What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment

Objectives:
Tobacco warning labels usually present information about the consequences of smoking but gain-framed messages could be a novel strategy to prevent wear out effects. Communicating the mental health benefits of stopping smoking could motivate cessation. We assessed whether such messaging was more effective at motivating cessation than blank labels and labels communicating the physical health benefits of cessation, and if there were any differences between those with mental ill health, or not.

Design:
An online randomised parallel experiment. Participants were randomly allocated using online randomised function to a condition, stratified by mental health status.

Setting:
Online survey platform, Qualtrics.

Participants:
People who smoke tobacco weekly, above the age of 18.

Intervention:
Gain-framed tobacco packaging labels with three conditions: i) mental health labels; ii) physical health labels; iii) blank labels. Each condition consisted of four labels, viewed for at least 10 seconds each.

Primary outcome measure:
Motivation to stop smoking, measured using the Motivation to Stop Scale (MTSS) at baseline and follow up immediately after viewing the labels. 631 people who smoke tobacco weekly were randomised. Compared to the blank labels, those who viewed mental health labels had higher post-viewing MTSS scores (β = 0.18, p = 0.003, 95% CI [0.07, 0.30]). There was no evidence for a difference in post-viewing MTSS scores between the mental health label and physical health label (β = 0.07, p = 0.16, 95% CI [-0.03, 0.18]) conditions. These findings did not differ based on mental health status or anhedonia symptoms.

Conclusions:
Labels on tobacco packaging that promote the mental health benefits of stopping smoking could motivate cessation and may be as effective as gain-framed physical health labels.

Trial registration:
clinicaltrials.gov NCT06762756, on 19/12/2024. Retrospectively registered.