Communicating Waterpipe Tobacco Harms to Reduce Use among Young Adults

项目摘要 在美国，年轻人是所有年龄组中吸烟率最高的。 大量的证据表明，他们一贯错误地认为WTS比WTS危害更小，成瘾性更小。 吸烟，这些误解与WTS呈正相关。尽管这些被广泛认为 尽管存在误解，但WTS与严重的急性和慢性危害有关，即使在不经常使用者中也是如此。在 此外，WTS与开始吸烟有关，使年轻人面临更大的风险 治疗癌症大量证据表明，香烟警告有效地传达了健康信息， 消费者，导致戒烟和戒烟尝试的动机增加。水管警报有可能 向消费者传达有关健康危害的准确信息，但目前强制性的文字警告， 仅仅关注尼古丁成瘾，可能影响有限。该项目的目标是开发 警告，以促进更好地了解危害，并减少年轻人的WTS行为。我们 将使用系统的，证据驱动的，严格的方法来开发水管警告，并测试这些新的- 在两种情况下开发警告：（1）水管烟草包装;（2）在生态有效的 水管咖啡厅的布置在目标1中，我们会设计水管式烟草警告的文字及图片， 传达一系列健康危害。我们将首先开发30个文本警告的基础上最 然后与WTS流行病学、毒性和监管方面的专家一起审查警告。我们接下来将 进行一项全国性的调查，以确定五个最有效的文字警告，然后将每一个配对 用三个不同的图像产生15个图形警告。我们将进行第二次全国调查， 为五个文本警告语句中的每一个确定最有希望的图像，从而产生五个文本和五个 相应的图形警告将转入目标2。在目标2中，我们将评估文本或 使用全国代表性样本对水烟筒烟草包装上的WTS意图进行图形警告 1，500名年轻人，并将确定两个文字和两个相应的图形警告， 在目标3中使用的感知有效性。在目标3中，我们将确定文字和图片警告的影响 显示在水管咖啡馆的WTS行为。我们将进行三臂（文字、图片、无预警管制） 在18家水管咖啡馆进行的一项随机交叉试验，以确定警告类型对年轻人的影响 成年人的WTS行为使用一个客观的，生物标志物的水烟消费（过期碳 一氧化物）。这项研究将有助于越来越多的研究如何最好地设计健康警告， 不鼓励WTS，并将确定重要的行为前因，其中可能包括负面影响， 认知阐述、感知风险和知识。拟议的研究有可能使 通过开发和测试减少WTS，为癌症预防做出重大贡献 可能影响地方、州和联邦政策的警告。

Project Summary Young adults have the highest prevalence of waterpipe tobacco smoking (WTS) of any age group in the U.S. Extensive evidence shows that they consistently misperceive WTS as less harmful and less addictive than cigarette smoking, and these misperceptions are positively associated with WTS. Despite these widely held misperceptions, WTS is associated with serious acute and chronic harms, even among infrequent users. In addition, WTS is prospectively associated with cigarette smoking initiation putting young adults at greater risk for cancer. Considerable evidence shows that cigarette warnings effectively convey health information to consumers, resulting in increased motivation to quit and quit attempts. Waterpipe warnings have the potential to convey accurate information about health harms to consumers, but the currently-mandated text warning, focused solely on nicotine addiction, is likely to have limited impact. The goal of this project is to develop warnings to promote greater understanding of harms and to reduce WTS behavior among young adults. We will use a systematic, evidence-driven, rigorous approach to develop waterpipe warnings and test these newly- developed warnings in two contexts: (1) on waterpipe tobacco packaging; and (2) in an ecologically-valid waterpipe café setting. In Aim 1, we will develop text and pictorial waterpipe tobacco warnings to effectively communicate a broad range of health harms. We will first develop 30 text warnings based on the most robust science; then vet warnings with experts in WTS epidemiology, toxicity, and regulation. We will next conduct a national survey to determine the five most effective text warnings, which will then each be paired with three different images creating 15 pictorial warnings. We will conduct a second national survey to determine the most promising image for each of the five text warning statements, resulting in five text and five corresponding pictorial warnings to be carried forward to Aim 2. In Aim 2, we will evaluate the effect of text or pictorial warnings on waterpipe tobacco packaging on WTS intentions using a nationally representative sample of 1,500 young adults and will determine the two text and two corresponding pictorial warnings with the highest perceived effectiveness for use in Aim 3. In Aim 3, we will determine the impact of text and pictorial warnings displayed at waterpipe cafés on WTS behavior. We will conduct a three-arm (text, pictorial, no warning control) cluster randomized crossover trial in 18 waterpipe cafés to determine the effect of warning type on young adults' WTS behavior using an objective, biological marker of waterpipe tobacco consumption (expired carbon monoxide). This study will contribute to a growing body of research on how best to design health warnings to discourage WTS, and will identify important behavioral antecedents, which may include negative affect, cognitive elaboration, perceived risks, and knowledge. The proposed research has the potential to make a significant contribution towards cancer prevention by reducing WTS through the development and testing of warnings that could influence local, state, and federal policies.