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Abstract
Background Dual use of e-cigarettes and cigarettes is prevalent among US adults, increasing nicotine addiction and health risks. This study investigated what type of narrative messages would be more effective in encouraging individuals who use both e-cigarettes and cigarettes to quit both smoking and vaping.
Methods We conducted an online between-subjects randomised experiment on individuals who currently use both e-cigarettes and cigarettes (n=489). The ‘biomarker outcome’ narrative group viewed a ‘why-quit’ message that highlighted a decrease in biomarkers of toxicant exposure on quitting smoking and vaping; the ‘cessation experience’ narrative group viewed a ‘how-to-quit’ message that highlighted strategies for quitting smoking and vaping. Multivariable regressions were conducted to evaluate message effects on motivation to quit smoking and vaping based on perceived importance, commitment and readiness (range: 0–10). Mediation analyses were performed to assess pathways from messages through emotional responses to motivation to quit.
Results As compared with viewing the ‘cessation experience’ narrative, exposure to the ‘biomarker outcome’ narrative led to larger increases in the motivation to quit smoking (adjusted β (SE)=0.3 (0.1), p=0.02) and vaping (adjusted β (SE)=0.5 (0.1), p=0.003). Individuals who were exposed to the ‘biomarker outcome’ narrative reported higher negative emotions and lower positive emotions than those in the ‘cessation experience’ narrative group. The message effects on changes in motivation to quit smoking (βindirect effect=0.06, p=0.002) and vaping (βindirect effect=0.05, p=0.009) were significantly mediated by negative emotions, but not by positive emotions.
Conclusion A biomarker outcome narrative message that highlights the efficacy of quitting smoking and vaping by presenting evidence-based, objective biomarkers of toxicant exposure may be a persuasive message format in anti-dual use messaging.
- Cessation
- Electronic nicotine delivery devices
- Co-substance use
Data availability statement
Data are available upon reasonable request. The data supporting the findings of this study are not publicly available to protect the privacy and confidentiality of the participants. However, the data can be made available from the corresponding author upon reasonable request, provided that appropriate data use agreements are in place and the request aligns with ethical and legal guidelines for data sharing.
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Data availability statement
Data are available upon reasonable request. The data supporting the findings of this study are not publicly available to protect the privacy and confidentiality of the participants. However, the data can be made available from the corresponding author upon reasonable request, provided that appropriate data use agreements are in place and the request aligns with ethical and legal guidelines for data sharing.
Footnotes
Contributors RS conceptualised the study, acquired the data, interpreted the results, drafted the manuscript, critically reviewed and revised the manuscript. KS acquired the data, performed the analysis and critically reviewed the manuscript. HDD is responsible for the overall content (as guarantor), and she conceptualised the study, performed the analyses, interpreted the results, drafted the manuscript, critically reviewed and revised the manuscript.
Funding The research reported in this publication was partially supported by R21DA058328 from the National Institute on Drug Abuse and the FDA Center for Tobacco Products (CTP) and by R34CA287719 from the National Cancer Institute.
Disclaimer The content is solely the responsibility of the author and does not necessarily represent the official views of the NIH or the Food and Drug Administration.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.