Nicotine - Effects of Messaging

For more information on stigmatizing people who smoke, please see our page about stigma.

Positive Outcomes

2024: Harnessing hope and bolstering knowledge of how to quit: a qualitative investigation of including efficacy content in tobacco risk communication via daily SMS

• "By contrast, messages that address efficacy beliefs can increase hope, knowledge of cessation supports and motivation, thus supporting adaptive responses to smoking health risks."
• Full text in PDF.
• Note this study is listed in both the positive outcomes and unintended consequences sections.
  • Citation: Lillian Brinken, Kate Shiells, Stuart G Ferguson, Stefania Franja, Anna Blackwell, Claire Braboszcz, Olivia M Maynard, Harnessing hope and bolstering knowledge of how to quit: a qualitative investigation of including efficacy content in tobacco risk communication via daily SMS, Nicotine & Tobacco Research, 2024;, ntae297, https://doi.org/10.1093/ntr/ntae297
    • Acknowledgement: This study was supported by an ESRC New Investigator‘s Award, awarded to Dr Olivia Maynard (ES/R003424/1) and Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/7). Stuart Ferguson has provided expert advice to various pharmaceutical companies and has received researcher-initiated project grant funding (through the GRAND initiative) and travel funds from Pfizer. These companies are not involved in the current study. All other project team members report no conflicts of interest.

2024: ‘Authentic’ or ‘corny’: LGBTQ+ young adults respond to visual, thematic and semantic elements of culturally targeted tobacco public education advertisements

• "Tobacco public education ads featuring ‘every-day’ LGBTQ+people in candid or unposed shots, personal stories with gain-framed messaging, and subtle Pride iconography and colours may increase acceptability among LGBTQ+YA. Researchers should focus on cultivating authenticity in ads and avoid outdated trends by consulting with the community and moving with speed from development to implementation."
  • Citation: Ennis AC, Meadows A, Jankowski E, et al‘Authentic’ or ‘corny’: LGBTQ+ young adults respond to visual, thematic and semantic elements of culturally targeted tobacco public education advertisementsTobacco Control Published Online First: 28 November 2024. doi: 10.1136/tc-2024-058858
    • Acknowledgement: Research reported in this publication was funded by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and the U.S. Food and Drug Administration (FDA) Center for Tobacco Products under Award Number K99CA260718 and R00CA260718 (PI: JGP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA. Research reported in this publication was supported by The Ohio State University Comprehensive Cancer Center and the OSU College of Public Health.

2020: Communicating the relative health risks of E-cigarettes: An online experimental study exploring the effects of a comparative health message versus the EU nicotine addiction warnings on smokers’ and non-smokers’ risk perceptions and behavioural intentions

• "This study investigated the effects of the European Union Tobacco Products Directive [EU-TPD] Article 20 E-cigarette (EC) health warnings (“This product contains nicotine which is a highly addictive substance. [It is not recommended for non-smokers.]”) and a comparative harm message (“Use of this product is much less harmful than smoking” [COMP]) on smokers’ and non-smokers’ perceptions and behavioural intentions."
• "The findings suggest that messages such as the COMP can help redress harm perceptions associated with EC and encourage smokers to switch to EC. When communicating health risks, it is important that messages are clear and unambiguous. Any future communication strategy to include a comparative message, such as the one developed here, has greater potential to impact as a stand-alone message."
  • Citation: Kimber C, Frings D, Cox S, Albery IP, Dawkins L. Communicating the relative health risks of E-cigarettes: An online experimental study exploring the effects of a comparative health message versus the EU nicotine addiction warnings on smokers' and non-smokers' risk perceptions and behavioural intentions. Addict Behav. 2020 Feb;101:106177. doi: 10.1016/j.addbeh.2019.106177. Epub 2019 Nov 4. PMID: 31753541; PMCID: PMC6891257.
    • Acknowledgement: This study was funded by Cancer Research UK's Tobacco Advisory Group (CRUK Grant Number: 25855). The funder played no role in the design of the study and drafting of the manuscript. CK has no conflict of interest to declare. DF is principal investigator on a randomised controlled trial funded by Allen Carr’s Easyway Ltd (ISRCN number: ISRCTN23584477). This trial is comparing the Allen Carr Easyway stop-smoking method to local NHS 1-1 stop smoking counselling service. The trial is being conducted independently, the protocol and analysis plan are both pre-registered and the research team are contractually free to independently publish the results of the trial regardless of the study outcome. DF has no other conflicts of interest to declare. SC has provided consultancy services to UK life insurers on smoking cessation and reduce risk products prevalence rates. IA is an investigator on a randomised controlled trial funded by Allen Carr’s Easyway Ltd (ISRCN number: ISRCTN23584477). This trial is comparing the Allen Carr Easyway stop-smoking method to local NHS 1-1 stop smoking counselling service. The trial is being conducted independently, the protocol and analysis plan are both pre-registered and the research team are contractually free to independently publish the results of the trial regardless of the study outcome. LD has provided consultancy for the pharmaceutical industry (2015, 2017) and acted as an expert witness for an EC patent infringement case (2015). Between 2011 and 2013 she conducted research for several independent electronic cigarette companies for which the University of East London received funds. The EC companies involved had no input into the design, conduct or write up of these projects.

2017: Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use

• Note this study is listed in both the positive outcomes and unintended consequences sections.
• Consistent with previous research we have found that smokers’ who reported greater feelings of stigmatization about their smoking were more likely to report having made recent quit attempts and report a stronger intention quit smoking in the future.
  • Citation: O'Connor RJ, Rees VW, Rivard C, Hatsukami DK, Cummings KM. Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use. Subst Abus. 2017 Jul-Sep;38(3):330-336. doi: 10.1080/08897077.2017.1326999. Epub 2017 May 8. PMID: 28481713; PMCID: PMC6319257.
    • Acknowledgement: This work was supported by a cooperative agreement from the National Cancer Institute (U19CA157345). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. KMC has received grant funding from Pfizer, Inc to study the impact of a hospital-based tobacco cessation intervention and also has served as an expert witness in litigation filed against the tobacco industry. The remaining authors declare they have no conflicts of interest.

Unintended Consequences

2024: Harnessing hope and bolstering knowledge of how to quit: a qualitative investigation of including efficacy content in tobacco risk communication via daily SMS

• "Participants in the present study described how GHWLs [graphic health warning labels] were experienced as stigmatising in the context of broader policies leading to denormalisation of smoking. They felt smokingrelated stigma negatively impacted their motivation to quit and confidence to do so. In light of these and other similar findings35,37, we suggest policies intended to promote denormalisation be re-considered."
• Note this study is in both the positive outcomes and the unintended consequences sections.
• Full text in PDF.
  • Citation: Lillian Brinken, Kate Shiells, Stuart G Ferguson, Stefania Franja, Anna Blackwell, Claire Braboszcz, Olivia M Maynard, Harnessing hope and bolstering knowledge of how to quit: a qualitative investigation of including efficacy content in tobacco risk communication via daily SMS, Nicotine & Tobacco Research, 2024;, ntae297, https://doi.org/10.1093/ntr/ntae297
    • Acknowledgement: This study was supported by an ESRC New Investigator‘s Award, awarded to Dr Olivia Maynard (ES/R003424/1) and Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/7). Stuart Ferguson has provided expert advice to various pharmaceutical companies and has received researcher-initiated project grant funding (through the GRAND initiative) and travel funds from Pfizer. These companies are not involved in the current study. All other project team members report no conflicts of interest.

2024: Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults

• "Moreover, findings illustrate that public health messages regarding the risks of e-cigarette use may have unintended consequences of increasing cigarette use to replace e-cigarette use for some SGM young adults, a practice that is incongruent with scientific evidence demonstrating that cigarettes and other combustible tobacco products are riskier than e-cigarettes and other forms of NT use."
  • Citation: Lipperman-Kreda S, Sanders E, Annechino R, Peterkin E, Antin TMJ. Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults. Drug Alcohol Rev. 2024 Feb;43(2):371-380. doi: 10.1111/dar.13812. Epub 2024 Jan 23. PMID: 38258463.
    • Acknowledgements: Unknown, paper is paywalled.

2022: Unintended Consequences: Testing the Effects of Adolescent-Targeted Anti-vaping Media Upon Adult Smokers

• Sensationalized youth-oriented anti-vaping messages may have unintended public health consequences upon adult audiences.
• Exposure to the PSA resulted in overall more negative expectancies about e-cigarettes, as well as increased perceived harmfulness and reduced effectiveness of e-cigarettes for smoking cessation. Findings showed that these PSAs could deter adult smokers from utilization of e-cigarettes as a smoking cessation or harm reduction strategy.
  • Citation: Sawyer LE, Brandon TH. Unintended Consequences: Testing the Effects of Adolescent-Targeted Anti-vaping Media Upon Adult Smokers. Nicotine Tob Res. 2023 Apr 6;25(5):967-974. doi: 10.1093/ntr/ntac277. PMID: 36482754; PMCID: PMC10077926.
    • Acknowledgement: This research was supported by funding from the University of South Florida and the H. Lee Moffitt Cancer Center & Research Institute, a comprehensive cancer center designated by the National Cancer Institute (grant P30-CA076292).

2021: Content analysis of the use of fear in The Real Cost Youth E-cigarette Prevention Campaign

• Campaigns with ineffective use of fear may produce an unwanted effect, such as making the target audience continue with their unhealthy behavior. Furthermore, exposure to these campaigns may even have boomerang effects. One study found that the frequent exposure to the campaign ads created a ‘meta-message’ among the audience that the youth drug use was prevalent and led to an increase in uses as a result.
• PDF Full Version
  • Citation: Citation: Ziming Xuan & Jasmin N. Choi (2021) Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign, Journal of Communication in Healthcare, DOI: 10.1080/17538068.2020.1860671
    • Acknowledgement: No potential conflict of interest was reported by the author(s). (No funding mentioned)

2020: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”

• "Teen vaping did not escalate despite the increased anti-vaping messaging. Adolescents’ curiosity and subsequent experimentation with vaping rose because of anti-vaping messaging."
  • Citation: Michelle Minton - Competitive Enterprise Institute

2019: The ironic effects of stigmatizing smoking: combining stereotype threat theory with behavioral pharmacology

• "Messages that elicit negative stereotypes of smokers operated as ‘smoking-promoting messages’ in the context of our controlled laboratory investigation."
• PDF of paper
  • Citation: Cortland, C. I., Shapiro, J. R., Guzman, I. Y., & Ray, L. A. (2019). The ironic effects of stigmatizing smoking: combining stereotype threat theory with behavioral pharmacology. Addiction. doi:10.1111/add.14696
    • Acknowledgement: This research was funded by a Tobacco-Related Disease Research Program (20XT-0154) grant awarded to the first and last authors. The authors would like to thank Spencer Bujarski for his assistance with the analyses.

2019: DOES IT HELP SMOKERS IF WE STIGMATIZE THEM? A TEST OF THE STIGMA-INDUCED IDENTITY THREAT MODEL AMONG U.S. AND DANISH SMOKERS

• " Consistent with the stigma-induced identity threat model (Major & O’Brien, 2005), we found that stigmatization generated a series of emotional, physiological, cognitive, and attitudinal reactions moving the smokers away from, rather than toward, quitting."
  • Citation: Helweg-Larsen M, Sorgen LJ, Pisinger C. DOES IT HELP SMOKERS IF WE STIGMATIZE THEM? A TEST OF THE STIGMA-INDUCED IDENTITY THREAT MODEL AMONG U.S. AND DANISH SMOKERS. Soc Cogn. 2019 Jun;37(3):294-313. doi: 10.1521/soco.2019.37.3.294. Epub 2019 Jun 7. PMID: 31303688; PMCID: PMC6625812.
    • Acknowledgement: The work was supported by the National Cancer Institute at the National Institutes of Health (R15-CA194937). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. The authors declare no competing interests.

2018: Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

• "This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force."
  • Citation: Lozano P, Thrasher JF, Forthofer M, Hardin J, Shigematsu LMR, Arillo Santillán E, Fleischer NL. Smoking-Related Stigma: A Public Health Tool or a Damaging Force? Nicotine Tob Res. 2020 Jan 27;22(1):96-103. doi: 10.1093/ntr/nty151. PMID: 30053141; PMCID: PMC7297009.
    • Acknowledgement: Funding for data collection came from the Mexican Consejo Nacional de Ciencia y Tecnología (Salud-2007-C01-70032), with additional funding for analysis provided by the National Cancer Institute at the National Institutes of Health (P01 CA138389), Canadian Institutes for Health Research (57897, 79551, and 115016), and GTF was supported by a Senior Investigator Award from Ontario Institute for Cancer Research and by a Prevention Scientist Award from the Canadian Cancer Research Institute.

2017: Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use

• Note this study is listed in both the positive outcomes and unintended consequences sections.
• It is also important to recognize the potential negative consequences associated with stigmatizing smokers, who may seek ways to evade stigma by segregating themselves into groups accepting of smoking and perhaps fostering the development of fatalistic attitudes about their ability to change their smoking behavior, which make quitting smoking harder to accomplish. Thus, behavioral interventions for smoking cessation might include addressing stigma-related issues as part of the quitting process.
  • Citation: O'Connor RJ, Rees VW, Rivard C, Hatsukami DK, Cummings KM. Internalized smoking stigma in relation to quit intentions, quit attempts, and current e-cigarette use. Subst Abus. 2017 Jul-Sep;38(3):330-336. doi: 10.1080/08897077.2017.1326999. Epub 2017 May 8. PMID: 28481713; PMCID: PMC6319257.
    • Acknowledgement: This work was supported by a cooperative agreement from the National Cancer Institute (U19CA157345). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. KMC has received grant funding from Pfizer, Inc to study the impact of a hospital-based tobacco cessation intervention and also has served as an expert witness in litigation filed against the tobacco industry. The remaining authors declare they have no conflicts of interest.

2016: Smoking Cessation and the Role of Stigma: A Systematic Review

• Anti-smoking campaigns have been used for the last three decades, and while there has been a decrease in smokers across the US, the number of smokers living in poverty has remained relatively unchanged. The research points to the use of stigma as a possible reason for smokers who are living in poverty to not stop smoking. The use of stigma to help a population, who may be stigmatized for multiple reasons, has shown through the research, to be a poor tool in moving them towards a smoke free life. The use of stigma in public health campaigns may lead to making things worse for smokers who live in poverty through discrimination in hiring policies and other unintended consequences.
  • Citation: Thesis - Carl White - University of St. Thomas, Minnesota
    • Acknowledgement: Contributors: Melissa Lundquist

2015: Article: Smoking stigma can hurt efforts to quit

• Public health campaigns that stigmatize smoking can backfire, according to a study published Monday, leading some people to become so angry and defensive that they refuse to quit and others feeling so bad about themselves that they give up trying.