Communicating Waterpipe Tobacco Harms to Reduce Use among Young Adults

项目摘要 在美国所有年龄段中，年轻人吸食水烟(WTS)的流行率最高。 广泛的证据表明，他们一直错误地认为WTS的危害和成瘾性低于 吸烟，而这些误解与WTS呈正相关。尽管人们普遍认为 误解，WTS与严重的急性和慢性危害有关，即使在不经常使用的用户中也是如此。在……里面 此外，WTS可能与开始吸烟会使年轻人面临更大的风险有关。 治疗癌症。大量证据表明，香烟警告有效地将健康信息传达给 消费者，导致戒烟和戒烟尝试的动机增加。水管警告有可能 为了向消费者传达关于健康危害的准确信息，但目前强制执行的文本警告， 只关注尼古丁成瘾，可能影响有限。这个项目的目标是开发 警告，促进对危害的更多了解，并减少年轻人的WTS行为。我们 将使用系统的、证据驱动的、严格的方法来制定水管警告并测试这些新的- 在两种情况下制定了警告：(1)关于水烟包装的警告；(2)在具有生态有效性的 自来水咖啡馆。在目标1中，我们将开发文字和图片水烟警告，以有效地 广泛传播对健康的危害。我们将首先开发30个文本警告，基于 可靠的科学；然后与WTS流行病学、毒性和监管方面的专家一起审查警告。接下来，我们将 进行一项全国性调查，以确定五个最有效的文本警告，然后将每个文本警告配对 三张不同的图片构成了15个图画警告。我们将进行第二次全国调查，以 为五个文本警告语句中的每一个确定最有希望的图像，结果是五个文本和五个 目标2。在目标2中，我们将评估文本或 使用具有全国代表性的样本对水烟包装上关于WTS意图的图示警告 并将确定两个文字和两个对应的图片警示与最高 在目标3中，我们将确定文字和图片警告的影响 在水管咖啡馆展示了S关于WTS的行为。我们将进行三臂(文字、图片、无警告控制) 18家水管咖啡馆S警示类型对青少年影响的整群随机交叉试验 使用客观、生物的水烟消费(过期碳)标志物的成年人的WTS行为 一氧化碳)。这项研究将有助于更多关于如何最好地设计健康警告的研究 不鼓励WTS，并将确定重要的行为前置因素，其中可能包括负面影响， 认知精细化、感知风险和知识。这项拟议的研究有可能使 通过开发和测试减少WTS，对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.