CONSTRUCTIVISMO SOCIO CULTURAL:

Message testing for anti-tobacco campaigns has consistently employed theories of reasoned action as a theoretical basis (Davis et al., 2017; Davis et al., 2013; Farrelly, Davis, Haviland, Messeri, & Healton, 2005; Fishbein et al., 2002). Within this framework, intentions to

“If I were to use an e-cigarette or other vaping device, I would…”

Health

1. Worry about my health 2. Wonder what I was inhaling 3. Damage my lungs

4. Get addicted

5. Not get enough nicotine

6. End up using other tobacco products too

Social

7. Look more attractive 8. Feel more sophisticated 9. Fit in better with friends

10.Be able to hide my use from others (e.g., parents) 11.Be able to create vapor clouds that look cool/appealing

12.Be able to do vape tricks (e.g., blowing vapor clouds or shapes like rings)

13.Look awkward 14.Look unpleasant

15.Look like I was smoking cigarettes 16.Look like I was trying to quit smoking

Personal experience

17.Feel less stressed 18.Feel good physically

19.Like the feeling of inhaling vapor into my mouth 20.Like the feeling of creating vapor clouds

21.Like the flavor of the vapor 22.Like the smell of the vapor 23.Smell bad

use a tobacco product or tobacco use are commonly employed outcomes (Brennan et al., 2013; Chauhan & Sharma, 2017; Duke et al., 2016; Rhodes et al., 2008). Behavioral models from this theoretical tradition also commonly examine the role that descriptive or injunctive norms play in predicting these outcomes. Descriptive norms in tobacco research are commonly assessed by examining the number of friends or family members that a respondent indicates use a particular tobacco product (e.g., Joung et al., 2016). A recent meta-analysis of the role of descriptive normative influence on tobacco initiation and cessation indicates that items with more detailed referents (e.g., asking respondents to list the proportion of close friends who use e-cigarettes instead of just asking the proportion of all friends) elicit greater predictive validity in modeling social influence (J. Liu et al., 2017). Liu and colleagues (2017) propose that studies may increase the predictive validity of descriptive norm measures by employing social network metrics (p. 21). Considering the importance of descriptive norms in determining tobacco use, their

relevance to theories of reasoned action, and recent calls for network metrics to be employed to improve their measurement, this study operationalized descriptive norms through detailed examination of relevant discussion networks as mentioned above.

Injunctive norms are often operationalized as a respondents’ perceptions of how close friends or family members would react if they knew the respondent were using tobacco products (e.g., Liu et al., 2017). Theories of reasoned action commonly utilize injunctive norms to assess the amount of social pressure there is to perform or not perform a behavior and consider them to be a second dimension of social norms that can be assessed alongside descriptive norms (Conner & Mcmillan, 1999; McMillan & Conner, 2003). Despite mixed results for the validity of

employing peer injunctive norms to predict tobacco use (Kam, Matsunaga, Hecht, & Ndiaye, 2009; McMillan & Conner, 2003), McMillan and Conner (2003) theorize that the differential

effects may be a substance-dependent (e.g., more predictive of marijuana use than tobacco use) or a result of social group identity. Additionally, when asked to provide specific alters who may approve or disapprove of a behavior, adolescent peer injunctive norms have been significantly associated with tobacco use intentions (Zaleski & Aloise‐Young, 2013). Considering the theoretical importance of peer approval of a behavior as well as the dearth of research

investigating young adult e-cigarette outcomes and injunctive norms, this study assessed them in two ways. First, the study employed two 7-point Likert scales in two items adapted from Gibson and colleagues (2018) that ask respondents how upset they believe their parents or close friends would be if they knew the respondent were using e-cigarettes. Second, this study built off of Zaleski and Aloise-Young’s (2013) findings as well as the recommendations posed by Liu and colleagues (2017) for improving descriptive norm measurement and adapt Gibson and colleagues (2018) injunctive measure to describe via a 7-point Likert scale the extent to which each alter listed by each respondent would be upset if they knew the respondent were using e-cigarettes.

Four key tobacco-related variables were assessed in this study: susceptibility to use, tobacco product use including e-cigarettes, quit intentions, and risk beliefs about e-cigarette use including comparative harm of e-cigarettes versus traditional cigarettes. Susceptibility to use a tobacco product is often employed in tobacco research to segment audience members who may not have used a tobacco product, but may be more amenable to future use than others. Typically, susceptible individuals are more likely to become tobacco users than non-susceptible individuals (Trinidad et al., 2017). Previous health messaging research on Real Cost advertisements among young adults suggests that individuals who are susceptible to become combustible cigarette smokers assess anti-smoking advertisements more favorably than cigarette smokers, but not as favorably as non-susceptible non-smokers (Hall et al., 2019). Considering the importance for

future initiation and the potential effect susceptibility status may have on perceptions of anti- vaping advertisements, this study operationalized susceptibility by employing a one-item

indicator adapted from previous research (G. C. Huang, Soto, et al., 2014; Pu & Zhang, 2017) in which respondents will indicate on a 7-point Likert scale (Extremely likely-Extremely unlikely) how likely they are to use e-cigarettes in the next 6 months.

One of the more consistent findings in measuring PME has been that individuals who use tobacco products tend to rate anti-tobacco messages less favorably than those who do not (e.g., Hall et al., 2019). In order to account for the role tobacco behaviors may play in existing outcome expectancies as well as assessments of anti-vaping messages, this study examined

tobacco ever use by having individuals indicate which of a number of tobacco products including e-cigarettes they have ever used as well as current tobacco use which was operationalized by having respondents indicate which products they have used in the past 30 days. Current users were also asked to provide the frequency with which they used tobacco products by indicating the number of days out of the last 30 they used each tobacco product.

Respondents who indicated that they use e-cigarettes were also asked about their e- cigarette quit intentions. Positive changes in quit intentions are one of the more common outcomes of interest in gauging the actual effectiveness of a tobacco campaign (Bigsby et al., 2013; Brennan et al., 2013; Noar, Barker, Bell, et al., 2018). Within reasoned action

frameworks, increased intentions to quit are theorized to indicate greater likelihood of quitting that behavior in the future (Fishbein & Ajzen, 2011; Fishbein & Cappella, 2006). This study employed an adaptation of a three-item quit intentions measure previously used to assess the effectiveness of anti-smoking campaigns (Bigsby et al., 2013). Respondents assessed on a 7- point Likert scale (Extremely likely - Extremely unlikely) how likely they are in the next three

months to quit using e-cigarettes completely, reduce the amount they vape in a day, or talk to someone they are close with (e.g., friend or family member) about quitting e-cigarettes.

The final tobacco-related variable this study utilized was respondents’ perceptions of harm for e-cigarettes as well as relative harms compared to traditional cigarettes. Risk beliefs about e-cigarette use will be measured by eight items adapted from previous research into e- cigarette risk beliefs as well as young adults’ tobacco risk beliefs (Brennan, Gibson, Kybert- Momjian, Liu, & Hornik, 2017; Crosby et al., 2018). These risk items assessed the extent to which respondents believe using e-cigarettes will harm their health (“damage my body”), lead to addiction (“will become addicted to vaping”), or lead to ingestion of toxic chemicals (“will inhale poisons”). As discussed in the literature review chapter, these items were included in order to examine whether exposure to messages in a brief intervention and were chosen to correspond closely with the a priori determined themes of the Real Cost advertisements. While similar in structure to a number of OE tested before exposure, the correspondence with the aims of the message differentiates these items.

Young adults have consistently indicated that e-cigarettes are less harmful to an individual’s health than traditional cigarettes. However, one of the stated concerns about deploying Real Cost advertisements nationally has been fear that they may shift the concerns of young adults such that e-cigarettes would be seen as similarly harmful as combustible cigarettes, thus lowering the number of young adults who may transition from combustible cigarettes to e- cigarettes (Crosby et al.). In order to provide data about the potential effects on perceptions of relative harms viewing anti-vaping advertisements may have on young adults, this study asked respondents to assess on a 7-point Likert scale (Much less harmful – Much more harmful) how harmful e-cigarettes are compared to combustible cigarettes.