Can the Public Be Educated About Constituents in Smokeless Tobacco? A Three-Wave Randomized Controlled Trial.

INTRODUCTION: The U.S. Food and Drug Administration (FDA) is required by law to inform the public about levels of harmful and potentially harmful tobacco constituents in a format that is "understandable and not misleading to a lay person." Our study addresses a critical gap in research on communicating such information for smokeless tobacco (SLT) products. METHODS: The design included random assignment to one of the experimental (online interactive) conditions differing in presentation format or a control condition (receiving no information). Experimental respondents viewed information on levels and health risks of 5 harmful constituents in up to 79 products. Outcome measures included knowledge of health risks of constituents, perception of constituent variability in SLT products, disease risk ratings, self-reported SLT use, and side-by-side product comparisons. The sample of 333 SLT users, 535 cigarette smokers, and 663 nontobacco users participated at baseline, time of intervention, and 6 weeks postintervention. RESULTS: Presentation formats showed few systematic differences so were combined in analyses. Experimental condition respondents increased their knowledge about constituent health effects and their perceptions of constituent variability in SLT products, from baseline to postintervention, and relative to the control condition. Changes in respondents' ratings of disease risk and their estimates of constituent exposure from specific products were observed, but not in self-reported SLT use. CONCLUSIONS: Interactive online graphic and numeric presentation formats can be efficient in increasing people's knowledge of health effects and perceived variation of constituents in SLT products. Further research on longer-term behavioral assessment, and usefulness of this approach for regulatory agencies, is needed. IMPLICATIONS: Research on communicating the information about harmful constituents in SLT products to lay persons is critically lacking. This study proposes novel formats for effective communication about the levels and the health effects of SLT constituents to multiple user groups. The lack of misperceptions among study participants that some tobacco products are safe suggests that such formats can potentially be used for public display of SLT constituent data by the FDA and regulatory agencies in other countries.

Reducing COVID vaccine hesitancy by inducing a comparative mindset.

OBJECTIVE: To investigate if a behavioral nudge comprising a vaccination opportunity that employs a comparative probe first (i.e., which vaccine to take) versus the more commonly-used deliberative probe (i.e., willingness to take a vaccine), reduces vaccine hesitancy, while controlling for political partisanship. METHODS: In a randomized study, conducted on Amazon Mechanical Turk and Prolific, we varied the manner in which the vaccination offer is posed. In one group, participants were asked to compare which vaccine they would like to take (i.e., the comparative probe), while, in another group, participants were asked to deliberate whether they would like to take the vaccine (i.e., the deliberative probe). Participants' political preferences were also measured. The primary outcome variable was vaccine hesitancy. RESULTS: A LOGIT regression (N = 1736), was conducted to test the research questions. Overall, the comparative probe yielded a 6% reduction in vaccine hesitancy relative to the typical deliberative probe. Additionally, while vaccine hesitancy varies due to individual political views, the comparative probe is effective at reducing vaccine hesitancy even among the most vaccine hesitant population (i.e., Pro-Trump Republicans) by almost 10% on average. CONCLUSIONS: Subtly changing the manner in which the vaccination offer is framed, by asking people to compare which vaccine to take, and not deliberate about whether they would like to take a vaccine, can reduce vaccine hesitancy, without being psychologically taxing or curtailing individuals' freedom to choose. The nudge is especially effective among highly vaccine hesitant populations such as Pro-Trump Republicans. Our results suggest a costless communication protocol in face-to-face interactions on doorsteps, in clinics, in Pro-Trump regions and in the mass media, that might protect 5 million Americans from COVID-19.