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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Positive mental health labels | Experimental | Participants viewed four messages, formatted as tobacco packaging labels, communicating the benefits of smoking cessation for mental health. The messages were:
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| Positive physical health labels | Active Comparator | Participants viewed four messages, formatted as tobacco packaging labels, communicating the benefits of smoking cessation for physical health. The messages were:
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| Blank labels | Placebo Comparator | Participants viewed four blank messages, formatted as tobacco packaging labels. The messages were:
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Messages on tobacco packaging labels | Behavioral | 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. |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
Did not smoke tobacco at least weekly
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| Name | Affiliation | Role |
|---|---|---|
| Gemma Taylor, PhD | University of Bath | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Bath | Bath | BA2 7AY | United Kingdom |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40610984 | Derived | Sawyer K, Hanafi A, Freeman TP, Burke C, Adams S, Aveyard P, Jacobsen P, Taylor G. 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. BMC Public Health. 2025 Jul 3;25(1):2331. doi: 10.1186/s12889-025-22795-0. |
| Label | URL |
|---|---|
| Pre-registered protocol on Open Science Framework | View source |
| ID | Type | URL | Comment |
|---|---|---|---|
| Individual Participant Data Set | View IPD |
The datasets generated and/or analysed during the current study are available in the University of Bath repository.
Data will be available on publication and indefinitely
Scripts are available at https://osf.io/v5deq/?view\_only=d5dd1f5903a0480d94402c7c6528c6a4
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| ID | Term |
|---|---|
| D000073869 | Tobacco Smoking |
| D012907 | Smoking |
| D016540 | Smoking Cessation |
| D000092862 | Psychological Well-Being |
| ID | Term |
|---|---|
| D001519 | Behavior |
| D064424 | Tobacco Use |
| D015438 | Health Behavior |
| D010549 | Personal Satisfaction |
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The intervention was tobacco warning labels with three conditions: i) positive mental health labels; ii) positive physical health labels; iii) blank labels. Participants were randomly allocated to one label condition using Qualtrics embedded randomisation function, stratified by mental health status, and viewed four labels for at least 10 seconds each.
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| 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 |
The datasets generated and/or analysed during the current study are available in the University of Bath repository. |
| Analytic Code | View IPD | Scripts are available on Open Science Framework |