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Grant Details

Grant Number: 5R01CA215466-05 Interpret this number
Primary Investigator: Thrasher, James
Organization: University Of South Carolina At Columbia
Project Title: Evaluation of Cigarette Package Inserts for Enhanced Communication with Smokers
Fiscal Year: 2023


PROJECT SUMMARY: Tobacco product labeling is a critical public health policy, and most countries around the world require health warning labels (HWLs) on cigarette pack exteriors. One labeling option is cigarette package inserts – small printed leaflets inside of cigarette packs. For over a century, cigarette manufacturers have used inserts to reach smokers with promotional messages every time they open a new pack. However, inserts remain underused for public health communication. Canada is the only country in the world that has both HWLs and inserts, for which our recent research finds very promising results on their effectiveness for helping smokers quit. The US Food and Drug Administration currently is developing new labels for cigarettes in the US, and research is urgently needed to support its decision making. Our proposed study is based on the importance of “efficacy” messages about the benefits of behavior change and that build confidence to change behavior, which is the type of message used on Canadian inserts. Efficacy messages on inserts may be most effective when accompanied by large pictorial HWLs that show harms from smoking. We aim to evaluate whether inserts with efficacy messages promote smoking cessation: AIM 1: We will evaluate the impact of inserts with efficacy messages using an experiment among adult smokers in the US. In Study 1, 320 smokers will be put into one of four labeling groups: 1. no inserts or pictorial HWLs; 2. inserts only; 3. pictorial HWLs only; 4. inserts & pictorial HWLs. Smokers will be given a 14- day supply of their preferred cigarette brand with packs labeled according to their group. Participants will answer a brief survey at the end of each day and four other times each day. We will study whether smokers in each group experience different psychological responses or behaviors associated with smoking cessation. AIM 2: We will evaluate the impact of an `inserts' labeling policy in Canada by following two groups of adult smokers who will be surveyed before and after Canada puts new inserts and HWLs on packs in 2020. Study 2a participants will answer surveys for 14 days (as in Study 1) both before and after the new policy is in place. In Study 2b we will survey 1500 smokers every 4 months over 2 years, covering the period before (3 surveys) and after (4 surveys) the new policy. The timing and questions for Studies 2a and 2b will allow us to compare their results, which will help us reach stronger conclusions about whether labels promote smoking cessation. The proposed study will provide the strongest research on package inserts to date. The strengths of the experiment in Study 1 are complemented by the evaluation of insert effects in more natural contexts for Studies 2a and 2b. Comparison of results across all three studies will help determine how inserts and HWLs work, including their effects on smoking cessation. The results will be useful for policy making both in the US and internationally. We will also improve understanding of product labeling, whose low cost and ability to repeatedly communicate with many people holds great potential for promoting healthy consumer behaviors.


Recruitment Methods, Inclusion, and Successful Participation in a Longitudinal Clinical Trial Using Ecological Momentary Assessment.
Authors: Porticella N. , Cannon J.S. , Wu C.L. , Ferguson S.G. , Thrasher J.F. , Hackworth E.E. , Niederdeppe J. .
Source: Health education & behavior : the official publication of the Society for Public Health Education, 2024 Apr; 51(2), p. 280-290.
EPub date: 2023-11-26.
PMID: 38008973
Related Citations

Combining Inserts With Warning Labels on Cigarette Packs to Promote Smoking Cessation: A 2-Week Randomized Trial.
Authors: Thrasher J.F. , Ferguson S.G. , Hackworth E.E. , Wu C.L. , Lambert V.C. , Porticella N. , Kim M. , Hardin J.W. , Niederdeppe J. .
Source: Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2024-01-01; 58(1), p. 56-66.
PMID: 37738629
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A mixed-method study of perceptions of cigarette pack inserts among adult smokers from New York and South Carolina exposed as part of a randomized controlled trial.
Authors: Hackworth E.E. , Budiongan J.R. , Lambert V.C. , Kim M. , Ferguson S.G. , Niederdeppe J. , Hardin J. , Thrasher J.F. .
Source: Health education research, 2023-12-11; 38(6), p. 548-562.
PMID: 37450334
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Examining the Effectiveness of the 2012 Canadian Graphic Warning Label Policy Change by Sex, Income, and Education.
Authors: Usidame B. , Meng G. , Thrasher J.F. , Thompson M. , Fong G.T. , Fleischer N.L. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2023-03-22; 25(4), p. 763-772.
PMID: 36205028
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The Differential Impact of the 2000 Canadian Graphic Warning Label Policy on Smoking Prevalence by Sex and Education: A Difference-in-Difference-in-Difference Model.
Authors: Usidame B. , Meng G. , Thrasher J.F. , Thompson M.E. , Fong G.T. , Fleischer N.L. .
Source: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2022-10-26; 24(11), p. 1732-1740.
PMID: 35536724
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Strategies to enhance the effects of pictorial warnings for cigarettes: results from a discrete choice experiment.
Authors: Thrasher J.F. , Islam F. , Arillo-Santillán E. , Rodriguez-Bolaños R. , Saenz de Miera Juarez B. , Hardin J.W. , Barrientos-Gutierrez I. .
Source: Addiction (Abingdon, England), 2022 Apr; 117(4), p. 1095-1104.
EPub date: 2021-11-15.
PMID: 34697845
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Evaluating Cigarette Pack Insert Messages with Tips to Quit.
Authors: Loud E.E. , Lambert V.C. , Porticella N. , Niederdeppe J. , Thrasher J.F. .
Source: Tobacco regulatory science, 2021 May; 7(3), p. 203-209.
PMID: 35546961
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Cessation Conversations and Quit Attempts: Differences by Ethnicity and Language Preference.
Authors: Lambert V.C. , Davis R.E. , Popova L. , Thrasher J.F. .
Source: American journal of health behavior, 2020-07-01; 44(4), p. 473-487.
PMID: 32553028
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The impact of the 2009/2010 enhancement of cigarette health warning labels in Uruguay: longitudinal findings from the International Tobacco Control (ITC) Uruguay Survey.
Authors: Gravely S. , Fong G.T. , Driezen P. , McNally M. , Thrasher J.F. , Thompson M.E. , Boado M. , Bianco E. , Borland R. , Hammond D. .
Source: Tobacco control, 2016 Jan; 25(1), p. 89-95.
EPub date: 2014-12-15.
PMID: 25512431
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