Effects of tobacco health warnings and television advertisements to counter reassurance-based tobacco marketing among Australian smokers

The study intervention involves exposing participants online to health warnings on tobacco packages. Participants will be randomly assigned to one of four conditions: (A) No Tobacco Health Warnings (control) consisting of exposure to warnings on over-the-counter medicines; (B) New Standard Health Warnings (control) to represent the usual situation; (C) Product Attribute Health Warnings; or (D) Product Attribute Health Warnings plus a TV advertisement. The online study will be accessed individually by participants (via a web link in an email invitation or the panel's online dashboard) at a time and location of their convenience. After completing baseline survey questions, participants will be exposed to the warning label intervention in the form of images of seven warnings on tailor-made cigarette packs or roll-your-own tobacco pouches. Participants will be shown, in order (i) an image of the front of the product; (ii) an image of the back of the product; (iii) an image of the side of the product (for tailor-made cigarette packs) or under the flap (for roll-your-own pouches); and (iv) an image of the full health warning (all three components together). These four images will be displayed on four consecutive screen displays. Each image will be displayed for a minimum of ten seconds and a maximum of two minutes. Participants will click on a ‘Next’ button when they are ready to move to the next image, and they will not be able to proceed without viewing each image. Participants will complete a single rating of each warning immediately after viewing it. After this section is complete, participants randomised to the Product Attribute Health Warnings plus TV advertisement condition will also view a 30 second TV advertisement twice; these participants will not be able to proceed until after the TV advertisement has finished playing. They will then complete ratings of the TV advertisement. Following the baseline survey and initial intervention exposure, for seven consecutive days consenting participants will be emailed a weblink which will take them to a single image of a warning containing all 3 warning components together that they were exposed to at baseline. (i.e., repeated exposure). After viewing the image, participants will be asked one or two simple questions (e.g. they will be asked to rate how believable or relevant they think the warning is). Participants randomised to the Product Attribute Health Warnings plus TV ad condition will also view a 15 second TV advertisement on days two and day four of the repeated warning exposure. Data collection will capture whether participants clicked on the weblink, and which image and TV advertisement they were served on each day of repeated exposure. Participants will then be invited to complete two follow-up surveys, one which will be sent eight days after completion of the initial exposure session, and another which will be sent approximately four weeks after completion of the initial exposure session. During the follow-up surveys, participants will be asked about their cigarette consumption, sensory experiences of different tobacco products, and quitting behaviours and intentions over the past week. The content and format of the intervention warning stimuli were systematically developed and professionally designed for the study. The content of the TV advertisement was professionally produced for the study.