that two of the warnings were the most believable. The warnings “Cigarettes are addictive,” and “this product contains nicotine derived from tobacco…nicotine is an addictive chemical” had higher odds of being believable in both adults and adolescents.  The first warning is one of the nine required warnings for cigarette packages in the United States under the Family Smoking Prevention and Tobacco Control Act. The second is one of the warnings that the FDA included in its expansion of its regulatory authority over other tobacco products like e-cigarettes.

They also tested warning language about addiction and menthol, or mint-flavored, cigarettes, which was considered less believable, Lazard said. There are no warnings in U.S. regulations that specifically address menthol, Lazard said. She added that marketing and positive associations connected with menthol-flavored cigarettes could be playing a role in the believability of warnings about them.

“No previous research on cigarette warnings has examined impacts of addiction themes, despite the fact that addiction warnings are being used increasingly as a major method to inform tobacco users about the addictive nature of tobacco products,” said Adam O. Goldstein, MD, MPH, a UNC Lineberger member and professor in the UNC School of Medicine’s Department of Family Medicine. “Addiction-related cigarette warnings appear to be very believable among youth and adults, and hold great promise for reducing tobacco consumption.”

Goldstein is director of a research project at UNC that is investigating the credibility of communication about tobacco. The project is one of a number of studies being conducted under the direction of UNC’s two nationally designated Tobacco Centers for Regulatory Science. The centers were launched to study how to communicate effectively the risks of cigarettes, cigarette smoke and other tobacco products, and to investigate the impact of new and emerging tobacco products on the lungs.

The researchers’ latest findings support the FDA’s recommendations for warnings on addiction. Lazard said this information may be particularly important for addiction warnings for products that the FDA has recently expanded its regulatory authority over, including cigars, water pipe tobacco and e-cigarettes.

Starting in August 2018, manufacturers cannot make, package, sell, offer, distribute or import tobacco products without a warning label statement. For hookah, gels, e-cigarettes and other products derived from tobacco, the package labels and advertisements must display a warning statement about nicotine addictiveness.

“Addiction warnings are important not only for cigarettes but for new products because there may be misperceptions that they never contain nicotine, or they’re less addictive,” Lazard said. “Sticking with messages that are believable, and applying them to new tobacco products, could be powerful to help change multiple tobacco use behaviors.”

In addition to Goldstein and Lazard, other authors include Sarah Kowitt, Seth Noar, and Kristen Jarman. 

Research reported in this publication was supported by grant number P50CA180907 from the National Cancer Institute and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.