Strasser, Andrew A.

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  • Publication
    Lower Nicotine Cigarettes may not Lower Harm
    (2006-11-17) Strasser, Andrew A.; Lerman, Caryn; Cappella, Joseph N
    In 2005, nearly 21% of American adults smoked cigarettes, and 81% of them smoked every day. For smokers unable or unwilling to quit, tobacco products that reduce the adverse health effects of smoking may be an attractive option. Potentially reduced exposure products (PREPs) were developed by the tobacco industry in response to smokers’ health concerns. PREPs purportedly lower the tar and/or nicotine levels of cigarettes, although the actual harm reduced remains questionable. One of the most recent additions to this product class are cigarettes that use genetically modified tobacco to reduce nicotine levels. This Issue Brief summarizes studies that investigate [1] how this product is used and [2] the messages smokers take away from product marketing. These complementary studies send a cautionary signal about the ability of these new cigarettes to reduce the harmful effects of smoking.
  • Publication
    Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial
    (2015-01-01) Evans, Abigail T; Strasser, Andrew A; Peters, Ellen; Emery, Lydia F; Romer, Daniel; Sheerin, Kaitlin M
    Objective Observational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates, but field studies lack experimental control. Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a randomized clinical trial involving exposure to modified cigarette packs over a 4-week period. Theories of graphic-warning impact were tested by examining affect toward smoking, credibility of warning information, risk perceptions, quit intentions, warning label memory, and smoking risk knowledge. Methods Adults who smoked between 5 and 40 cigarettes daily (N = 293; mean age = 33.7), did not have a contra-indicated medical condition, and did not intend to quit were recruited from Philadelphia, PA and Columbus, OH. Smokers were randomly assigned to receive their own brand of cigarettes for four weeks in one of three warning conditions: text only, graphic images plus text, or graphic images with elaborated text. Results Data from 244 participants who completed the trial were analyzed in structural-equation models. The presence of graphic images (compared to text-only) caused more negative affect toward smoking, a process that indirectly influenced risk perceptions and quit intentions (e.g., image->negative affect->risk perception->quit intention). Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings, a process that also indirectly affected risk perceptions and quit intentions (e.g., image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention). Unexpectedly, elaborated text reduced warning credibility. Finally, graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later. Conclusions In the first naturalistic clinical trial conducted, graphic warning labels are more effective than text-only warnings in encouraging smokers to consider quitting and in educating them about smoking’s risks. Negative affective reactions to smoking, thinking about risks, and perceptions of credibility are mediators of their impact.
  • Publication
    Content Matters: Neuroimaging Investigation of Brain and Behavioral Impact of Televised Anti-Tobacco Public Service Announcements
    (2013-04-24) Wang, An-Li; Ruparel, Kosha; Loughead, James W; Strasser, Andrew A.; Blady, Shira J; Lynch, Kevin G; Romer, Daniel; Cappella, Joseph N; Lerman, Caryn; Langleben, Daniel D
    Televised public service announcements are video ads that are a key component of public health campaigns against smoking. Understanding the neurophysiological correlates of anti-tobacco ads is an important step toward novel objective methods of their evaluation and design. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate the brain and behavioral effects of the interaction between content ("argument strength," AS) and format ("message sensation value," MSV) of anti-smoking ads in humans. Seventy-one nontreatment-seeking smokers viewed a sequence of 16 high or 16 low AS ads during an fMRI scan. Dependent variables were brain fMRI signal, the immediate recall of the ads, the immediate change in intentions to quit smoking, and the urine levels of a major nicotine metabolite cotinine at a 1 month follow-up. Whole-brain ANOVA revealed that AS and MSV interacted in the inferior frontal, inferior parietal, and fusiform gyri; the precuneus; and the dorsomedial prefrontal cortex (dMPFC). Regression analysis showed that the activation in the dMPFC predicted the urine cotinine levels 1 month later. These results characterize the key brain regions engaged in the processing of persuasive communications and suggest that brain fMRI response to anti-smoking ads could predict subsequent smoking severity in nontreatment-seeking smokers. Our findings demonstrate the importance of the quality of content for objective ad outcomes and suggest that fMRI investigation may aid the prerelease evaluation of televised public health ads.
  • Publication
    Desire Versus Efficacy in Smokers’ Paradoxical Reactions to Pictorial Health Warnings for Cigarettes
    (2013-01-29) Romer, Daniel; Strasser, Andrew A.; Langleben, Daniel D; Peters, Ellen
    Pictorial health warnings on cigarette packs create aversive emotional reactions to smoking and induce thoughts about quitting; however, contrary to models of health behavior change, they do not appear to alter intentions to quit smoking. We propose and test a novel model of intention to quit an addictive habit such as smoking (the efficacy-desire model) that can explain this paradoxical effect. At the core of the model is the prediction that self-efficacy and desire to quit an addictive habit are inversely related. We tested the model in an online experiment that randomly exposed smokers (N = 3297) to a cigarette pack with one of three increasing levels of warning intensity. The results supported the model’s prediction that despite the effects of warnings on aversion to smoking, intention to quit smoking is an inverted U-shape function of the smoker’s self-efficacy for quitting. In addition, smokers with greater (lesser) quit efficacy relative to smoking efficacy increase (decrease) intentions to quit. The findings show that previous failures to observe effects of pictorial warning labels on quit intentions can be explained by the contradictory individual differences that warnings produce. Thus, the model explains the paradoxical finding that quit intentions do not change at the population level, even though smokers recognize the implications of warnings. The model suggests that pictorial warnings are effective for smokers with stronger quit-efficacy beliefs and provides guidance for how cigarette warnings and tobacco control strategies can be designed to help smokers quit.
  • Publication
    Reduced prefrontal and temporal processing and recall of high "sensation value" ads
    (2009-05-01) Langleben, Daniel D; Loughead, James W.; Ruparel, Kosha; Strasser, Andrew A.; Cappella, Joseph N.; Lerman, Caryn; Hakun, Jonathan G.; Busch-Winokur, Samantha; Holloway, Matthew B.
    Public service announcements (PSAs) are non-commercial broadcast ads that are an important part of televised public health campaigns. “Message sensation value” (MSV), a measure of sensory intensity of audio, visual, and content features of an ad, is an important factor in PSA impact. Some communication theories propose that higher message sensation value brings increased attention and cognitive processing, leading to higher ad impact. Others argue that the attention-intensive format could compete with ad's message for cognitive resources and result in reduced processing of PSA content and reduced overall effectiveness. Brain imaging during PSA viewing provides a quantitative surrogate measure of PSA impact and addresses questions of PSA evaluation and design not accessible with traditional subjective and epidemiological methods. We used Blood Oxygenation Level Dependent (BOLD) functional Magnetic Resonance Imaging (fMRI) and recognition memory measures to compare high and low MSV anti-tobacco PSAs and neutral videos. In a short-delay, forced-choice memory test, frames extracted from PSAs were recognized more accurately than frames extracted from the NV. Frames from the low MSV PSAs were better recognized than frames from the high MSV PSAs. The accuracy of recognition of PSA frames was positively correlated with the prefrontal and temporal, and negatively correlated with the occipital cortex activation. The low MSV PSAs were associated with greater prefrontal and temporal activation, than the high MSV PSAs. The high MSV PSAs produced greater activation primarily in the occipital cortex. These findings support the “dual processing” and “limited capacity” theories of communication that postulate a competition between ad's content and format for the viewers' cognitive resources and suggest that the “attention-grabbing” high MSV format could impede the learning and retention of an ad. These findings demonstrate the potential of using neuroimaging in the design and evaluation of mass media public health communications.