Trial reportSocial science & medicine (1982)2018
Why smokers avoid cigarette pack risk messages: Two randomized clinical trials in the United States.
Trial report in Social science & medicine (1982), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Sugary drink warnings: A meta-analysis of experimental studies.PLoS medicine · 2020Pooled it
- Consumer Reactions to Positive and Negative Front-of-Package Food Labels.American journal of preventive medicine · 2023Trial
- Trial
- Health Warnings and Beverage Purchase Behavior: Mediators of Impact.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2020Trial
- Defensive Reactions to Pictorial Warning Labels Featuring Narrative Versus Non-Narrative Content.Health communication · 2026Article
- Article
- Health harms that discourage alcohol consumption: A randomized experiment of warning messages.Addictive behaviors · 2024Article
- "You are Telling the Story Yourself": Defining and Developing Narrative Pictorial Warning Labels.Health communication · 2024Article
- Is evoking fear effective? Exploratory findings from a randomised experiment on the impacts of health warning labels on sugar-sweetened beverages.Public health nutrition · 2023Article
- Reducing Misperceptions About Very Low Nicotine Content Cigarettes: Insights From Adults Who Smoke.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2022Article
- Adolescents' Perceptions of Harmfulness of Tobacco and Tobacco-like Products in Finland.International journal of environmental research and public health · 2022Article
- Message perceptions and effects perceptions as proxies for behavioral impact in the context of anti-smoking messages.Preventive medicine reports · 2021Article
- Incremental criterion validity of message perceptions and effects perceptions in the context of anti-smoking messages.Journal of behavioral medicine · 2021Article
- Impact of e-cigarette health warnings on motivation to vape and smoke.Tobacco control · 2019Article
- Conversations about pictorial cigarette pack warnings: Theoretical mechanisms of influence.Social science & medicine (1982) · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution.
Funding
Abstract
backgroundMessage avoidance (e.g., trying not to look at the message) may be motivated by reactance, a maladaptive rejection of the message. An alternative view is that avoidance indicates that a message is eliciting fear and other negative affect, thereby increasing the likelihood of behavioral change. We sought to identify which psychological mechanism-reactance or fear and other negative affect-explains message avoidance. We also examined whether avoidance was associated with more forgoing or butting out of cigarettes.
methodTrial 1 randomly assigned 2149 adult U.S. smokers to receive either pictorial warnings (intervention) or text-only warnings (control) on their cigarette packs for four weeks in 2014 and 2015. Trial 2 randomly assigned 719 adult U.S. smokers to receive either messages about toxic chemicals in cigarette smoke (intervention) or messages about not littering cigarette butts (control) for three weeks in 2016 and 2017. Negative affect included fear, anxiety, disgust, sadness, and guilt. Reactance included perceived threat to freedom, anger, and counterarguing.
resultsIntervention messages led to greater message avoidance in both trials (both p < .001). In Trial 1, intervention messages elicited greater negative affect, which in turn was associated with greater avoidance (mediated effect = 0.21, p < .001). In contrast, reactance explained only a small part of the effect in Trial 1 (mediated effect = 0.03, p < .001). Similarly, in Trial 2, intervention messages elicited greater negative affect, which was associated with more avoidance (mediated effect = 0.12, p < .001); reactance did not explain any of the effect. In both trials, avoidance was associated with more forgoing or butting out of cigarettes (ps < .001).
conclusionsSmokers may avoid cigarette pack risk messages because they evoke aversive types of emotion. These studies add to a growing body of evidence that, in the context of cigarette pack messages, avoidance is not a form of defensive processing but instead a sign of deeper processing.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.