Allison M. Schmidt

Source Credibility in Tobacco Control Messaging

OBJECTIVES Perceived credibility of a messages source can affect persuasion. This paper reviews how beliefs about the source of tobacco control messages may encourage attitude and behavior change. METHODS We conducted a series of searches of the peer-reviewed literature using terms from communication and public health fields. We reviewed research on source credibility, its underlying concepts, and its relation to the persuasiveness of tobacco control messages. RESULTS We recommend an agenda for future research to bridge the gaps between communication literature on source credibility and tobacco control research. Our recommendations are to study the impact of source credibility on persuasion with long-term behavior change outcomes, in different populations and demographic groups, by developing new credibility measures that are topic- and organization-specific, by measuring how credibility operates across media platforms, and by identifying factors that enhance credibility and persuasion. CONCLUSIONS This manuscript reviews the state of research on source credibility and identifies gaps that are maximally relevant to tobacco control communication. Knowing first whether a source is perceived as credible, and second, how to enhance perceived credibility, can inform the development of future tobacco control campaigns and regulatory communications.

The sales and marketing practices of English-language internet alcohol vendors.

AIMS This study aimed to fill information gaps about the sales and marketing practices of internet alcohol vendors and their implications for addressing youth access and other legal violations. Further, it aimed to expand the limited scientific literature on internet alcohol sales using systematic survey methods to inform future efforts to regulate this industry and prevent sales to minors. DESIGN The design was a cross-sectional website content analysis survey. SETTING [Not applicable]. PARTICIPANTS A total of 105 internet alcohol vendor websites. MEASUREMENTS Six key content analysis topics were explored: products offered, average prices and proportions of vendors using different promotions, policy statements and methods for age verification, payment and delivery. FINDINGS Websites sell and promote a variety of alcohol products, offered as cheaply as

Communicating program outcomes to encourage policymaker support for evidence-based state tobacco control.

1.93 for a 750-ml bottle. Vendors rely heavily upon age verification methods that are unlikely to prevent sales to minors. Many vendors advertise shipping of products via methods through which it is illegal or against delivery company policies to transport alcohol, and 99% of vendors accept credit cards. Limiting and enforcing delivery and payment options are types of policy interventions that have been used successfully with internet cigarette vendors that may be applicable to internet alcohol vendors as well. CONCLUSIONS Internet alcohol vendor practices are insufficient to prevent sales to minors, and need further regulation and enforcement of existing policies. Their sales practices are similar to those of internet cigarette vendors prior to regulation, and similar regulatory approaches may be effective in reducing internet alcohol sales to minors.

Attitudes Toward FDA Regulation of Newly Deemed Tobacco Products

Tobacco use, the leading cause of preventable death in the U.S., can be reduced through state-level tobacco prevention and cessation programs. In the absence of research about how to communicate the need for these programs to policymakers, this qualitative study aimed to understand the motivations and priorities of policymakers in North Carolina, a state that enacted a strong tobacco control program from 2003–2011, but drastically reduced funding in recent years. Six former legislators (three Democrats, three Republicans) and three lobbyists for health organizations were interviewed about their attitudes towards tobacco use, support of state-funded programs, and reactions to two policy briefs. Five themes emerged: (1) high awareness of tobacco-related health concerns but limited awareness of program impacts and funding, (2) the primacy of economic concerns in making policy decisions, (3) ideological differences in views of the state’s role in tobacco control, (4) the impact of lobbyist and constituent in-person appeals, and (5) the utility of concise, contextualized data. These findings suggest that building relationships with policymakers to communicate ongoing program outcomes, emphasizing economic data, and developing a constituent advocacy group would be valuable to encourage continued support of state tobacco control programs.

Development of the FDA Tobacco Credibility Scale (FDA-TCS)

Objective To examine how smokers perceive FDA oversight of e-cigarettes, hookah, and cigars. Methods Current US smokers (N = 1,520) participating in a randomized clinical trial of pictorial cigarette pack warnings completed a survey that included questions about attitudes toward new FDA regulations covering newly deemed tobacco products (ie, regulation of e-cigarettes, nicotine gels or liquids used in e-cigarettes, hookah, and cigars). Results Between 47% and 56% of current smokers viewed these new FDA regulations favorably and between 17% - 24% opposed them. Favorable attitudes toward the regulations were more common among smokers with higher quit intentions (adjusted odds ratio (aOR): 1.17, 95% CI: 1.02, 1.33) and more negative beliefs about smokers (aOR: 1.18, 95% CI: 1.05, 1.33). Participants with higher education, higher income, and previous exposure to e-cigarette advertisements had higher odds of expressing positive attitudes toward the new FDA regulations (p < .05). Conclusions Almost half of current smokers viewed FDA regulation of newly deemed tobacco products favorably. Local and state policy-makers and tobacco control advocates can build on this support to enact and strengthen tobacco control provisions for e-cigarettes, cigars, and hookah.

Public Knowledge and Credibility Perceptions of the FDA as a Tobacco Regulator

OBJECTIVES Messages from organizations with high, compared to low, credibility may be more persuasive. Whereas the tobacco industry has long recognized the importance of credibility in promoting its messages and public image, the source credibility of key tobacco control organizations has gone largely unmeasured. To assess credibility of a key tobacco regulator, we developed a scale of the US Food and Drug Administration (FDA) tobacco-related credibility. METHODS We developed and tested 30 items reflective of the dimensions of source credibility (trust, expertise, and public interest) and FDAs tobacco regulatory roles in a sample of 1353 US adults and assessed reliability and validity. RESULTS Factor analysis identified 3 dimensions of the FDA Tobacco Credibility Scale (FDA-TCS): public interest, trust, and expertise. The 3 subscales showed evidence of reliability and convergent validity; all subscales were correlated with general FDA credibility and trust in government. Those who knew that the FDA regulates tobacco scored higher on the trust and expertise subscales. The subscales were also associated with support for potential regulations, suggesting criterion-related validity. CONCLUSIONS The FDA-TCS allows for an understanding of the impact of credibility on responses to the FDAs tobacco control communications and regulatory efforts.

Attitudes towards Potential New Tobacco Control Regulations among U.S. Adults

Introduction Since the U.S. Food and Drug Administration (FDA) was granted regulatory authority over tobacco products in 2009, few studies have examined perceived credibility of the FDA in this role. The current study assessed knowledge and credibility of the FDA as a regulator of tobacco products. Methods In a nationally representative survey of U.S. adults (N = 4758), we assessed knowledge that the FDA regulates the manufacture, distribution, and marketing of cigarettes, and credibility of the FDA as a tobacco regulator. We examined demographic differences in knowledge and credibility, and associations of knowledge and trust in government with credibility perceptions. Results Less than half of respondents reported knowing the FDA regulates how cigarettes are sold (46.8%) and advertised (49.7%), and only 36.0% knew the FDA regulates how cigarettes are made, with few demographic differences. Respondents reported that the FDA was moderately credible in regulating tobacco. Knowledge of the FDA as a tobacco regulator and trust in government were the strongest predictors of credibility. Being of younger age, being White (compared to African American), and being male were associated with higher credibility ratings of the FDA. Conclusions Much of the public still does not know that the FDA regulates tobacco products, and credibility perceptions are moderate. Greater knowledge of the FDAs regulatory role was associated with higher credibility; efforts that increase the publics understanding of the FDAs role as a tobacco regulator may positively impact views of the agencys credibility. This may in turn improve public reception to the FDAs messages and regulations. Implications This study is the first to show nationally representative estimates of both knowledge and credibility of the FDA as a tobacco regulator. Our research shows further that knowledge of the FDAs tobacco regulatory roles is likely to be an important factor related to perceived credibility of the FDA. Increasing the publics knowledge of the FDAs roles may enhance the agencys credibility, which can improve public reception to messages and regulations.

Cigarette Constituent Health Communications for Smokers: Impact of Chemical, Imagery, and Source

Favorable attitudes towards tobacco control policies can facilitate their implementation and success. We examined attitudes toward four potential U.S. Federal tobacco regulations (banning menthol from cigarettes, reducing nicotine levels in cigarettes, banning candy and fruit flavored electronic cigarettes, and banning candy and fruit flavored little cigars and cigarillos) and associations with individual and state variables. A nationally representative phone survey of 4337 adults assessed attitudes toward potential policies. Weighted logistic regression was used to assess relationships between attitudes and demographic factors, smoking behavior, beliefs about the government (knowledge, trust, and credibility), exposure to tobacco control campaigns, and state variables from the US Centers for Disease Control and Prevention (CDC) State Tobacco Activities Tracking and Evaluation (STATE) System. Most respondents supported three out of four policies. Respondents that were female, non-white, Latino, living below the poverty line, had less than high school education, were of older age, did not smoke, had higher trust in government, and were exposed to national tobacco control campaigns had higher odds of expressing favorable attitudes toward potential new tobacco regulations than did their counterparts. No state-level effects were found. While differences in attitudes were observed by individual demographic characteristics, behaviors, and beliefs, a majority of participants supported most of the potential new tobacco regulations surveyed.

Should the Legal Age for Tobacco Be Raised? Results From a National Sample of Adolescents

INTRODUCTION Communication campaigns are incorporating tobacco constituent messaging to reach smokers, yet there is a dearth of research on how such messages should be constructed or will be received by smokers. METHODS In a 2 × 2 × 2 experiment, we manipulated three cigarette constituent message components: (1) the toxic constituent of tobacco (arsenic vs. lead) with a corresponding health effect, (2) the presence or absence of an evocative image, and (3) the source of the message (FDA vs. no source). We recruited smokers (N = 1669, 55.4% women) via an online platform and randomized them to one of the eight message conditions. Participants viewed the message and rated its believability and perceived effectiveness, the credibility of the message source, and action expectancies (ie, likelihood of seeking additional information and help with quitting as a result of seeing the message). RESULTS We found significant main effects of image, constituent, and source on outcomes. The use of arsenic as the constituent, the presence of an evocative image, and the FDA as the source increased the believability, source credibility, and perceived effectiveness of the tobacco constituent health message. CONCLUSIONS Multiple elements of a constituent message, including type of constituent, imagery, and message source, impact their reception among smokers. Specifically, communication campaigns targeting smokers that utilize arsenic as the tobacco constituent, visual imagery, and the FDA logo may be particularly effective in changing key outcomes that are associated with subsequent attitude and behavioral changes. IMPLICATIONS This article describes how components of communication campaigns about cigarette constituents are perceived. Multiple elements of a tobacco constituent message, including type of constituent, image, and message source may influence the reception of messages among current smokers. Communication campaigns targeting smokers that utilize arsenic as the tobacco constituent, visual imagery, and the FDA logo may be particularly effective in changing key outcomes among smokers. The effects of such campaigns should be examined, as well as the mechanisms through which such campaigns affect change.

Awareness and trust of the FDA and CDC: Results from a national sample of US adults and adolescents

Raising the minimum age of legal access to tobacco products may reduce smoking initiation and save lives. In a national telephone survey (2014–2015), US adolescents aged 13 to 17 years (N = 1,125; response rate, 66%) were asked about raising the age of legal access to tobacco products and randomized to hear one of 3 ages (19, 20, or 21 y). Most adolescents, across all US regions, favored raising the minimum age of legal access to 19 (75.7%), 20 (80.6%), or 21 (76.4%). These supportive attitudes may be useful to tobacco prevention and control practitioners who seek to reduce tobacco use among adolescents.