Impact of Positive Mental Vs. Physical Health Messaging on Motivation to Stop Smoking

What is the Effect of Presenting Evidence of the Mental Vs Physical Health Benefits of Quitting Smoking on Motivation to Stop Smoking? an Online Randomised Controlled Experiment

This study tested whether positive messages on tobacco packaging about the mental health benefits of quitting smoking could help motivate people to stop smoking. It compared three types of labels: ones focusing on mental health benefits, ones focusing on physical health benefits, and blank labels.

The experiment involved 631 people who smoke who were randomly shown one of these label types on an online survey platform. Participants' motivation to quit smoking was measured before and after viewing the labels.

Study Overview

• Status: Completed
• Conditions: Smoking, Tobacco
• Intervention / Treatment: Behavioral: Messages on tobacco packaging labels

• Study Type: Interventional
• Enrollment (Actual): 631
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • Bath, United Kingdom, BA2 7AY
    • University of Bath

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Self-reported weekly tobacco smokers
2. Aged at least 18 years
3. Could read English

Exclusion Criteria:

Did not smoke tobacco at least weekly

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Positive mental health labels; Participants viewed four messages, formatted as tobacco packaging labels, communicating the benefits of smoking cessation for mental health. The messages were: "Quitting smoking improves your mental health"; "Quitting smoking reduces feelings of depression"; "Quitting smoking reduces feelings of anxiety"; "Quitting smoking can improve your mood"	Behavioral: Messages on tobacco packaging labels; The intervention was messages of the benefits of smoking cessation formatted as tobacco packaging labels with three conditions. Participants viewed the messages online. There were four messages in each condition. The intervention was informed by relevant patient and public groups.
Active Comparator: Positive physical health labels; Participants viewed four messages, formatted as tobacco packaging labels, communicating the benefits of smoking cessation for physical health. The messages were: "Quitting smoking improves your health"; "Quitting smoking reduces risk your risk of having a heart attack"; "Quitting smoking reduces shortness of breath and coughing"; "Quitting smoking can improve your oral health"	Behavioral: Messages on tobacco packaging labels; The intervention was messages of the benefits of smoking cessation formatted as tobacco packaging labels with three conditions. Participants viewed the messages online. There were four messages in each condition. The intervention was informed by relevant patient and public groups.
Placebo Comparator: Blank labels; Participants viewed four blank messages, formatted as tobacco packaging labels. The messages were: Blank template; Template with "Example"; Template with "Template"; Template with "Image, Text"	Behavioral: Messages on tobacco packaging labels; The intervention was messages of the benefits of smoking cessation formatted as tobacco packaging labels with three conditions. Participants viewed the messages online. There were four messages in each condition. The intervention was informed by relevant patient and public groups.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motivation to stop smoking	Motivation to stop smoking was measured using the Motivation to Stop Scale (MTSS). The MTSS asks participants "Which of the following best describes you?" with the following ordinal scale: 1) "I don't want to stop smoking"; 2) "I think I should stop smoking but don't really want to"; 3) "I want to stop smoking but haven't thought about when"; 4) "I REALLY want to stop smoking but I don't know when I will"; 5) "I want to stop smoking and hope to soon"; 6) "I REALLY want to stop smoking and intend to in the next 3 months"; 7) "I REALLY want to stop smoking and intend to in the next month".	At baseline and follow up immediately after viewing the labels

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intention to Quit	Participants were asked their intention to quit smoking "Are you planning to quit smoking within the next month?" using a 10-point visual analogue scale, where 1 indicates low intention to quit and 10 indicates higher intention to quit smoking	Measured at baseline and follow up immediately after viewing the labels
Quitting Self-Efficacy	To measure participants' self-efficacy to quit smoking, participants responded to the questions "Overall, how confident are you that you can stop smoking within the next month?" on a 5-point scale 1 ('not at all') to 5 ('completely confident') and "For me cutting down on the number of cigarettes that I smoke in the next month would be…." On a scale off 1 ('very difficult') to 5 ('very easy'). The mean score across the two items was calculated, with a higher score indicating higher self-efficacy	Measured at baseline and follow up immediately after viewing the labels
Smoking Beliefs	Participants rated their agreement to the statements "smoking helps people relax", "smoking helps to reduce stress", "smoking helps to keep weight down" "smoking increases social comfort" "those who smoke are more popular" and "second hand smoke is not harmful" using a 5-point scale from 1 ('not at all') to 5 ('a lot'). The mean score across the five items was calculated, with a higher score indicating more favourable beliefs towards smoking	Measured at baseline and follow up immediately after viewing the labels
Attention	Participants rated two statements 'these labels are worth remembering' and 'these labels grabbed my attention' on a 5-point scale from 1 ('not at all') to 5 ('a lot'), mean score across the two items was calculated, with a higher score indicating greater attention	Measured at follow up immediately after viewing the labels
Affective Reactions	To measure affective reactions to the health labels we used the Self-Assessment Manakin (SAM, (Bradley & Lang, 1994)). Participants rated their affective reactions: valence, arousal, and dominance on a 9-point visual analogue scale. Scales for valence range from 1 'unpleasant' to 9 'pleasant', arousal ranged from 1 'calm' to 9 'excited', and dominance ranged from 1 'controlled' to 9 'in control' with 5 as neutral for all items	Measured at follow up immediately after viewing the labels
Believability	Perceptions of believability of the health label were measured using the question "How believable are these health labels?", participants rated this on a 5-point scale from 1 ('not at all') to 5 ('a lot')	Measured at follow up immediately after viewing the labels

Collaborators and Investigators

• Sponsor: Katherine Sawyer
• Investigators: Principal Investigator: Gemma Taylor, PhD, University of Bath

Publications and helpful links

Helpful Links

• Pre-registered protocol on Open Science Framework

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2022
• Primary Completion (Actual): February 28, 2023
• Study Completion (Actual): February 28, 2023

Study Registration Dates

• First Submitted: December 19, 2024
• First Submitted That Met QC Criteria: January 6, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 7, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: Smoking; Smoking cessation; Mental health; Public health; Tobacco warning labels
• Other Study ID Numbers: 21-244

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The datasets generated and/or analysed during the current study are available in the University of Bath repository.
• IPD Sharing Time Frame: Data will be available on publication and indefinitely
• IPD Sharing Access Criteria: Scripts are available at https://osf.io/v5deq/?view_only=d5dd1f5903a0480d94402c7c6528c6a4
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ANALYTIC_CODE

Study Data/Documents

1. Individual Participant Data Set
   Information comments: The datasets generated and/or analysed during the current study are available in the University of Bath repository.
2. Analytic Code
   Information comments: Scripts are available on Open Science Framework

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No