Evaluating the corrective statements proposed in the court case U.S. Department of Justice vs. Philip Morris U.S.A. Inc., et al.
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Background . In 1999, the United States Department of Justice (DOJ) filed a lawsuit against major cigarette manufacturers in which they accused the companies of violating the Racketeering Influenced and Corrupt Organizations act by acting to defraud the American Public for over half a century. After nearly seven years of litigation, the Court, under Judge Gladys Kessler, ruled that the defendants had indeed acted to defraud the American Public in five major areas: (1) the adverse health effects caused by smoking; (2) addiction (that both nicotine and cigarette smoking are addictive); (3) adverse health effects caused by exposure to secondhand smoke, (4) manipulation of the physical and chemical design of cigarettes, and (5) the fallaciousness of light and low tar cigarette marketing. One of the several remedies ordered by Judge Kessler requires the defendants to publish full page corrective statements in major newspapers throughout the United States. The Defendants, the DOJ, and a third party of Interveners proposed corrective statements to the Court, and it has yet to be decided which format of corrective statements will be published. Purpose . The goal of this study is to evaluate the relative effectiveness of different message delivery formats for proposed corrective statements ordered by Judge Kessler as a result of the court case. Methods . Statements proposed to date by the three different parties to the litigation (DOJ, Defendants, Interveners) have suggested text-based formatting to communicate the corrective statements. Therefore, the Roswell Park Cancer Institute Health Communications Testing Lab created two additional versions that include graphics and testimonials to test if the inclusion of these images elicits a stronger affective response to the messages from the target audience of adult daily cigarette smokers. These two versions differed by the degree of affective response elicited by adult smokers (high vs. low affect). For this study, the statements proposed by Philip Morris, USA were chosen to represent the statements proposed by the defendants. A total of 239 participants were randomly assigned to view one of five versions of corrective statements. Prior to viewing the statements, data was collected on the participants'demographic and tobacco use characteristics, as well as knowledge and beliefs about cigarettes, health risks of smoking and secondhand smoke, and perceptions of the tobacco industry. An advertisement rating form was used to collect information about the participants' emotional response and appraisal of the advertisement. Eye tracking equipment was used to capture the gaze patterns and pupil diameter of a sub-sample of participants as they viewed the statements. Knowledge and beliefs were again assessed immediately after baseline and one week later over the telephone. The one week survey also assessed unaided and aided recall of the statements. Results . Smokers were found to be misinformed about cigarettes and the health effects of smoking at baseline. The results showed an increase in beliefs and knowledge from baseline to post-session and one week follow-up for all of the versions (not statistically significant), although the changes diminished over time. There was no consistent difference between the versions in their ability to elicit this change. The DOJ, RPCI Testimonial, and Interveners versions were more emotional and persuasive than the Philip Morris USA and RPCI Neutral versions. Pupil dilation, measured with the eye tracking equipment, was used as a marker for emotional arousal, and the results reflected the self-reported emotional responses. The eye tracking data also showed that the RPCI Testimonial version was able to attract the attention of its viewers in a shorter amount of time (not statistically significant). Unaided recall results also found that participants who viewed the RPCI Testimonial version were more likely to recall specific details from the statements one week later compared to the other versions. Conclusions . The findings from this study suggest that a single exposure to a corrective statement in the newspaper may help correct decades of misperceptions maintained by the tobacco industry about the dangers of tobacco use, to an extent. This study also found that the use of a high affect graphic may be more effective in communicating this information quicker than a text-based message, a finding that is critical considering the single exposure. Therefore, in a real-world setting, when the statements are published in major newspapers, the RPCI Testimonial version may perform best because of its ability to convey the important information in an emotional, persuasive manner most efficiently.