Short and Sweet: The Persuasive Effects of Message Framing and Temporal Context in Antismoking Warning Labels

Current warning labels on cigarette packages are generally focused on long-term losses that can be incurred if one continues smoking. This study compares the effects of these labels against warning labels that stress short-term losses of smoking as well as labels that stress short- and long-term benefits that can be obtained when one quits smoking. A 2 (message frame: gain vs. loss) × 2 (temporal context: short vs. long term) between-subjects experiment was conducted among 132 smokers, with attitude toward quitting smoking and intention to quit smoking, as well as information-seeking behavior and message recall, as the dependent variables. Findings were in line with theory regarding message framing and temporal discounting, showing enhanced effects of gain over loss frames and short-term over long-term consequences on warning labels for attitudes and intentions. In addition, an interaction between message frame and temporal context was found. Especially, gain-framed messages showed stronger effects on intentions to quit smoking than loss-framed messages when warning labels concerned short-term outcomes. Findings suggest that current warning labels, with an emphasis on long-term negative health outcomes, should be reconsidered.     

“I Quit”: Testing the Added Value and Sequencing Effects of an Efficacy-focused Message among Cigarette Warning Labels

Many emotional appeal theorists argue that negative affect and efficacy work together to promote adaptive behavioral responses to a threat, yet most research on cigarette warning label messages has not examined the intersection between negative affect, hope, and efficacy. The current study tests effects of exposure, at different points in a sequence, to an efficacy-focused warning label in the context of threat-focused warning labels. We conducted an online, between- and within-subjects experiment with 398 adult smokers, testing the effects of warning label exposure on negative affect, hope, efficacy beliefs, and intentions to quit. Exposure to the efficacy-focused “Quit” label aroused higher levels of reported hope and lower levels of reported negative affect than threat-focused labels. Negative affect increased with each additional exposure to a threat-focused warning label, regardless of the order in which respondents saw the “Quit” label. Exposure to the “Quit” label (within a larger set of three threat-focused labels) led to greater self-efficacy but did not influence response efficacy or intentions to quit. We conclude that “Quit” messaging on warning labels can inspire both hopeful feelings and efficacy beliefs. Future research should identify the optimal balance between threat-focused and hopeful quit messages.     

When Health Policy and Empirical Evidence Collide: The Case of Cigarette Package Warning Labels and Economic Consumer Surplus

In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost “pleasure” smokers experience when they stop smoking; this is quantified as lost “consumer surplus.” Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health.The 2009 Family Smoking Prevention and Tobacco Control Act (HR 1256, 2009) required the United States Food and Drug Administration (FDA) to issue a regulation requiring cigarette companies to place large graphic warnings on all cigarette packages. As part of the process of issuing this regulation, the FDA conducted a cost–benefit analysis of the graphic warning label regulation.1 In its analysis, the FDA estimated the benefits of graphic warning labels, including reduced tobacco-induced illness and premature death, then cut the estimated benefits of these warning labels in half to account for the cost of lost “pleasure” smokers incurred as a result of quitting (and lost pleasure would-be smokers would never experience) because of the new warning labels. The FDA quantified the cost of this lost pleasure using the economic concept of “consumer surplus,” which is the difference between what a utility maximizing individual would be willing to pay and the actual price.2–6Because of the extent that smokers are willing to pay more for cigarettes than their monetary cost, this willingness to pay more is an indication that smokers obtain a surplus benefit of smoking beyond the cost of the cigarettes. The FDA justified applying a large discount to the estimated health benefits of the warning labels, stating,

The concept of consumer surplus is a basic tool of welfare economics… . In an analysis of benefits based on willingness-to-pay, we cannot reject this tool and still fulfill our obligation to conduct a full and an objective economic analysis.1^(p36714)

Consumer surplus based on willingness to pay is a well-established concept in classical economics and is grounded in rational choice theory, a normative model of human decision-making.7 Rational choice theory represents human decision-making at its most logical, when decisions are the result of careful cost–benefit analysis, with people choosing the option that maximizes the utility of the choice after subtracting perceived costs.8–10When applied to smoking, this theory posits that smokers (and potential smokers) smoke because they computed that the current and future benefits of the pleasures of smoking outweigh the present value of future financial, social, and medical costs of smoking.11–13 These benefits may include both the physiologic responses and emotional or social advantages (either real or imagined) that smoking provides.By contrast, a large body of empirical evidence from cognitive behavioral sciences demonstrates that smokers (and would-be smokers) smoke because they are addicted and overestimate their ability to quit in the future.14 Rational choice theory (and the adjustments that have been proposed to deal with addictive behaviors) assumes stable preferences, foresight, knowledge, and adequate cognitive abilities to make the decision to start or continue smoking. Conversely, empirical evidence demonstrates that these assumptions are seriously violated by smoking behavior that almost always begins during adolescence15^(p179) and continues in adulthood through addictive consumption. In addition, there is no empirical literature that suggests adults who start smoking engage in deliberate decision-making processes in which they evaluate risks against benefits. The empirical literature suggests the opposite; even adults, who presumably are better equipped to consider the risks and benefits of smoking, do not anticipate regret or understand addiction.16–18Applying a significant loss in (real or potential) consumer surplus when measuring the value of antismoking initiatives has important implications for policy, including reducing the benefits of proposed health regulations. This reduction in the estimated benefits of the policy results in weakened regulations that are harder to defend when challenged in court.19,20 In using consumer surplus, a measure grounded in rational choice theory, to estimate a theoretical “cost” of not smoking,1^(p36772),4 the FDA is ignoring the strong empirical evidence against the validity of applying rational choice to smoking decisions, leading the FDA to seriously overestimate the costs of reducing smoking, and in turn, underestimate the net benefits.     

Adolescents' Perceptions of Print Cigarette Advertising: A Case for Counteradvertising

Coverage of medical and health care issues has become a staple of the American press. To explain today's saturation of such coverage, I present a political continuum from reporting on the health of President Franklin Roosevelt to that of Republican presidential candidate Robert Dole. I suggest that the public can better be served by disclosures of medical records of political candidates as well as of elected officials.     

Effects of Varying Color,Imagery, and Text of Cigarette Package Warning Labels among Socioeconomically Disadvantaged Middle School Youth and Adult Smokers

ABSTRACT

The U.S. Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 paved the way for the Food and Drug Administration (FDA) to propose nine different graphic warning labels (GWLs) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements. Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies’ free speech without sufficiently advancing the government’s public health interests. This study examines whether less extensive alternatives to the original full-color GWLs, including black-and-white GWLs and text-only options, have similar or divergent effects on visual attention, negative affect, and health risk beliefs. We used a mobile media research lab to conduct a randomized experiment with two populations residing in socioeconomically disadvantaged communities: biochemically confirmed adult smokers (N = 313) and middle school youth (N = 340). Results indicate that full-color GWLs capture attention for longer than black-and-white GWLs among both youth and adult smokers. Among adults, packages with GWLs (in either color or black-and-white) engendered more negative affect than those with text-only labels, while text-only produced greater negative affect than the packages with brand imagery only. Among youth, GWLs and text-only labels produced comparable levels of negative affect, albeit more so than brand imagery. We thus offer mixed findings related to the claim that a less extensive alternative could satisfy the government’s compelling public health interest to reduce cigarette smoking rates.     

Interpretations of Cigarette Advertisement Warning Labels by Philadelphia Puerto Ricans

This study examined Philadelphia Puerto Ricans' interpretations of the Surgeon General's warnings that appear on cigarette packaging and in advertisements. In-home family focus groups in which participants were asked to comment on magazine cigarette advertisements showed a great variety of interpretations of the legally mandated warning labels. These findings (a) corroborate and add to research in public health and communications regarding the possibility of wide variations in message interpretations and (b) support the call for public health messages to be carefully tested for effectiveness among different social groups. The article's focus on Puerto Ricans addresses the problem of misleading conclusions that can arise from aggregating all Latino subpopulations into one group. The use of a naturalistic setting to examine interpretations of messages about smoking departs from the experimental methods typically used for such research and provides new evidence that even a seemingly straightforward message can be interpreted in multiple ways. Understanding and addressing differences in message interpretation can guide public health campaigns aimed at reducing health disparities.     

The Effects of Message Framing and Risk Perceptions for HPV Vaccine Campaigns: Focus on the Role of Regulatory Fit

This study investigates the effects of framing and risk perception, and their interaction effects on human papillomavirus (HPV) vaccination. Based on a 2 (message frames) × 2 (perceived risk) experimental design, the interaction effects reveal the effectiveness of loss- (vs. gain-) framed messages would be maximized for high (vs. low) perceived risk condition. Based on regulatory fit principles the synergy effects are shown in terms of attitudes toward advertising and HPV vaccination, HPV vaccination intention, and ad-promoted behavioral intention. The findings indicate right message appeals should be selected for the right target audiences in the setting of HPV vaccine promotions.     

Effect of the Framework Convention on Tobacco Control and Voluntary Industry Health Warning Labels on Passage of Mandated Cigarette Warning Labels From 1965 to 2012: Transition Probability and Event History Analyses

Objectives. We quantified the pattern and passage rate of cigarette package health warning labels (HWLs), including the effect of the Framework Convention on Tobacco Control (FCTC) and HWLs voluntarily implemented by tobacco companies.Methods. We used transition probability matrices to describe the pattern of HWL passage and change rate in 4 periods. We used event history analysis to estimate the effect of the FCTC on adoption and to compare that effect between countries with voluntary and mandatory HWLs.Results. The number of HWLs passed during each period accelerated, from a transition rate among countries that changed from 2.42 per year in 1965–1977 to 6.71 in 1977–1984, 8.42 in 1984–2003, and 22.33 in 2003–2012. The FCTC significantly accelerated passage of FCTC-compliant HWLs for countries with initially mandatory policies with a hazard of 1.27 per year (95% confidence interval = 1.11, 1.45), but only marginally increased the hazard for countries that had an industry voluntary HWL of 1.68 per year (95% confidence interval = 0.95, 2.97).Conclusions. Passage of HWLs is accelerating, and the FCTC is associated with further acceleration. Industry voluntary HWLs slowed mandated HWLs.The United States implemented the first cigarette package health warning label (HWL) in 1966 with the weak message, “Cigarette smoking may be hazardous to your health” on the side of the pack. By 2012, 209 countries and territories had implemented HWLs, ranging from weak text messages on the side of the pack to strong graphic warning labels (GWLs) on the pack front.1 Experimental and epidemiological data suggest that HWLs, especially GWLs, are important tools in tobacco control.2 Indeed, there is some evidence that GWLs enhance relevance and perceived effectiveness of tobacco control messages for individuals in disadvantaged groups3 and smokers cite GWLs as an impetus for quitting.4 Fong et al. prepared an extensive review of GWL literature that was published in 2009 concluding that GWLs have been an effective tobacco control intervention in numerous countries worldwide and may reduce disparities in knowledge for tobacco-related harms in countries with low literacy.5The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is a public health treaty designed to address issues of tobacco control. Article 11 of the treaty commits parties to implement large (at least 30% of the front surface area of the pack) rotating labels that may include graphics that may disrupt the impact of brand imagery on packaging and decrease the overall attractiveness of the package.6,7By applying transition probability matrices and event history analysis, we quantified the effects of voluntary industry regulation on the underlying process of implementation of HWLs. Understanding how voluntary regulation impedes adoption may help explain why some countries never adopt mandatory HWLs and health policies more generally. Indeed, voluntary regulations have been used to preempt regulation in other health-related areas8 including food advertising and labeling regulation.9 This is particularly important in public health as many industries use voluntary regulation to preempt or delay the regulatory process.There has been some research quantifying the effect of the tobacco industry and the FCTC on smoke-free policies. There is some evidence that being connected to GLOBALink (a tobacco control online community) increased the likelihood of ratifying the FCTC.10 Furthermore, there was a positive effect of the FCTC on strength and presence of tobacco control policies in individual countries.11In examining the implementation of HWLs, it is important to consider tobacco companies’ attempts to hamper this process.1 One way that tobacco companies seek to block or delay tobacco control policies is by implementing ineffective voluntary regulation to displace advertising restrictions12,13 and smoke-free policies,14 avoid taxation,12,15 and delay the FCTC itself.16 Health warning labels were no different. Between 1992 and 2012, 16 countries made voluntary agreements with the tobacco industry to put weak HWLs on cigarette packages, and in 1992 Philip Morris unilaterally put English-language HWLs on the sides of packages being sold in 49 small, mostly African, countries whose native languages were not English.1,17 British American Tobacco followed the same practice soon after. To date, no one has quantified the effect of these voluntary HWLs (whether by voluntary agreement or unilateral) on the rate of adoption of stronger HWLs.We describe the process of adopting HWLs over time beginning with the first mandated warning labels in the United States in 1966. We also tested whether the FCTC affected adoption of HWLs and quantified the effect of voluntary industry HWLs on the adoption of strong HWLs.     

Examining Interpretations of Graphic Cigarette Warning Labels Among U.S. Youth and Adults

Few studies have examined how diverse populations interpret warning labels. This study examined interpretations of 9 graphic cigarette warning labels (image plus text) proposed by the U.S. Food and Drug Administration among a convenience sample of youth (ages 13–17) and adults (18+) across the United States. Participants (N = 1,571) completed a cross-sectional survey. Participants were asked to select 1 of 3 plausible interpretations (1 preferred vs. 2 alternative) created by the research team about the particular consequence of smoking addressed in each warning label. Participants also rated each label for novelty, counterarguing, perceived effectiveness, and harm. Smokers reported their thoughts of quitting, self-efficacy, and motivation to quit. Although at least 70% of the sample chose the preferred interpretation for 7 of 9 labels, only 13% of participants chose all 9 preferred interpretations. The odds of selecting the preferred interpretation were lower among African Americans, among those with less education, and for labels perceived as being more novel. Smokers reported greater counterarguing and less perceived effectiveness and harms than nonsmokers, but results were not consistent across all labels and interpretations. The alternative interpretations of cigarette warning labels were associated with lower perceived effectiveness and lower perceived harms of smoking, both of which are important for motivating quit attempts.     

The Effects of Varying Electronic Cigarette Warning Label Design Features On Attention,Recall, and Product Perceptions Among Young Adults

ABSTRACT

This study was a 3 (Brand: Blu, MarkTen, Vuse) by 3 (Warning Size: 20%, 30%, or 50% of advertisement surface) by 2 (Warning Background: White, Red) experimental investigation of the effects of electronic cigarette (e-cigarette) warning label design features. Young adults aged 18–30 years (n = 544) were recruited online, completed demographic and tobacco use history measures, and randomized to view e-cigarette advertisements with warning labels that varied by the experimental conditions. Participants completed a task assessing self-reported visual attention to advertisements with a-priori regions of interest defined around warning labels. Warning message recall and perceived addictiveness of e-cigarettes were assessed post-exposure. Approximately half of participants reported attending to warning labels and reported attention was greater for warnings on red versus white backgrounds. Recall of the warning message content was also greater among those reporting attention to the warning label. Overall, those who viewed warnings on red backgrounds reported lower perceived addictiveness than those who viewed warnings on white backgrounds, and e-cigarette users reported lower perceived addictiveness than non-users. Among e-cigarette users, viewing warnings on white backgrounds produced perceptions more similar to non-users. Greater recall was significantly correlated with greater perceived addictiveness. This study provides some of the first evidence that e-cigarette warning label design features including size and coloring affect self-reported attention and content recall.     

A Qualitative Content Analysis of Cigarette Health Warning Labels in Australia,Canada, the United Kingdom,and the United States

The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization’s Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced.Visual imagery of the health effects of smoking has a long history in the context of antitobacco campaigns. Such images featured prominently in Victorian era antismoking literature,1,2 and visual representations of the deleterious effects of smoking on the body have been a continuous thread in modern-day tobacco control and public health iconography. The first warning labels mandated on cigarette packaging were text-based only, enacted in the United States a year after the 1964 Surgeon General’s Report decisively linked smoking to cancer and other adverse health outcomes.3 In 1965, the US Federal Cigarette Labeling Act required cigarette cartons and packs to carry the warning, “Caution: cigarette smoking may be hazardous to your health.”4^(p13) The addition of pictures to warning labels on tobacco packaging is a relatively recent phenomenon, legislated first in Canada in 2000.5 Following Canada’s lead, many other countries have since followed suit, with text and picture-based warnings required in 63 countries worldwide as of 2012.6 The use of visual imagery (referred to specifically as “health warning labels”) on tobacco packaging has been driven by the World Health Organization’s Framework Convention on Tobacco Control and is based on the premise that “a picture says a thousand words.”6^(p1) Article 11 sets out clear standards for health warning labels, which are expected to cover “as much of the principal display areas as possible.”7^(p34)For tobacco control advocates, the impetus for visually based warning labels was clearly protection and empowerment against the tobacco industry’s tactics—for children and youths, who were seen as particularly susceptible to “prosmoking” media imagery, and for consumers, who had been subject to industry “fraud” and misinformation about the health risks and consequences of smoking.5^(p356) However, although the ostensible purpose of the visual imagery used on health warning labels is to educate smokers about the effects of smoking, it draws some of its impetus from the assumption that the subjective emotional response the images may provoke will force smokers into “realizing the harm done to their bodies.”8^(p358) In other words, the transition from text-based to visual warning labels reflects a growing awareness that the labels could be used not just to transmit information but to affect behavioral change. Indeed, health warning labels on cigarette packages are seen to be even more effective than traditional print and television campaigns because they “potentially reach smokers every time they purchase or consume tobacco products.”7^(p23) The underlying assumption is that, in contrast to similar messages presented in other mediums, the warnings are unavoidable. From a public health standpoint, a third goal of such labels is to facilitate tobacco denormalization by challenging the social and cultural acceptability of smoking, especially the glamorization of tobacco in media and popular visual culture.9 In this respect, the visual culture of tobacco control has been heavily influenced by the tobacco industry, and aims to use its strategies and practices against it.10Numerous studies support the view that hard-hitting graphic labels are more effective than text-based warning labels in stimulating awareness of tobacco-related health risks and increasing motivation and intentions to quit smoking.8,11,12 Plain cigarette packaging is seen to be particularly effective in reducing the appeal of smoking and focusing attention on the image and text of the health warning labels.13 Australia’s introduction of plain cigarette packaging requirements in December 2012 has generated considerable interest in such legislation. However, one limitation of the available research is that responses to cigarette packages are studied in a context in which the ordinary coordinates of smoking are absent, making effectiveness very difficult to judge.14Critical approaches to health promotion challenge the assumption of a simplistic or unidirectional relationship between public health campaigns and their intended targets, in which audiences are passive recipients of health information. Contrary to a didactic model of health education and its emphasis on individual behavioral change, critical approaches recognize the structural context of smoking and the social, historical, and political circumstances in which antismoking messages are deployed. Thus, multiple readings and responses on the part of message recipients are inevitable. In the arena of smoking cessation, this includes the potential for negative responses, ranging from context dissonance15 to defiance or resistance.16–18 This recognition challenges mainstream and top-down approaches in health promotion, which may assume that health-related behavior change is merely a matter of better education for at-risk individuals and groups (i.e., that programmers and policymakers just need to get the message right). These approaches also highlight the need for public health policies to move beyond an exclusive emphasis on questions of efficacy to consider the ethics of the strategies employed (i.e., even if they do work, at what cost?). Without careful consideration of the ethical implications and unintended consequences of such messaging, the “war against smoking” may instead become a counterproductive “war against smokers.”Our analysis of health warning labels on cigarette packaging has been informed by previous research on the visual culture of public health, which suggests that health promotion and education campaigns are constitutive of deeply embedded cultural understandings of health, illness, and social relations of power.19–21 From this standpoint, it is useful to consider how health-related imagery presented as scientific and objective privileges particular ways of seeing and defining both the bodies and identities of those who are “healthy” and pathological bodies at risk for illness.22–24 As critical public health scholars suggest, health promotion campaigns not only reinforce a normative imagery of health but can also contribute to social exclusion, stigmatization, and dehumanization when graphic and confronting images designed to provoke disgust are used.16,25 These tendencies have been explored in the context of issues such as injury prevention and disability,26,27 HIV/AIDS,22,28,29 obesity,25 and substance use, including alcohol30 and smoking.31,32 For example, analyses of antitobacco messages for pregnant women33 and campaigns directed toward adolescent girls34 suggest that the former promote the notion of the “bad mother” and neglect smoking by fathers and other men, whereas the latter reinforce the idea that what is most valuable about women is their external, physical appearance.35We analyzed the visual culture of tobacco control as represented by cigarette health warning labels in the context of 4 countries, and interpreted what this reveals about smoking as a social identity and practice. Such labels provide openings through which to see the “densely elaborated iconography”36^(p107) of tobacco control and how it conceptualizes smoking and people labeled as smokers. We contend that the currently used and proposed sets of health warning labels ground understandings of smoking and its effects in ways that obscure certain dimensions of the practice while foregrounding and prefiguring others. In particular, they frame smoking as an individual risk behavior, one entirely isolable from its social context. Our approach is critical of such framing, and cuts against both its emphasis on a biomedical imagery of the “diseased and dying” body and its diminishment of agency.9     

Differential Effects of Message Framing on Obesity Policy Support Between Democrats and Republicans

This study tests whether gain- and loss-framed messages about establishing obesity-reducing policies have different persuasive effects on Republicans and Democrats. In a randomized between-subject experiment, participants (N = 384) read a message emphasizing either benefits to a society by establishing policies aimed to reduce obesity (i.e., gain-framed message) or costs to a society that fails to establish those policies (i.e., loss-framed message). Results indicated that Democrats perceived the gain-framed message as more persuasive than the loss-framed message and the perceived argument strength fully mediated the framing effect on Democrats’ policy support; however, there was no framing effect on perceived argument strength among Republicans. On the other hand, the gain-framed message led Republicans to attribute the cause of obesity less to the individual level compared to the loss-framed message and the no-message condition. We observed no framing difference among Democrats on causal attributions. Theoretical and practical implications of these findings are discussed.     

The Effects of Message Framing Within the Stages of Change on Smoking Cessation Intentions and Behaviors

This study examines two commonly used and accepted theoretical models in health communication—the stages of change and message framing—to determine whether gain- or loss-framed messages are more effective at getting people to intend to quit smoking depending on their current stage of change (precontemplation, contemplation, or preparation). One hundred forty-eight current smokers were exposed to one of four gain- or loss-framed messages that emphasized the benefits of cessation or the costs of smoking. Message believability, message processing, and stage movement were measured to see if any differences existed as a function of the individual's base stage of change and message frame exposure. Overall, results indicated that all participants, regardless of stage and frame, engaged in more central than peripheral message processing. However, those in the precontemplation/loss frame and preparation/gain frame conditions engaged in significantly less cognitive processing than those in all other conditions. Additionally, gain-framed messages were most influential at getting individuals to progress from the contemplation to the preparation stage. Implications and future directions for research are also discussed.     

The Word Outside and the Pictures in Our Heads: Contingent Framing Effects of Labels on Health Policy Preferences by Political Ideology

This study uses data from systematic Web image search results and two randomized survey experiments to analyze how frames commonly used in public debates about health issues, operationalized here as alternative word choices, influence public support for health policy reforms. In Study 1, analyses of Bing (N = 1,719), Google (N = 1,872), and Yahoo Images (N = 1,657) search results suggest that the images returned from the search query “sugar-sweetened beverage” are more likely to evoke health-related concepts than images returned from a search query about “soda.” In contrast, “soda” search queries were more likely to incorporate brand-related concepts than “sugar-sweetened beverage” search queries. In Study 2, participants (N = 206) in a controlled Web experiment rated their support for policies to reduce consumption of these drinks. As expected, strong liberals had more support for policies designed to reduce the consumption of these drinks when the policies referenced “soda” compared to “sugar-sweetened beverage.” To the contrary, items describing these drinks as “soda” produced lower policy support than items describing them as “sugar-sweetened beverage” among strong conservatives. In Study 3, participants (N = 1,000) in a national telephone survey experiment rated their support for a similar set of policies. Results conceptually replicated the previous Web-based experiment, such that strong liberals reported greater support for a penny-per-ounce taxation when labeled “soda” versus “sugar-sweetened beverages.” In both Studies 2 and 3, more respondents referred to brand-related concepts in response to questions about “sugar-sweetened beverages” compared to “soda.” We conclude with a discussion of theoretical and methodological implications for studying framing effects of labels.     

The Effects of Natural Cigarette Claims on Adolescents' Brand-Related Beliefs,Attitudes, and Intentions

The marketing of natural cigarettes has been widely criticized by consumer advocates and public policymakers. The present research is designed to inform the ongoing policy debate by examining the effects of natural cigarette claims on adolescents' brand impressions. The authors report the results of an experiment in which high school students viewed images of cigarette packages for three different brands. Findings indicate that including natural claims on cigarette packages can weaken beliefs that the cigarettes cause diseases. Results also reveal that skepticism toward marketing claims may play an important role in undermining brand attitudes and trial intentions toward cigarette brands promoted with natural claims. Policy implications and suggestions for further research are provided.     

Reading or Listening to a Gain- or Loss-Framed Health Message: Effects of Message Framing and Communication Mode in the Context of Fruit and Vegetable Intake

Gain-framed health messages are found to be more effective when targeting prevention behaviors. However, framing research has only minimally investigated the role of communication mode, another important factor in health communication. This study explored the role of communication mode in interaction with message framing, and the influence of two individual differences related to involvement as conditions under which gain framing can lead to health behavior change. Participants (N = 258) were exposed to either an auditory or written health message concerning fruit and vegetable intake, with either gain- or loss-framed arguments. In addition, the online experiment consisted of baseline and posttest measures, among which intention to consume sufficient fruit and vegetables. Moderating effects of perceived baseline fruit and vegetable consumption and baseline intention were assessed. A significant interaction between message framing and communication mode was observed: In case of a gain-framed message, an auditory message resulted in a higher intention than a written message. This pattern was most explicitly found among those with a lower perceived fruit and vegetable intake at baseline. Although further research is warranted in health persuasion research, the findings can possibly be used to target health interventions better at specific groups of people who behave less healthy.     

Message Framing in Vaccine Communication: A Systematic Review of Published Literature

Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O’Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.     

Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review

Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.     

A Serial Mediation Model of Message Framing on Intentions to Receive the Human Papillomavirus (HPV) Vaccine: Revisiting the Role of Threat and Efficacy Perceptions

Previous research has yielded mixed findings regarding the potential for message framing to influence HPV vaccine-related intentions. Drawing on the Extended Parallel Process Model (EPPM), the current study focuses on the role of threat and efficacy as serial mediators linking message framing and HPV vaccine-related intentions. College-age females and their parents participated in a between-subjects, posttest only experiment to investigate whether behavioral intentions to talk to a doctor about the HPV vaccine differ as a function of framing messages in terms of disease prevention. For young women, framing messages as preventing genital warts (as compared to cancer prevention) significantly increased perceptions of self-efficacy, which enhanced response efficacy perceptions that, in turn, increased intentions to talk to a doctor about the HPV vaccine. There were no effects of message framing among parents. However, response efficacy was a significant mediator of self-efficacy and behavioral intentions for both the college-age females and their parents. The results of this study suggest new approaches for considering the relationship among EPPM constructs.