Sarah Durkin

Issue Addressed: To explore Australian adolescents' perceptions of the risks and health harms associated with vaping and their attitudes towards e‐cigarettes and examine if these vary by demographic and other factors. Methods: Data were from a 2022‐2023 cross‐sectional, school‐based survey of Victorian students aged 12–17 years ( n = 1701 [weighted]; n = 1696 [unweighted]). Separate multivariable logistic regression models tested associations between agreement with each perception/attitude and predictors (age group, gender, area‐based socio‐economic status, vaping susceptibility, e‐cigarette marketing exposure, peer vaping), controlling for education sector and school‐level clustering. Results: Most students (≥ 86%) agreed that vaping is harmful and addictive and that e‐cigarettes contain harmful substances and nicotine, while agreement that breathing other people's e‐cigarette vapour can affect your health was somewhat lower (69%). Perceptions of vaping harms tended to be stronger among females (vs. males) and weaker among past‐month vapers (vs. non‐susceptible, never‐vapers). Overall, students held more negative than favourable attitudes towards e‐cigarettes. However, vaping susceptibility, being of younger age and having a close friend that vapes were independently associated with having more favourable attitudes towards e‐cigarettes (e.g., they look cool, make vaping look exciting). Further, past‐month exposure to e‐cigarette advertising was associated with students believing that e‐cigarettes look good, make vaping look appealing, encourage them to vape and encourage them to buy an e‐cigarette. Conclusions: Findings provide support for recent government policies to limit e‐cigarette advertising and retail access, and the delivery of youth‐targeted educational campaigns about vaping. So What?: Ongoing monitoring is important to assess sustained change over time in e‐cigarette knowledge and attitudes among Australian adolescents, with this study providing an important pre‐reform baseline against which such changes can be evaluated.

Background: Pictorial health warnings on tobacco packs stimulate short-term cognitive and emotional responses that can lead to quit attempts. We tested novel product attribute health warnings (PAHWs) that corrected misperceptions about product harmfulness. PAHWs uniquely influenced outcomes assessing knowledge of industry manipulation of cigarettes, industry-centric negative emotional responses and product-specific smoking dissonance. We aimed to examine if these unique short-term responses predicted subsequent quitting-related behaviours. Method: We analysed follow-up data from a between-subjects online experiment during which participants were randomised to view PAHWs alone (PAHW condition) or with a complementary video (PAHW+Video) during a baseline session and daily for 7 days. In the present study, covariate-adjusted logistic regression models examined associations between short-term responses to the PAHWs measured at 8-day follow-up (predictors) and subsequent quitting-related behaviours measured at 4-week follow-up (outcomes). Results: Participants with valid data for the 8-day and 4-week follow-up surveys were analysed (N=301). Two short-term responses to the PAHWs—knowledge of industry manipulation of cigarettes and product-specific smoking dissonance—significantly and positively predicted all three quitting-related outcomes: smoke-limiting microbehaviours (eg, foregoing cigarettes), quit attempts and 7-day sustained abstinence. Industry-centric negative emotional responses positively predicted smoke-limiting microbehaviours and 7-day sustained abstinence but not quit attempts. Conclusion: Short-term responses elicited by PAHWs featuring corrective information about the tobacco industry’s manipulation of tobacco products predicted subsequent engagement in smoke-limiting microbehaviours, quit attempts and sustained quit attempts. PAHWs can complement other health warnings featuring the health risks of smoking and may help motivate people who smoke to quit and stay quit.

Background Tobacco cessation services delivered via quitlines increase the likelihood of smoking cessation. Integrated media communication campaigns are a critical channel for promoting quitlines. This study used real-world data to explore the effect of various tobacco control advertising campaign strategies on generating quitline self-referrals, including among high prevalence communities. Methods Monthly counts of self-referrals to the Victorian quitline were examined during periods of Quit Victoria advertising campaign activity and inactivity between January 2018 and December 2023. Campaigns varied by spend, pairing of motivational plus capacity-building messages or not, and extent of repeated airings over the previous 6 years. Negative binomial regression models examined associations between different advertising campaign strategies and self-referrals, adjusted for periods surrounding tobacco tax increases, and time. Results Self-referral rates accelerated as funding increased. These accelerating effects were particularly evident among high prevalence groups. Greater increases were observed when messages with different behavioural goals (eg, motivational and capacity-building) were delivered together, as well as during advertising campaign periods with messages that had aired at least once before in the previous 6 years. Conclusions Findings reinforce the importance of well-funded advertising campaigns, especially for high prevalence groups. Effects of previously delivered campaign messages can build with repeated use and so can be effectively re-used over an extended period. Pairing creative concepts with distinct behaviour change objectives may also drive a greater number of self-referrals to quitlines.

Objective Regulating tobacco product features can reduce the appeal and addictiveness of smoking and promote quitting, but may be undermined by misperceptions about the reasons for the ban and the relative harmfulness of the remaining products. We tested how messages about slated (menthol/flavoured crushballs) or hypothetical (filter ventilation, regular nicotine content) tobacco product bans in Australia affected quit intentions, product harmfulness perceptions and knowledge about the ban’s rationale. Methods Australian adults who currently smoked (n=1514) completed one arm of an online study (menthol, filter ventilation or regular nicotine content, allocated based on the products they usually smoke). Within arms, participants were randomly allocated to one of three message conditions: condition A introduced the ban and rationale and encouraged quitting; B and C additionally highlighted the harmfulness of remaining products; and C additionally described other negative attributes of remaining products. Results Message condition did not affect perceived product harmfulness or quit intentions for any ban. Awareness of one (of three) accurate statements about the menthol ban rationale was significantly higher in condition C than A. Regardless of condition, awareness of the rationale (menthol arm: one of three statements, other arms: all statements) predicted quit intentions in response to each ban. Conclusions Boosting awareness of the rationale for tobacco product bans may maximise quitting in response. This may be achieved for a menthol ban using messages describing the rationale, emphasising the remaining products’ harmfulness and negative attributes and explicitly encouraging quitting (relative to merely describing the ban and rationale and encouraging quitting).

Objective: To assess adolescents baseline knowledge of smoking health harms scheduled to be covered in future graphic health warnings (GHWs) and inform the content of future tobacco control public communication campaigns. Methods: Cross-sectional survey of 8631 secondary school students (mean age=14.5 years) in Australia in 2022/2023 (weighted n=8655). Students were asked (a) for their agreement/disagreement that smoking causes each of nine harms (eg, lung cancer, stomach cancer and asthma), (b) to indicate where most of smokings harmful chemicals come from and (c) for their agreement/disagreement concerning the relative harmfulness of different tobacco product attributes (eg, menthol and roll-your-own). Multivariable logistic regression analyses examined associations between students knowledge and perceptions and their smoking status, controlling for demographics and school-level clustering. Results: Students had greater awareness of harms previously publicised in Australia. Among students who had never smoked, those open to future smoking had lower awareness of six smoking harms than those with a firm future intention not to smoke. Only 17.8% of all students were aware that most harmful chemicals came from burning the tobacco, with 37.8% not knowing and 34.6% attributing the source to additives. Three-quarters held misperceptions that roll-your-own cigarettes are less harmful than factory-made cigarettes or that cigarette smoke which feels light or smooth is less harmful than smoke that feels harsh. Only 25.9% of students were aware that menthol cigarettes are more addictive than non-menthol cigarettes. Discussion: New GHWs and public communication campaigns could improve student knowledge of previously unpublicised smoking harms and counter pervasive misperceptions about tobacco products.

Objective. Regulating tobacco product features can reduce the appeal and addictiveness of smoking and promote quitting, but may be undermined by misperceptions about the reasons for the bans and about the relative harmfulness of tobacco products remaining for sale. We tested the impact of messages about slated (menthol/flavoured crushballs) or hypothetical (filter ventilation, regular nicotine content) tobacco product bans in Australia on quit intentions, product harmfulness perceptions, and knowledge about the ban’s rationale. Methods. Australian adults who currently smoked (N=1,514) completed an online study about a menthol, filter ventilation, or regular nicotine content ban. Participants were randomly allocated to one of three message conditions: Condition A introduced the ban and rationale and encouraged quitting; Conditions B and C additionally highlighted the harmfulness of remaining products; and Condition C additionally described other negative attributes of remaining products. Results. Awareness of the menthol ban rationale was significantly higher in Condition C than Condition A. Message condition did not affect perceived product harmfulness or quit intentions for any ban, however, awareness of the rationale, regardless of condition, predicted quit intentions in response to menthol and filter ventilation bans. Quit intentions in response to each ban were significantly higher among participants who were already considering quitting. Conclusions. Quitting in response to menthol bans could be maximised using messages describing the rationale, emphasising the remaining products’ harmfulness and negative attributes, and explicitly encouraging quitting. To optimise impact of tobacco product bans, interventions boosting quitting motivation and capacity should be deployed prior and during implementation.

Background: Pictorial health warnings on tobacco packs can stimulate short-term cognitive and emotional responses that lead to quit attempts. We tested novel product attribute health warnings (PAHWs) that corrected misperceptions about harm created by the use of filter-venting, menthol and roll-your-own tobacco. PAHWs uniquely influenced outcomes assessing knowledge of industry manipulation of cigarettes, industry-centric negative emotional responses, and product-specific smoking dissonance. In this study, we examined if these unique short-term responses predicted subsequent quitting-related behaviours. Method: We analysed follow-up data from a between-subjects online experiment that assessed effects of new PAHWs. Participants were randomised to view PAHWs alone (PAHW condition) or with a complementary video (PAHW+Video), and exposure occurred during a baseline session and then repeatedly each day for 7 days. Short-term PAHW responses were measured at 8-day follow-up (N=712). Quitting-related behaviours were measured at 4-week follow-up (N=301). Covariate-adjusted logistic regression models examined associations between short-term PAHW responses and subsequent quitting-related behaviours. Results: Two of the short-term responses – knowledge of industry manipulation of cigarettes, and product-specific smoking dissonance – significantly and positively predicted all three quitting-related outcomes: smoke-limiting micro-behaviours (e.g., foregoing cigarettes), quit attempts, and 7-day sustained abstinence. Additionally, industry-centric negative emotional responses significantly and positively predicted smoke-limiting micro-behaviours and 7-day sustained abstinence, but not quit attempts. Conclusion: PAHWs featuring corrective information about the tobacco industry’s manipulation of tobacco products elicited short-term responses that predicted subsequent engagement in smoke-limiting micro-behaviours, quit attempts, and sustained quit attempts. PAHWs can complement other health warnings featuring the health risks of smoking and may help motivate people who smoke to quit and stay quit.

The media landscape changes have resulted in significantly more people viewing content in shorter and skippable formats. There is limited evidence about the impact of these formats on anti-tobacco campaign effectiveness. This study examined the effect of anti-tobacco ad length and skippability on perceived message effectiveness (PME) and emotional responsiveness among people who smoke. Initially, 805 people who smoke were randomized to a message type (anti-tobacco vs. control) × message length (15 vs. 30 seconds) condition. A week later, participants saw the same message, but were randomized to a skippable or non-skippable version. Following ad exposure, outcomes were measured and examined in mixed-effects linear regression models. We found that at initial exposure, participants in the 30-second anti-tobacco condition reported significantly higher scores on personal relevance (75% cf. 68%), motivation to act (61% cf. 52%), action-oriented negative emotion (62% cf. 53%) and positive emotion (37% cf. 28%) relative to participants in the 15-second anti-tobacco condition. At repeated exposure, there was no effect of ad skippability on PME or emotional responsiveness regardless of message type condition. However, participants in the 30-second anti-tobacco condition reported significantly higher scores on action-oriented negative emotion (60% cf. 50%) and inaction-oriented negative emotion (54% cf. 46%) relative to participants in the 15-second anti-tobacco condition. Our findings suggest that initial exposure to non-skippable and longer novel anti-tobacco messages can lead to stronger personal relevance, motivation to act and emotional arousal, and ongoing negative emotional arousal, which may attenuate the negative effects of allowing individuals to skip later.