Date of Award

Summer 2024

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

James F. Thrasher

Abstract

The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. A very low nicotine content (VLNC) policy aimed primarily at cigarettes could drive people to other combusted products like little cigars and cigarillos (LCCs), potentially undermining its effectiveness. Expanding the policy to include LCCs requires effective messages for people who use LCCs. This dissertation explores how to communicate the reduced nicotine policy to people who use LCCs. The research recruited four populations with the highest prevalence of cigar use: African American and White males and females, aged 18-44 years, who had smoked LCCs in the past month. The first study conducted eight focus groups to document reactions to messages about the policy. These included: three messages about the equal risk of LCCs with regular and low nicotine levels; three quit efficacy messages about VLNC LCCs being easier to quit; one message to correct misperceptions about the policy causing people to smoke more to get desired nicotine; and one message about using alternative nicotine sources. The second study employed a discrete choice experiment (DCE) with 1722 participants. This experiment varied seven message attributes (source, chemicals, harm, nicotine, addictiveness, quitting efficacy, enjoyment) across 20 choice sets. Participants evaluated their affect towards the policy, perceived harm of VLNC LCCs, and motivation to quit smoking VLNC LCCs. Focus groups revealed that risk messages were the most motivating for quitting, while efficacy messages raised concerns about relapse among former LCC users. The DCE indicated that source information increased positive affect towards the policy, perceived harm of VLNC LCCs, and motivation to quit smoking VLNC LCCs. Source information was the most influential for promoting positive affect and motivation to quit, while chemical information had the most substantial impact on perceived harm. Effective VLNC communication strategies for people who use LCCs should include credible source information and harm and chemical properties to correct misperceptions. The FDA should tailor its communications to acknowledge that LCCs are perceived and used differently than cigarettes.

Rights

© 2024, Charity Afi Ntansah

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