DoubleTake: Effect of Message Exposure Via a Discrete Choice Experiment With Eye-Tracking on Quit Attempts Among Adults Who Smoke Menthol Cigarettes

Discrete choice experiments (DCEs) are increasingly used in tobacco research to understand which message features people perceive as most effective. However, DCE studies are typically designed to assess message preferences and are not designed to test whether exposure to these messages has any downstream effect on actual behavior. Because DCEs expose participants to a large number of messages in a single session, a much higher dose of message exposure than in typical single- or few-message studies, it is possible that this cumulative exposure itself influences quitting-related outcomes such as making a quit attempt. This study (DoubleTake) is a randomized controlled trial designed to address this gap by testing whether exposure to multiple messages in the context of a DCE with concurrent eye-tracking affects quitting-related behaviors among adults who smoke menthol cigarettes, a population disproportionately affected by tobacco-related health disparities.

The study is a two-arm, randomized, waitlist-controlled trial with a planned total enrollment of approximately 200 participants (approximately 100 per arm). After completing eligibility screening and baseline questions on demographics and tobacco use, eligible participants will be randomly assigned to one of two conditions:

• Immediate condition: Participants complete the in-person DCE/eye-tracking study visit right away and then complete an online questionnaire assessing quitting-related behaviors 2 weeks later.
• Waitlist control condition: Participants wait 2 weeks and then attend an in-person visit, at the start of which they answer questions about quitting-related behaviors covering the preceding 2-week waiting period, and then complete the DCE/eye-tracking study.

This design allows researchers to isolate the effect of message exposure on quitting-related behaviors by comparing outcomes reported by the immediate condition (after exposure) to those reported by the waitlist condition (before exposure, over an equivalent 2-week window).

All participants will attend a 1-hour in-person study visit at one of two sites (Georgia State University or the University of California, Santa Barbara). During this visit, participants will view 64 anti-smoking social media messages, presented across 16 choice sets, while an eye-tracking device records their eye movements and pupil dilation. Within each choice set, participants will indicate which message most attracts their attention, which they would be most likely to share, and which would most motivate them to quit smoking.

The primary outcome is a self-reported quit attempt within 2 weeks following randomization. Secondary outcome is intentions to quit smoking.