NCT03723616|CompletedResults
Reactions to Warnings on Hookah Ads
Exploring Reactions to Health Warnings on Waterpipe Tobacco Ads
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Exploring Reactions to Health Warnings on Waterpipe Tobacco Ads
Sponsor study identifier
interventional
2,588
1 country
1
Study Start
October 5, 2018
Actual (reported)Primary Completion
March 26, 2021
Actual (reported)Study Completion
March 26, 2021
Actual (reported)The purpose of this study is to help us better understand what kinds of waterpipe tobacco advertisements appeal to young adults as well as to help evaluate and create health warnings that can be placed on waterpipe tobacco advertisements to inform young adults of the risks associated with smoking hookah tobacco.
Registry-reported information. Elapsed time and enrollment totals alone do not measure study progress or recruitment pace.
March 26, 2021
Actual (reported)Click on a node to explore related trials.
Some registry-reported names shown below are not yet linked in this graph.
Dates and qualifiers reported by the registry. Estimated dates do not confirm that a milestone has occurred.
October 5, 2018
Actual (reported)October 26, 2018
Actual (reported)October 29, 2018
Actual (reported)March 26, 2021
Actual (reported)March 26, 2021
Actual (reported)December 18, 2025
Actual (reported)Emotional Reactions to Ads
Participants rated on 7-point bipolar scales the extent each ad made them feel not at all anxious/very anxious, not at all worried/very worried, not at all fearful/very fearful and good /bad. Reported as a composite score created by averaging the items. Mean scores range from 1 to 7 where higher mean values represent more negative emotional reactions to viewing the ad.
up to 45 minutes
Attitudes Toward Waterpipe Tobacco Smoking (WTS) as Measured by Questionnaire
Participant rated on 9-point bipolar scale an ad's portrayal of WTS. The five attributes that tapped cognitions were: safe/unsafe, healthy/unhealthy, useful/useless, harmful/beneficial, and wise/foolish. The five attributes that captured affect were: pleasant/unpleasant, nice/nasty, enjoyable/not enjoyable, satisfying/unsatisfying, gratifying/revolting. Reported as a composite score created by averaging the items. The mean scores could range from 1 to 7 where a higher mean score reflects a more negative attitude towards WTS.
up to 45 minutes
Reactance to Ads
Two items from the University of North Carolina (UNC) short reactance scale were asked from 1=strongly disagree to 7=strongly agree: "This ad is trying to manipulate me", and "This ad annoys me." Reported as a composite score created by averaging the items. Mean scores can range from 1 to 7. A higher mean score reflect higher reactance, meaning that participants felt more reactance (e.g., felt their freedoms were being taken away).
Perceived Risk as Measured by Questionnaire
up to 45 minutes
Global Attitude on Waterpipe Tobacco Smoking (WTS)
up to 45 minutes
Urge to Smoke
up to 45 minutes
Avoidance / Acceptance of Health Warnings as Measured by Eye Tracking
up to one hour
Described below is Phase 3. Phase 1 and Phase 2 were small pilots used to inform and select study stimuli. Phase 3 was the larger randomized controlled online trial testing effects of warnings on social allure ads.. Participants were randomized to one of three health warning label (HWL) arms in a 1:2:2 ratio: 1) ads only, 2) ads with text HWLs only, and 3) ads with text + graphic HWLs. Within the latter two groups, participants were then randomized with equal probability to view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text or text + graphic HWLs were placed randomly on two social allure ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different social allure ad. Participants in the ads only arm, only viewed two ads without replacement.
Participants will view 2 ads without replacement.
Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text HWLs were placed randomly on two ads out of the possible four ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different ad.
Duke University
Durham, North Carolina, 27710, United States
Isaac Lipkus, PhD
Duke University
2,588 participants (actual enrollment reported by the registry).
First Submitted
October 26, 2018
First Posted
October 29, 2018
Study Start
October 5, 2018
Actual (reported)Effect of Concurrent Hookah and Alcohol Consumption on Smoking Topography and Toxicant Exposure
up to 45 minutes
Perceived Effectiveness of Health Warnings
Participants used a three-item measure as a gestalt assessment of how well an ad dissuaded WTS. The three items, rated from 1=strongly disagree to 7=strongly agree were: "This ad discourages me from wanting to smoke waterpipe tobacco", "This ad makes me concerned about the health effects of smoking waterpipe tobacco", and "This ad makes smoking waterpipe tobacco seem unpleasant to me". Reported as a composite score created by averaging the items. The mean score could ranged from 1 to 7. A higher mean score reflects that the ad was more effective at dissuading WTS.
up to 45 minutes
Ad Effect on Desire to Smoke
Participants were asked, "To what extent did this ad affect your desire to smoke waterpipe tobacco?" from 1=Reduced my desire a lot to 7=Increased my desire a lot. Mean scores could range from 1 to 7. A higher mean score reflects that the ad increased a participant's desire to smoke waterpipe tobacco.
up to 45 minutes
Ad Effect on Event Participation
Participants who completed the social allure study were asked, "If the activities in the ad were to take place in a location near you, how likely are you to participate in those activities?". Response options were: 1=No chance, 2=Very unlikely, 3=Unlikely, 4=Moderately likely, 5=Likely, 6=Very Likely, and 7=Certain to happen. Mean scores could range from 1 to 7. A higher mean score reflects a higher probability that the participant would participate in the event depicted in the ad.
up to 45 minutes
Ad Effect on Product Purchase
Participants who completed the social allure study were asked, "How likely are you to buy the product in the ad?". Response options were: 1=No chance, 2=Very unlikely, 3=Unlikely, 4=Moderately likely, 5=Likely, 6=Very Likely, and 7=Certain to happen. Means scores could range from 1 to 7. A higher mean score reflects that the study participant would have a higher probability of purchasing the product depicted in the ad.
up to 45 minutes
Described below is Phase 3. Phase 1 and Phase 2 were small pilots used to inform and select study stimuli. Phase 3 was the larger randomized controlled online trial testing effects of warnings of product ads. Participants were first randomized to one of three health warning label (HWL) arms in a 1:2:2 ratio: 1) ads only, 2) ads with text HWLs only, and 3) ads with text + graphic HWLs. Within the latter two groups, participants were then randomized with equal probability to view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text or text + graphic HWLs were placed randomly on two ads that represented a flavored tobacco product or a waterpipe apparatus. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a product ad Participants in the ads only arm, only viewed two product ads without replacement.
Participants will view HWLs in one of four domains: long- and short-term health events, toxicants, and addiction; participants viewed two HWLs within each domain - there were two HWLs per domain. The text + graphic HWLs were placed randomly on two ads out of the possible four ad themes without replacement. Thus, participants viewed two HWLs within the same domain, with each warning being placed on a different ad.
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Primary Completion
March 26, 2021
Actual (reported)Study Completion
March 26, 2021
Actual (reported)Last Updated
December 18, 2025
Results First Posted
December 18, 2025
Record last verified: 2025-12
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