Project Overview +

This project explores the psychological processes underlying how valence of images in anti-smoking advertisements influences uptake and follow through for a smoking cessation program. Specifically, we seek to investigate whether self-affirmation or exposure to different types of images (positive images (e.g. images of health, happiness) or negative images (e.g. images of death, sickness)) are more likely to effectively change attitudes towards smoking and increase motivation to join and complete a smoking cessation program.

Aims +

Aim 1: Determine if affirmation increases the uptake of an offer of joining a stop smoking program.

Aim 2: Determine if image type (positive vs. neutral vs. negative) increases the uptake of the stop smoking program offer.

Aim 3: Determine whether there is an interaction between image type and affirmation in peopleís willingness to join a stop smoking program.

Participants +

Participants for the study are recruited from an online subject pools maintained by Survey Sampling International (SSI). SSI pre-screens participants to identify current smokers ages 18 and up, and those participants will be invited to enroll in our study.

Intervention +

Participants are randomized to one of six groups in our 2x3 design. Half the participants take part in an affirmation writing reflection (for example, people are asked to rank their values,  and for their top rated value, they are asked why itís important to them and how it is shown in their daily lives), and half will do a control reflection, where they are asked to write about why their lowest rated value might be important to someone else.

Participants are also randomized to view one of three sets of images. One-third of participants are shown negative pictures of smokers based on the Food and Drug Administrationís (FDA) proposed cigarette pack warning label images (negative depiction of smokers and smoking-related health conditions). These images were considered as part their campaign, but never used. Another third see positive images of people enjoying life. These images were also proposed by the FDA.  The final third of participants will see neutral, calm, or happy faces (from the MacBrain Face Stimulus Set (NimStim)).

For each image viewed, participants are asked questions to get them thinking about the person in the image and their views/assumed views toward smoking cessation. Directly following the writing reflection and image rating task, participants complete a survey retesting their intentions to quit, motivation, confidence and reasons for quitting.

After completing the mood and image rating tasks, all participants are offered the opportunity to take part in our online smoking cessation program, Project Quit.

Project Quit is a six-session web-based smoking cessation program. The program provides the participant with tools to recognize stress, overcome barriers to staying quit, and helps with motivation during the initial weeks of quitting smoking. As part of the intervention, participants receive a 2-week supply NicoDerm CQ nicotine replacement (NRT) patches. NRT patches work as a temporary aid to help people quit smoking by reducing nicotine withdrawal symptoms. Participants will receive 1 box of Step 1 (21 mg) patches (includes 14 patches).

Project Quit is a research-supported online tool that has been shown to improve quit success rates through individual tailoring of the message content; previous studies have examined the optimal amount of tailoring and timing of message exposure. Participants from all study arms will be invited to join the smoking cessation program; it is not part of the experimental design. All participants will receive the same content, except that the images in the email invitations and first page of the web sessions will match the images viewed earlier.

Project Quit Plan Z

01/01/2013 - 12/31/2014


National Cancer Institute

Principal Investigator:

Lawrence C. An, MD