What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking?: An online randomised controlled experiment

Katherine Sawyer; Adham Hanafi; Tom P. Freeman; Chloe Burke; Sally Adams; Paul Aveyard; Pamela Jacobsen; Gemma Taylor

doi:10.1186/s12889-025-22795-0

What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment

Katherine Sawyer
, Adham Hanafi
, Tom P. Freeman
, Chloe Burke
, Sally Adams
, Paul Aveyard
, Pamela Jacobsen
, Gemma Taylor

University of Birmingham
University of Oxford
NIHR Oxford Biomedical Research Centre
NIHR Oxford and Thames Valley Applied Research Collaboration

Research output: Contribution to journal › Article › peer-review

1 Citation (SciVal)

Abstract

OBJECTIVES: Tobacco warning labels usually present information about the consequences of smoking but gain-framed messages could be a novel strategy to prevent wear out effects. Communicating the mental health benefits of stopping smoking could motivate cessation. We assessed whether such messaging was more effective at motivating cessation than blank labels and labels communicating the physical health benefits of cessation, and if there were any differences between those with mental ill health, or not.

DESIGN: An online randomised parallel experiment. Participants were randomly allocated using online randomised function to a condition, stratified by mental health status.

SETTING: Online survey platform, Qualtrics.

PARTICIPANTS: People who smoke tobacco weekly, above the age of 18.

INTERVENTION: Gain-framed tobacco packaging labels with three conditions: i) mental health labels; ii) physical health labels; iii) blank labels. Each condition consisted of four labels, viewed for at least 10 seconds each.

PRIMARY OUTCOME MEASURE: Motivation to stop smoking, measured using the Motivation to Stop Scale (MTSS) at baseline and follow up immediately after viewing the labels. 631 people who smoke tobacco weekly were randomised. Compared to the blank labels, those who viewed mental health labels had higher post-viewing MTSS scores (β = 0.18, p = 0.003, 95% CI [0.07, 0.30]). There was no evidence for a difference in post-viewing MTSS scores between the mental health label and physical health label (β = 0.07, p = 0.16, 95% CI [-0.03, 0.18]) conditions. These findings did not differ based on mental health status or anhedonia symptoms.

CONCLUSIONS: Labels on tobacco packaging that promote the mental health benefits of stopping smoking could motivate cessation and may be as effective as gain-framed physical health labels.

TRIAL REGISTRATION: clinicaltrials.gov NCT06762756, on 19/12/2024. Retrospectively registered.

Original language	English
Article number	2331
Journal	BMC Public Health
Volume	25
Issue number	1
Early online date	3 Jul 2025
DOIs	https://doi.org/10.1186/s12889-025-22795-0
Publication status	Published - 3 Jul 2025

Data Availability Statement

The datasets generated and/or analysed during the current study are available in the University of Bath repository https://doi.org/10.15125/BATH-01424. Scripts are available at https://doi.org/10.15125/BATH-01424, the protocol can be found at https://doi.org/10.17605/OSF.IO/3C75J.

Acknowledgements

We are grateful to Fleur Gill for designing and illustrating the images for the labels, the PPI group for their time and advice in the design process, and the participants for taking part in this study. As per CREDIT Taxonomy: Katherine Sawyer: Conceptualisation, Methodology, Resources, Formal analysis, Data curation, Writing – Original Draft, Visualization, Project administration, Funding acquisition. Adham Hanafi: Methodology, Resources, Validation, Formal analysis, Data curation, Writing – Review & Editing, Visualization. Chloe Burke: Methodology, Resources, Writing – Review & Editing. Tom P Freeman: Methodology, Writing – Review & Editing. Sally Adams: Methodology, Writing – Review & Editing. Paul Aveyard: Methodology, Writing – Review & Editing. Pamela Jacobsen: Methodology, Data curation, Writing – Review & Editing, Supervision. Gemma Taylor: Conceptualisation, Methodology, Writing – Review & Editing, Supervision.

Funding

This work is supported by grant MR/N0137941/1 for the GW4 BIOMED MRC DTP, awarded to the Universities of Bath, Bristol, Cardiff and Exeter from the Medical Research Council (MRC)/UKRI. Katherine Sawyer also received a grant from the University of Bath Department of Psychology Research Fund to fund recruitment for the study. Adham Hanafi completed this work as part of Clinical Psychologist training on the University of Bath\u2019s Doctorate in Clinical Psychology, funded by Health Education England. Dr Gemma Taylor receives funding from a Cancer Research UK Population Researcher Postdoctoral Fellowship award (C56067/A21330) and Cancer Research UK project award (PPRCPJT/100023). Chloe Burke receives funding from a PhD studentship awarded by the Society for the Study of Addiction (SSA). Funding sources were not involved in the study design, collection, analysis and interpretation of data, writing of the report and decision to submit the article for publication.

Funders	Funder number
Society for the Study of Addiction
University of Bath Department of Psychology
Medical Research Council
Population Researcher Postdoctoral Fellowship
Health Education England
UK Research & Innovation
Cancer Research UK	PPRCPJT/100023, C56067/A21330

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Humans
Motivation
Smoking Cessation/psychology
Male
Female
Adult
Middle Aged
Mental Health
Product Labeling/methods
Young Adult
Surveys and Questionnaires
Internet
Health Status

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

Access to Document

10.1186/s12889-025-22795-0Licence: CC BY

Cite this

Sawyer, K., Hanafi, A., Freeman, T. P., Burke, C., Adams, S., Aveyard, P., Jacobsen, P., & Taylor, G. (2025). What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment. BMC Public Health, 25(1), Article 2331. https://doi.org/10.1186/s12889-025-22795-0

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title = "What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking?: An online randomised controlled experiment",

abstract = "OBJECTIVES: Tobacco warning labels usually present information about the consequences of smoking but gain-framed messages could be a novel strategy to prevent wear out effects. Communicating the mental health benefits of stopping smoking could motivate cessation. We assessed whether such messaging was more effective at motivating cessation than blank labels and labels communicating the physical health benefits of cessation, and if there were any differences between those with mental ill health, or not.DESIGN: An online randomised parallel experiment. Participants were randomly allocated using online randomised function to a condition, stratified by mental health status.SETTING: Online survey platform, Qualtrics.PARTICIPANTS: People who smoke tobacco weekly, above the age of 18.INTERVENTION: Gain-framed tobacco packaging labels with three conditions: i) mental health labels; ii) physical health labels; iii) blank labels. Each condition consisted of four labels, viewed for at least 10 seconds each.PRIMARY OUTCOME MEASURE: Motivation to stop smoking, measured using the Motivation to Stop Scale (MTSS) at baseline and follow up immediately after viewing the labels. 631 people who smoke tobacco weekly were randomised. Compared to the blank labels, those who viewed mental health labels had higher post-viewing MTSS scores (β = 0.18, p = 0.003, 95\% CI [0.07, 0.30]). There was no evidence for a difference in post-viewing MTSS scores between the mental health label and physical health label (β = 0.07, p = 0.16, 95\% CI [-0.03, 0.18]) conditions. These findings did not differ based on mental health status or anhedonia symptoms.CONCLUSIONS: Labels on tobacco packaging that promote the mental health benefits of stopping smoking could motivate cessation and may be as effective as gain-framed physical health labels.TRIAL REGISTRATION: clinicaltrials.gov NCT06762756, on 19/12/2024. Retrospectively registered.",

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What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment

Abstract

Data Availability Statement

Acknowledgements

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Dataset for "What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment"

Cite this

What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment

Abstract

Data Availability Statement

Acknowledgements

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Datasets

Dataset for "What is the effect of presenting evidence of the mental vs physical health benefits of quitting smoking on motivation to stop smoking? An online randomised controlled experiment"

Cite this