CHIP PI Advising FDA on New Cigarette Warning Labels

L Snyder
Leslie Snyder, PhD

UConn Communication Professor Leslie Snyder, who directs the Center for Health Communication and Marketing (CHCM) at CHIP, has been awarded a nearly $1 million National Cancer Institute (NCI) grant to assess the potential impact of controversial, new graphic warning labels for cigarette packages and to suggest directions for future national anti-tobacco campaigns.

The new labels, which must cover 50 percent of cigarette packs, are a requirement of the 2009 Family Smoking Prevention and Tobacco Control Act, which also gave the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products for the first time. The new graphic warnings labels were supposed to be on boxes starting September, 2012, but legal challenges by tobacco companies have placed them on hold for the present, and it is likely that the case will be sent to the Supreme Court.

The nine images selected by the FDA include a healthy and smoke-blackened lung side by side, a man smoking through a tracheotomy hole in his neck, and a staged photo of a corpse on a coroner’s table.

FDA officials have called the graphic warnings “the most significant change to health warnings in 25 years.”

cigarette boxes for IRB submission 2
Dr. Snyder’s research team created sample cigarette boxes with the new FDA warning labels to show study participants.

Dr. Snyder, a CHIP principal investigator (PI) whose own center is a CDC-established Center of Excellence, specifically will study the impact of the graphic warning labels in two high-risk populations: youth and pregnant women.

Initial work has involved teenagers ages 13 to 18 recruited from two Hartford high schools with predominantly African American and Puerto Rican populations, and from two other areas of the country (Nashville and Milwaukee) with relatively high teen smoking rates. Young adults 18-24 years old also will be studied using Internet-based surveys.

The pregnant women from various target populations (urban and rural African Americans, urban Puerto Ricans, Native Americans, Native Hawaiians, rural whites and non-rural whites) will be recruited from locations across the country.

To understand how people are reacting to the graphic warning labels, Dr. Snyder will have experimental and control arms, with only some individuals in the target populations being shown the nine proposed labels. Dr. Snyder and her colleagues anticipate different images will prove more effective with different target populations.

In addition to studying reactions to the images, Dr. Snyder’s team will conduct surveys, focus groups and interviews to elicit and test additional targeted messages to reduce smoking initiation and promote quitting among smokers.

The research is being used to inform a new youth tobacco prevention program the FDA plans to launch next fall, regardless of the status of the injunction against the labels. Dr. Snyder and her team have been sharing their preliminary findings with the FDA and with the contractors recently hired to run the youth campaigns. One important trend, for example, is that many young people smoke occasionally and neither think of themselves as smokers nor consider themselves at risk. The youth media campaign will need messages and media strategies to encourage them to smoke less or not at all, Dr. Snyder said.

The goal of Dr. Snyder’s message development and testing for the pregnant smoker target populations is two-fold: smoking cessation and “staying quit” after pregnancy.

“Half of pregnant women stop smoking during pregnancy before their first doctor’s visit, but a significant number of those women start smoking again after having their babies,” Dr. Snyder said.

Dr. Snyder’s collaborators at UConn include CHIP Affiliate Dr. Michelle Cloutier, a UConn Health Center (UCHC) and Connecticut Children’s Medical Center (CCMC) pediatric pulmonologist,  Dr. Cheryl Oncken, also from the Health Center, who specializes in smoking cessation in pregnant women, and Dr. Hart Blanton, a social psychologist. Dr. Cloutier’s team at CCMC is conducting the warning label research in Hartford with teens and pregnant women.   Dr. Oncken is consulting on the project design, potential messages, and interpretation of findings with pregnant women.  Dr. Blanton is working on understanding the psychological reactions to the graphic warnings and the persuasion strategies that can be used in future FDA campaigns. Joy Larson is the team’s Project Manager.

Dr. Snyder is conducting her study as part of an elite group of researchers. In addition to Dr. Snyder’s CHCM, the Lung Cancer Disparities Center at Harvard University, the Annenberg School of Communication at the University of Pennsylvania and the Health Communication Research Laboratory at St. Louis University have been awarded NCI funds to study the impact of the FDA-required graphic warning labels with different target populations.