Smoking kills, but you can quit: Threat and efficacy messaging to prevent tobacco smoking among adults and adolescents

吸烟仍然是英国可预防的死亡和疾病的主要原因。仅去年一年，英国就有9.6万人直接因吸烟而过早死亡，而吸烟的儿童人数是这个数字的两倍多。由于“平均”吸烟者每天吸烟12支，每年至少会看到他们的烟盒4,300次，烟盒为政府提供了一个独特的工具来传达吸烟对健康的影响。采用标准化（即，在英国，香烟的普通包装将意味着包装上的健康警告更加明显。然而，为了使这一具有里程碑意义的立法有效，这些健康警告需要发出正确的信息。尽管在100多个国家的香烟包装上使用了带有强烈威胁性图像和信息的健康警告，但有证据表明，吸烟者可能会避免使用这些警告或对它们产生负面反应。理论表明，如果警告将联合收割机的威胁信息与那些增加吸烟者感知的戒烟能力和戒烟益处的信息（称为“功效”信息）结合起来，则最有可能导致积极的行为改变。尽管如此，关于烟草警示中功效信息的影响的研究很少，没有关于青少年对功效信息的反应的研究，全球几乎没有采用烟草警示中的功效信息。本项目将通过检查对含有“功效”和“威胁”内容的警示的反应，并开展关于有效警示的研究，来解决这些关键问题。这项研究至关重要，因为健康警告可能会教育个人吸烟的风险并鼓励他们戒烟。它将应用一个强有力的理论框架，以检查成人和青少年之间的警告功效和威胁性内容的作用。鉴于三分之二的吸烟者在18岁之前就开始吸烟，令人惊讶的是，关于警告对青少年的影响的研究很少。我的研究将填补文献中的这一关键空白。这个项目是及时和重要的，不仅是因为最近引入了标准化包装的香烟。英国退出欧盟将为英国政府提供一个独特的机会来实施新的警告和加强烟草控制政策，因为这些将不再由欧盟范围内的烟草产品指令执行。我将在成年人和青少年吸烟者中进行在线调查。这些调查将首次审查对威胁和功效警告的反应及其对吸烟态度的影响。然后，我将利用这些研究的结果，在成年人和青少年中进行两项“混合方法研究”，以测量自我报告的反应，大脑激活和吸烟行为对健康警告的反应。我的研究使用了一种独特的结合主观和客观技术的创新方法。这项研究在许多方面都是新颖的。首先，它将提供客观的和以前未探索的见解，成人和青少年之间的警告反应的差异。其次，它将发展我们对功效和威胁警告的反应机制的理解。最后，它将产生第一个证据，证明对警告的神经和主观反应如何相关，以及这些如何预测长期吸烟行为和态度。这项研究将支持制定更好、更有效的烟草产品警示，并为制定酒精和不健康食品等一系列不健康产品的有效警示提供一个工具包，可供国际学术界和决策者使用。该项目的最终目标是通过提供证据支持烟草包装政策的改变，降低吸烟导致的过早死亡和疾病的发生率。

Smoking remains the primary cause of preventable death and disease in the UK. Last year alone, 96,000 people in the UK died prematurely as a direct result of smoking and more than double this number of children took up smoking to take their place. As the 'average' smoker, smoking 12 cigarettes per day, will view their cigarette pack at least 4,300 times a year, the cigarette pack offers governments a unique tool to communicate the health impacts of smoking. The introduction of standardised (i.e., plain) packaging of cigarettes in the UK will mean that health warnings on packs are more noticeable. However, in order for this landmark legislation to be effective, these health warnings need to be sending out the right messages.Although health warnings with strong, threatening images and messages are used on cigarette packs in over 100 countries, there is evidence that smokers may avoid them or react negatively towards them. Theory suggests that warnings are most likely to result in positive behaviour change if they combine threatening messages with those which increase a smoker's perceived ability to stop smoking and knowledge of the benefits of stopping (known as 'efficacy' messages). Despite this, there has been very little research on the impact of efficacy messages on tobacco warnings, no research on how adolescents respond to efficacy messages and almost no adoption of efficacy messages on tobacco warnings globally.This project will address these key issues by examining responses to warnings with 'efficacy' and 'threatening' content and developing research on what constitutes effective warnings. This research is critically important given the potential for health warnings to educate individuals about the risks of smoking and encourage them to stop. It will apply a strong theoretical framework to examine the roles of efficacy and threatening content on warnings among both adults and adolescents. Given that two-thirds of smokers start before the age of 18, there is surprisingly little research on the impact of warnings among adolescents. My research will address this critical gap in the literature.This project is timely and important, not only because of the recent introduction of standardised packaging of cigarettes. Britain's exit from the EU will provide the UK government with a unique opportunity to implement new warnings and strengthen tobacco control policies, as these will no longer be enforced by the EU-wide Tobacco Products Directive.I will conduct online surveys among adults and adolescents smokers. These surveys will examine, for the first time, responses to threatening and efficacy warnings and their impact on attitudes towards smoking. I will then use the findings of these studies to conduct two 'mixed methods studies' among adults and adolescents to measure self-reported reactions, brain activation and smoking behaviour in response to health warnings.My research uses a unique combination of innovative approaches combining subjective and objective techniques. This research is novel in a number of ways. First, it will provide objective and previously unexplored insights into differences in response to warnings among adults and adolescents. Second, it will develop our understanding of the mechanisms underlying responses to efficacy and threatening warnings. Finally, it will produce the first evidence demonstrating how neural and subjective responses to warnings are related and how these predict longer-term smoking behaviours and attitudes. This research will support the development of better, more effective warnings for tobacco products and provide a toolkit for the development of effective warnings for a range of unhealthy products, such as alcohol and unhealthy food, which can be used by academics and policymakers internationally. This project ultimately aims to reduce the rates of premature death and disease caused by smoking by providing evidence to support tobacco packaging policy change.