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Communicating about chemicals in cigarette smoke: impact on knowledge and misunderstanding
  1. Allison J Lazard1,2,
  2. M Justin Byron2,3,4,
  3. Ellen Peters5,
  4. Noel T Brewer2,3
  1. 1 School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina, USA
  2. 2 Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Department of Health Behavior, Gillings School of Global Public, University of North Carolina, Chapel Hill, North Carolina, USA
  4. 4 Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
  5. 5 Psychology, Ohio State University, Columbus, Ohio, USA
  1. Correspondence to Dr Noel T Brewer, Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA; ntb{at}


Background The USA must publicly share information about harmful and potentially harmful constituents (chemicals) in tobacco products. We sought to understand whether webpages with chemical information are “understandable and not misleading to a lay person.”

Methods Participants were a national probability sample of US adults and adolescents (n=1441, 18% smokers). In an online experiment, we randomly assigned participants to view one of the developed webpages (chemical names only, names with quantity ranges, names with visual risk indicators) or no webpage in phase one (between subjects). Participants completed a survey assessing knowledge, misunderstanding, perceived likelihood, perceived severity of health effects from smoking and quit intentions (smokers only). In phase two (within subjects), participants viewed all three webpage formats and reported webpage perceptions (clarity, usability, usefulness) and perceived impact (affect, elaboration, perceived effectiveness).

Results In phase one, viewing any webpage led to more knowledge of chemicals (48%–54% vs 28% no webpage, ps<0.001) and health harms (77% vs 67% no webpage, ps<0.001). When exposed to any webpage, 5%–23% endorsed misunderstandings that some cigarettes are safer than others. Webpage format did not affect knowledge or reduce misunderstandings. Viewing any webpage led to higher perceived likelihood of experiencing health effects from smoking (p<0.001) and, among smokers, greater intentions to quit smoking (p=0.04). In phase two, where participants viewed all formats, a visual risk indicator led to the highest perceived impact.

Conclusions Knowledge of chemicals and health effects can increase after viewing a website. Yet, websites may not correct the misunderstanding that some cigarettes are safer.

  • media
  • carcinogens
  • public opinion

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  • Contributors All authors contributed significantly to the production of the article.

  • Funding Research reported in this publication was supported by grant number P50CA180907-03S1 from the National Cancer Institute and the Food and Drug Administration (FDA) Center for Tobacco Products. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.