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Objectives: Health warning messages could be an effective means of communicating the health risks associated with waterpipe (WP) smoking. The objective of this study was to select a message that conveyed the risks associated with WP smoking. Methods: A mixed-methods approach was used to explore the effectiveness of the Food and Drug Administration's (FDA's) mandated message, and others, among young adults using focus groups and surveys. Two focus group studies and one convenience survey were conducted to examine the FDA's mandated message and 11 other WP warning messages. The final study, conducted with a random sample of firstyear university students, examined the effectiveness and reactance of the chosen message using previously validated items (scored on a 1-5 scale). Results: The FDA's mandated message did not resonate well with focus group participants. In the random sample of students, the top message (WARNING: Hookah smoke contains poisons that cause lung and oral cancers) had high effectiveness (M = 4.49) and a low reactance (M = 2.12). Conclusions: Our studies suggest that other messages are more effective for communicating the risks associated with WP smoking than the FDA's message for WP tobacco. [ABSTRACT FROM AUTHOR]

Objectives: The tobacco industry has a history of making "natural" claims in advertisements. We report how viewing advertisements with such claims affected what adolescents found memorable. Methods: Adolescent boys (N = 1220; 11-16 years old) were randomly assigned to view a Natural American Spirit (NAS) or other brand cigarette advertisement, and were asked what they remembered about the advertisement. Survey-weighted logistic regression models assessed whether memorability of advertisement components differed by NAS advertisement exposure. Results: Adolescents viewing a NAS advertisement (vs another brand) had lower odds of finding memorable the advertisement's warning (OR = 0.58; 95% CI: [0.34, 0.98]) or brand (OR = 0.25; 95% CI: [0.11, 0.54]). They had higher odds of mentioning tobacco (OR = 2.33; 95% CI: [1.49, 3.63]) and packaging (OR = 2.57; 95% CI: [1.51, 4.37]). An estimated 6.7% of those viewing an NAS advertisement said the product was not addictive. Conclusions: Reduced-harm claims on cigarette advertisements may affect what adolescents find salient about the advertisement. As the FDA's agreement with Santa Fe Natural Tobacco Company to remove these claims is not inclusive of all reduced-harm claims and does not apply to other companies, findings underscore the need for prohibiting all reduced-harm claims from cigarette advertisements. [ABSTRACT FROM AUTHOR]

Objectives: E-cigarettes are now the most commonly-used tobacco product among adolescents; yet, little work has examined how the appealing food and flavor cues used in their marketing might attract adolescents' attention, thereby increasing willingness to try these products. In the present study, we tested whether advertisements for fruit/sweet/savory-flavored ("flavored") e-cigarettes attracted adolescent attention in real-world scenes more than tobacco flavored ("unflavored") e-cigarettes. Additionally, we examined the relationship between adolescent attentional bias and willingness to try flavored e-cigarettes. Methods: Participants were 46 adolescents (age range: 16-18 years). All participants took part in an eye-tracking paradigm that examined attentional bias to flavored and unflavored e-cigarette advertisements embedded in pictures of real-world storefront scenes. Afterwards, participants' willingness to try flavored and unflavored e-cigarettes was assessed. Results: In support of our primary hypothesis, adolescents looked longer and fixated more frequently on flavored (vs unflavored) e-cigarette advertisements. Moreover, this attentional bias towards flavored e-cigarette advertisements predicted a greater willingness to try flavored vs unflavored e-cigarettes. Conclusions: These findings suggest that flavored e-cigarette marketing attracts the attention of adolescents, increases their willingness to try flavored e-cigarette products, and could, therefore, put them at greater risk for tobacco initiation. [ABSTRACT FROM AUTHOR]

Objectives: In the United States, print advertisements for smokeless tobacco (SLT) feature a large warning covering 20% of the advertisement space, whereas cigarette and e-cigarette advertisements cover approximately 4%. We explored how warning size affects adolescent boys' recollection of the warning, brand-relevant advertisement features, and product risks. Methods: Overall, 1220 adolescent males (ages 11-16) viewed SLT, cigarette, and e-cigarette advertisements and were asked to recall what they remembered most. Coders identified recalls of the warning label, advertisement features, and risks associated with the product in responses. Results: Participants were less likely to recall warnings in the cigarette versus SLT (OR = 0.30, p < .001) and e-cigarette versus SLT (OR = 0.15, p < .001) ads. Separate GEEs revealed that boys who recalled warnings were less likely to mention brand-relevant advertisement features (OR's < 0.32, ps < .001). Logistic regressions revealed that boys who recalled the warnings were more likely to mention risks associated with the products (ORs > 3.50, ps < .001). Conclusions: Adolescent boys are more likely to recall large SLT warnings than small cigarette and e-cigarette warnings. Warning recall is associated with lower likelihood of recalling brand-relevant advertisement features and greater likelihood of mentioning product risks. [ABSTRACT FROM AUTHOR]

This study tested whether age is a factor in viewing time for tobacco warning labels. The approach drew from previous work demonstrating an age-related positivity effect, whereby older adults show preferences toward positive and away from negative stimuli. Methods: Participants were 295 daily smokers from Appalachian Ohio (age range: 21-68). All participants took part in an eye-tracking paradigm that captured the attention paid to elements of health warning labels in the context of magazine advertisements. Participants also reported on their past cessation attempts and their beliefs about the dangers of smoking. Results: Consistent with theory on age-related positivity, older age predicted weaker beliefs about smoking risks, but only among those with no past-year quit attempts. In support of our primary hypothesis, older age was also related to a lower percentage of time spent viewing tobacco warning labels, both overall (text + image) and for the graphic image alone. These associations remained after controlling for cigarettes smoked per day. Conclusions: Overall, findings suggest that age is an important consideration for the design of future graphic warning labels and other tobacco risk communications. For older adults, warning labels may need to be tailored to overcome the age-related positivity effect. [ABSTRACT FROM AUTHOR]

Objective: To determine how electronic cigarettes (e-cigarettes) are portrayed in newspaper informative articles and opinion pieces. Methods: A content analysis was conducted on 450 articles published in the United States from 1997 to mid-2014 and obtained by a Newsbank search. The articles were reliably coded for overall frame, type of article, first topic and main topics addressed. Results: The article topics have changed over time and suggest significant differences between news articles and opinion pieces. Informative articles focused on e-cigarette regulation, whereas opinion pieces highlighted their increasing popularity and perceived health benefits. Conclusions: This content analysis uncovered significant interest in e-cigarettes, particularly in their regulation. The FDA should consider public perceptions of e-cigarettes when developing regulations. [ABSTRACT FROM AUTHOR]