Tobacco-Related Carcinoma
Conditions
Keywords
health communication, LGBT
Brief summary
This trial refines and evaluates how cultural targeting influences the effectiveness of anti-tobacco messages among lesbian, gay, bisexual, and transgender (LGBT) young adults at risk for the use of more than one tobacco product (polytobacco use). Polytobacco use is associated with nicotine dependence and tobacco use into adulthood, and is disproportionately high among LGBT young adults. This trial seeks to determine how cultural targeting can be applied to communicate polytobacco use risk to at-risk LGBT young adults.
Detailed description
The goal of this study is to identify if culturally targeted (CT) or non-targeted (NT) anti-polytobacco messages are most effective for engaging LGBT consumers. Using the most effective NT messages from Aim 1, investigators will create a set of CT messages. Message framing will remain consistent between CT and NT messages; however, CT messages will include language and graphics representing LGBT values formative research and the existing peer-reviewed literature. Participants will be randomized to view CT or NT messages in a virtual lab where investigators will assess eye-tracking, self-reported perceived effectiveness, risk perceptions, and behavioral intentions. Participants will also complete a 1-week follow-up. The study aims to determine the effects of cultural targeting on attention to anti-polytobacco messages and perceived effectiveness among LGBT young adults susceptible to polytobacco use.
Interventions
BEHAVIORALHealth communications
Participants will view eight culturally targeted or non-targeted health communications about the health risks of nicotine and tobacco use.
Sponsors
National Institutes of Health (NIH)
National Cancer Institute (NCI)
Ohio State University Comprehensive Cancer Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* Speaks English fluently * Self-identifies as lesbian, gay, bisexual, transgender, queer, or another non- heterosexual orientation or non-binary gender identity * Ever used e-cigarettes AND combustible cigarettes * Currently uses e-cigarettes, combustible cigarettes, or both e-cigarettes and combustible cigarettes * Resides in the United States * Access to a laptop or desktop computer with a camera for virtual eye-tracking
Exclusion criteria
* Glaucoma * Cataracts
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Behavioral Intentions to Quit Vaping | Difference between conditions in behavioral intentions to quit vaping at 1-week follow-up after intervention exposure | Number of participants who answer Yes to the following: Do you plan to quit vaping nicotine in the next 30 days? (Yes/No) |
| Visual Attention - Dwell Time | During intervention on Day 1, on average 3 minutes | Visual attention measured by dwell time (milliseconds) on areas of interest (AOI; e.g., text, graphic) within a stimuli was assessed via eye-tracking for each message (n=8). Dwell times on AOIs were summed for all stimuli viewed by each participant and averaged. Scores represent total average dwell time on AOIs across stimuli. |
| Visual Attention - Time to First Fixation | During intervention on Day 1, on average 3 minutes. | Time (milliseconds) to first fixation on areas of interest (text, graphic) within a stimuli was assessed via eye-tracking for each message (n=8). Time to first fixation on a specific AOI was summed for all stimuli viewed by each participant and averaged. Scores represent total average time to first fixation on AOIs across stimuli. |
| Perceived Message Effectiveness - Message Perceptions | Immediately post-exposure to intervention | 6-items on a 5-point scale where 1 = Not at all and 5 = Very much. Please rate each statement from 1 (not at all) to 5 (very much). These message are worth remembering. These messages grabbed my attention. These messages are powerful. These messages are convincing. These messages are meaningful. These messages are informative. Individual items are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a better outcome. |
| Perceived Message Effectiveness - Effects Perceptions | Immediately post-exposure to intervention | 6-items. 5-point scale where 1 = Strongly disagree to 5 = Strongly agree These messages discourage me from smoking cigarettes. These messages make me concerned about the negative effects of smoking cigarettes These messages make smoking cigarettes seem unpleasant to me. 3-items above are summed and averaged. Higher scores indicate better outcome. These messages discourage me from vaping nicotine. These messages make me concerned about the negative effects of vaping nicotine. These messages make vaping nicotine seem unpleasant to me. 3-items above are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a better outcome. |
| Change in Behavioral Intentions | Change from Baseline in behavioral intentions immediately post-exposure to intervention | 8 items total. 4-point scale 1 = Definitely not to 4 = Definitely will. The following items were asked at baseline and post-exposure. How likely is it that in the next 3 months, you will refrain from vaping nicotine.... * completely and permanently? * when you get lonely? * when you are with your friends who use them? * when someone hands you a vape? How likely is it that in the next 3 months, you will refrain from smoking cigarettes... * completely and permanently? * when you get lonely? * when you are with your friends who use them? * when someone hands you a cigarette? For each subscale, pre-test and post-test items were summed and averaged. Change scores were calculated for each subscale by subtracting pre-test scores from post-test scores. Change scores could range from 0 to 3. Higher change scores indicate a better outcome (i.e. greater change in intentions to refrain from smoking or vaping) |
| Behavioral Intentions: Quitting Smoking | Difference between conditions in behavioral intentions to quit smoking at 1-week follow-up after intervention exposure | Number of participants who answer Yes to the following: Do you plan to quit smoking cigarettes in the next 30 days? (Yes/No) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ad Relevance | Immediately post-exposure to intervention | 5 items; 7-point Likert scale where 1 = Strongly Disagree and 7 = Strongly agree These ads were created just for me. These ads were created for people like me. These ads were relevant to me. These ads were of value to me. These ads were important to me. Items were summed and averaged for a total score ranging from 1 to 7. Higher scores indicate a better outcome. |
| Liking | Immediately post-exposure to intervention | Single item; 5-point Likert scale where 1 = Strongly disagree and 5 = Strongly agree I like these messages. |
| Attitudes | Immediately post-exposure to intervention | Two items; 7-point Likert scale where 1 = These message made me feel much worse and 7 = These message made me feel much better. Did these messages change how you feel about smoking combustible cigarettes? Did these messages change how you feel about vaping nicotine? Higher scores mean a worse outcome. |
| Response Efficacy | Immediately post-exposure to intervention | 6-items; 5 point Likert scale where 1 = Strongly disagree and 5 = Strongly agree These messages will motivate CIGARETTE SMOKERS to switch to vaping. These messages will motivate people to quit ALL smoking and vaping. These messages will motivate NON-USERS to start vaping. These messages will motivate NON-USERS to start smoking cigarettes. These messages will motivate CIGARETTE SMOKERS to quit. These messages will motivate VAPERS to quit. Higher scores mean a better outcome. |
| Qualitative Recall of Health Messages | 1-week follow-up after intervention exposure | Participants will be asked the following question: The images that you viewed included health messages. What do you remember about the health messages? Outcome indicates then number of participants who qualitatively reported recalling something about the health message. |
| Reactance | Immediately post-exposure to intervention | 3-items; 5-point Likert scale where 1 = Strongly disagree and 5 = Strongly agree These messages are trying to manipulate me. These messages annoy me. The health effects of these messages are overblown. Items are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a worse outcome. |
Countries
United States
Participant flow
Pre-assignment details
Participants who consented to the study but did not complete the activity in REDCap that triggered randomization to an arm, were excluded from the rest of the study.
Participants by arm
| Arm | Count |
|---|---|
| Culturally Targeted Messages Participants will view 8 nicotine and tobacco health messages with LGBT culturally targeted messages and imagery
Health communications: Participants will view eight culturally targeted or non-targeted health communications about the health risks of nicotine and tobacco use. | 129 |
| Non-targeted Messages Participants will view 8 nicotine and tobacco health messages with universal messages and imagery
Health communications: Participants will view eight culturally targeted or non-targeted health communications about the health risks of nicotine and tobacco use. | 122 |
| Total | 251 |
Baseline characteristics
| Characteristic | Culturally Targeted Messages | Non-targeted Messages | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 129 Participants | 122 Participants | 251 Participants |
| Behavioral Intentions Subscale 1: Behavioral intentions to avoid cigarettes | 2.61 units on a scale STANDARD_DEVIATION 0.81 | 2.49 units on a scale STANDARD_DEVIATION 0.85 | 2.55 units on a scale STANDARD_DEVIATION 0.83 |
| Behavioral Intentions Subscale 2: Behavioral intentions to avoid nicotine vapes | 2.29 units on a scale STANDARD_DEVIATION 0.77 | 2.17 units on a scale STANDARD_DEVIATION 0.67 | 2.23 units on a scale STANDARD_DEVIATION 0.72 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 11 Participants | 15 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 123 Participants | 110 Participants | 233 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 2 Participants | 1 Participants | 3 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 17 Participants | 11 Participants | 28 Participants |
| Race (NIH/OMB) Black or African American | 54 Participants | 59 Participants | 113 Participants |
| Race (NIH/OMB) More than one race | 6 Participants | 2 Participants | 8 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 52 Participants | 49 Participants | 101 Participants |
| Region of Enrollment United States | 129 participants | 122 participants | 251 participants |
| Sex/Gender, Customized Female | 61 Participants | 64 Participants | 125 Participants |
| Sex/Gender, Customized Male | 44 Participants | 33 Participants | 77 Participants |
| Sex/Gender, Customized Unknown | 24 Participants | 25 Participants | 49 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 129 | 0 / 122 |
| other Total, other adverse events | 0 / 129 | 0 / 122 |
| serious Total, serious adverse events | 0 / 129 | 0 / 122 |
Outcome results
Primary
Behavioral Intentions: Quitting Smoking
Number of participants who answer Yes to the following: Do you plan to quit smoking cigarettes in the next 30 days? (Yes/No)
Time frame: Difference between conditions in behavioral intentions to quit smoking at 1-week follow-up after intervention exposure
Population: Participants who reported current cigarette smoking at 1-week follow-up
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Culturally Targeted Messages | Behavioral Intentions: Quitting Smoking | 22 Participants |
| Non-targeted Messages | Behavioral Intentions: Quitting Smoking | 25 Participants |
Primary
Behavioral Intentions to Quit Vaping
Number of participants who answer Yes to the following: Do you plan to quit vaping nicotine in the next 30 days? (Yes/No)
Time frame: Difference between conditions in behavioral intentions to quit vaping at 1-week follow-up after intervention exposure
Population: Participants reporting nicotine vaping at follow-up
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Culturally Targeted Messages | Behavioral Intentions to Quit Vaping | 29 Participants |
| Non-targeted Messages | Behavioral Intentions to Quit Vaping | 31 Participants |
Primary
Change in Behavioral Intentions
8 items total. 4-point scale 1 = Definitely not to 4 = Definitely will. The following items were asked at baseline and post-exposure. How likely is it that in the next 3 months, you will refrain from vaping nicotine.... * completely and permanently? * when you get lonely? * when you are with your friends who use them? * when someone hands you a vape? How likely is it that in the next 3 months, you will refrain from smoking cigarettes... * completely and permanently? * when you get lonely? * when you are with your friends who use them? * when someone hands you a cigarette? For each subscale, pre-test and post-test items were summed and averaged. Change scores were calculated for each subscale by subtracting pre-test scores from post-test scores. Change scores could range from 0 to 3. Higher change scores indicate a better outcome (i.e. greater change in intentions to refrain from smoking or vaping)
Time frame: Change from Baseline in behavioral intentions immediately post-exposure to intervention
Population: Analytic sample includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Change in Behavioral Intentions | Change in cigarette smoking behavioral intentions | .20 score on a scale |
| Culturally Targeted Messages | Change in Behavioral Intentions | Change in nicotine vaping behavioral intentions | .44 score on a scale |
| Non-targeted Messages | Change in Behavioral Intentions | Change in cigarette smoking behavioral intentions | .36 score on a scale |
| Non-targeted Messages | Change in Behavioral Intentions | Change in nicotine vaping behavioral intentions | .30 score on a scale |
Primary
Perceived Message Effectiveness - Effects Perceptions
6-items. 5-point scale where 1 = Strongly disagree to 5 = Strongly agree These messages discourage me from smoking cigarettes. These messages make me concerned about the negative effects of smoking cigarettes These messages make smoking cigarettes seem unpleasant to me. 3-items above are summed and averaged. Higher scores indicate better outcome. These messages discourage me from vaping nicotine. These messages make me concerned about the negative effects of vaping nicotine. These messages make vaping nicotine seem unpleasant to me. 3-items above are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a better outcome.
Time frame: Immediately post-exposure to intervention
Population: Analytic sample includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Perceived Message Effectiveness - Effects Perceptions | Effects Perceptions: Smoking Cigarettes | 3.64 score on a scale |
| Culturally Targeted Messages | Perceived Message Effectiveness - Effects Perceptions | Effects Perceptions: Vaping Nicotine | 3.49 score on a scale |
| Non-targeted Messages | Perceived Message Effectiveness - Effects Perceptions | Effects Perceptions: Smoking Cigarettes | 3.80 score on a scale |
| Non-targeted Messages | Perceived Message Effectiveness - Effects Perceptions | Effects Perceptions: Vaping Nicotine | 3.69 score on a scale |
Primary
Perceived Message Effectiveness - Message Perceptions
6-items on a 5-point scale where 1 = Not at all and 5 = Very much. Please rate each statement from 1 (not at all) to 5 (very much). These message are worth remembering. These messages grabbed my attention. These messages are powerful. These messages are convincing. These messages are meaningful. These messages are informative. Individual items are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a better outcome.
Time frame: Immediately post-exposure to intervention
Population: Analytic sample includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Culturally Targeted Messages | Perceived Message Effectiveness - Message Perceptions | 3.68 score on a scale |
| Non-targeted Messages | Perceived Message Effectiveness - Message Perceptions | 3.7 score on a scale |
Primary
Visual Attention - Dwell Time
Visual attention measured by dwell time (milliseconds) on areas of interest (AOI; e.g., text, graphic) within a stimuli was assessed via eye-tracking for each message (n=8). Dwell times on AOIs were summed for all stimuli viewed by each participant and averaged. Scores represent total average dwell time on AOIs across stimuli.
Time frame: During intervention on Day 1, on average 3 minutes
Population: Participants were included for analysis if they completed the eye-tracking experiment and were not missing dwell time data.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Visual Attention - Dwell Time | Textual AOI: Efficacy | 1695.21 milliseconds |
| Culturally Targeted Messages | Visual Attention - Dwell Time | Image AOI: Central Image | 2771.12 milliseconds |
| Culturally Targeted Messages | Visual Attention - Dwell Time | Textual AOI: Quit Resources | 317.90 milliseconds |
| Culturally Targeted Messages | Visual Attention - Dwell Time | Image AOI: Logo | 80.75 milliseconds |
| Culturally Targeted Messages | Visual Attention - Dwell Time | Textual AOI: Threat | 1871.00 milliseconds |
| Non-targeted Messages | Visual Attention - Dwell Time | Image AOI: Logo | 97.80 milliseconds |
| Non-targeted Messages | Visual Attention - Dwell Time | Textual AOI: Threat | 1881.01 milliseconds |
| Non-targeted Messages | Visual Attention - Dwell Time | Textual AOI: Efficacy | 1603.15 milliseconds |
| Non-targeted Messages | Visual Attention - Dwell Time | Textual AOI: Quit Resources | 338.23 milliseconds |
| Non-targeted Messages | Visual Attention - Dwell Time | Image AOI: Central Image | 2692.30 milliseconds |
Primary
Visual Attention - Time to First Fixation
Time (milliseconds) to first fixation on areas of interest (text, graphic) within a stimuli was assessed via eye-tracking for each message (n=8). Time to first fixation on a specific AOI was summed for all stimuli viewed by each participant and averaged. Scores represent total average time to first fixation on AOIs across stimuli.
Time frame: During intervention on Day 1, on average 3 minutes.
Population: Participants were included for analysis if they completed eye-tracking and did not have missing data capturing time to first fixation.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Efficacy | 3525.47 milliseconds |
| Culturally Targeted Messages | Visual Attention - Time to First Fixation | Image AOI: Central Image | 1570.31 milliseconds |
| Culturally Targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Quit Resources | 1919.12 milliseconds |
| Culturally Targeted Messages | Visual Attention - Time to First Fixation | Image AOI: Logo | 993.50 milliseconds |
| Culturally Targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Threat | 890.45 milliseconds |
| Non-targeted Messages | Visual Attention - Time to First Fixation | Image AOI: Logo | 1061.08 milliseconds |
| Non-targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Threat | 929.25 milliseconds |
| Non-targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Efficacy | 3494.96 milliseconds |
| Non-targeted Messages | Visual Attention - Time to First Fixation | Textual AOI: Quit Resources | 1997.02 milliseconds |
| Non-targeted Messages | Visual Attention - Time to First Fixation | Image AOI: Central Image | 1520.20 milliseconds |
Secondary
Ad Relevance
5 items; 7-point Likert scale where 1 = Strongly Disagree and 7 = Strongly agree These ads were created just for me. These ads were created for people like me. These ads were relevant to me. These ads were of value to me. These ads were important to me. Items were summed and averaged for a total score ranging from 1 to 7. Higher scores indicate a better outcome.
Time frame: Immediately post-exposure to intervention
Population: Analysis includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Culturally Targeted Messages | Ad Relevance | 3.65 score on a scale |
| Non-targeted Messages | Ad Relevance | 3.64 score on a scale |
Secondary
Attitudes
Two items; 7-point Likert scale where 1 = These message made me feel much worse and 7 = These message made me feel much better. Did these messages change how you feel about smoking combustible cigarettes? Did these messages change how you feel about vaping nicotine? Higher scores mean a worse outcome.
Time frame: Immediately post-exposure to intervention
Population: Analysis includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Attitudes | Change in feelings about smoking cigarettes | 2.78 score on a scale |
| Culturally Targeted Messages | Attitudes | Change in feelings about vaping nicotine | 2.81 score on a scale |
| Non-targeted Messages | Attitudes | Change in feelings about smoking cigarettes | 2.94 score on a scale |
| Non-targeted Messages | Attitudes | Change in feelings about vaping nicotine | 2.90 score on a scale |
Secondary
Liking
Single item; 5-point Likert scale where 1 = Strongly disagree and 5 = Strongly agree I like these messages.
Time frame: Immediately post-exposure to intervention
Population: Analysis includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Culturally Targeted Messages | Liking | 3.82 score on a scale |
| Non-targeted Messages | Liking | 4.04 score on a scale |
Secondary
Qualitative Recall of Health Messages
Participants will be asked the following question: The images that you viewed included health messages. What do you remember about the health messages? Outcome indicates then number of participants who qualitatively reported recalling something about the health message.
Time frame: 1-week follow-up after intervention exposure
Population: Number of participants who reported recalling something about the health messages.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Culturally Targeted Messages | Qualitative Recall of Health Messages | 81 Participants |
| Non-targeted Messages | Qualitative Recall of Health Messages | 79 Participants |
Secondary
Reactance
3-items; 5-point Likert scale where 1 = Strongly disagree and 5 = Strongly agree These messages are trying to manipulate me. These messages annoy me. The health effects of these messages are overblown. Items are summed and averaged for a total score ranging from 1 to 5. Higher scores indicate a worse outcome.
Time frame: Immediately post-exposure to intervention
Population: Analysis includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Culturally Targeted Messages | Reactance | 2.11 score on a scale |
| Non-targeted Messages | Reactance | 2.07 score on a scale |
Secondary
Response Efficacy
6-items; 5 point Likert scale where 1 = Strongly disagree and 5 = Strongly agree These messages will motivate CIGARETTE SMOKERS to switch to vaping. These messages will motivate people to quit ALL smoking and vaping. These messages will motivate NON-USERS to start vaping. These messages will motivate NON-USERS to start smoking cigarettes. These messages will motivate CIGARETTE SMOKERS to quit. These messages will motivate VAPERS to quit. Higher scores mean a better outcome.
Time frame: Immediately post-exposure to intervention
Population: Analysis includes all participants for whom baseline and post-exposure data is available.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Culturally Targeted Messages | Response Efficacy | These messages will motivate CIGARETTE SMOKERS to switch to vaping. | 2.07 score on a scale |
| Culturally Targeted Messages | Response Efficacy | These messages will motivate people to quit ALL smoking and vaping. | 3.48 score on a scale |
| Culturally Targeted Messages | Response Efficacy | These messages will motivate NON-USERS to start vaping. | 1.53 score on a scale |
| Culturally Targeted Messages | Response Efficacy | These messages will motivate NON-USERS to start smoking cigarettes. | 1.46 score on a scale |
| Culturally Targeted Messages | Response Efficacy | These messages will motivate CIGARETTE SMOKERS to quit. | 3.41 score on a scale |
| Culturally Targeted Messages | Response Efficacy | These messages will motivate VAPERS to quit. | 3.34 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate CIGARETTE SMOKERS to quit. | 3.46 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate CIGARETTE SMOKERS to switch to vaping. | 1.93 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate NON-USERS to start smoking cigarettes. | 1.38 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate people to quit ALL smoking and vaping. | 3.43 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate VAPERS to quit. | 3.51 score on a scale |
| Non-targeted Messages | Response Efficacy | These messages will motivate NON-USERS to start vaping. | 1.51 score on a scale |