Communication Strategies for Health Issues
Elizabeth Nelson
Elizabeth Nelson

Communication Strategies for Health Issues

by Jackie Swift

Communicating health issues is not easy. If you want to discourage smoking, for instance, how do you reach the target audience, given that it is segmented among many subgroups: teens, adult smokers, and those struggling to quit? “It’s complicated,” says Jeff Niederdeppe, Communication. “We need to understand our audience, the issues, and how people make sense of different kinds of messages to really understand the role of communication in shaping attitudes and opinions.”

Impact of New Cigarette Warning-Label Designs

Recently, Niederdeppe served as co-principal investigator, along with Sahara Byrne, Communication, on a multi-year study looking at cigarette warning labels. Niederdeppe and Byrne were joined in their research by Alan D. Mathios and Rosemary J. Avery, both Policy Analysis and Management; Michael C. Dorf, Law; and Amelia Greiner Safi, Communication/Population Medicine and Diagnostic Sciences.

“The warning labels on cigarette packages hadn’t been refreshed in almost 30 years,” Niederdeppe says, explaining that the Food and Drug Administration (FDA) had proposed new labels in 2011 that would have covered the upper half of cigarette packs and featured warning text along with photos of the health consequences of smoking, such as lip cancer and people with tracheal stomas. When tobacco companies won a lawsuit at a federal appeals court claiming the labels were unconstitutional, the FDA funded research to address some of the issues raised by the legal challenge, in particular the assertion that new warning labels had to fulfill the government’s interest in a manner least restrictive to the cigarette companies’ first amendment protections of free commercial speech.

Niederdeppe and his collaborators won a grant from the FDA’s Center for Tobacco Products, via the National Institutes of Health, and crafted a series of sequential experiments seeking to test whether various alterations to the FDA’s original proposed warning labels were still effective. “The question of whether the new warning labels are least restrictive has a lot of components,” Niederdeppe says. “Do the labels have to be in color to have the desired impact or can they be in black and white? Do they have to have pictures or can they be text only? Do they have to cover the top 50 percent of the front of the pack, or could they only cover 30 percent? And what sort of language do they use? Do they say that smoking may cause cancer, can cause cancer, will cause cancer?”

The researchers focused on low-income smokers without college or vocational educations—the people most likely to smoke. They purchased and designed a recreational vehicle as a mobile research lab and partnered with community organizations to reach low-income smokers in various rural and urban communities across the region, including places such as food pantries. They also brought the mobile lab to middle schools in poorer communities to test students’ reactions to various messages.

“The test subjects looked at the larger, full-color [cigarette warning] labels longer and reported higher negative emotions in response.”

Adults and Youth React Differently to Label Designs

“There were some interesting differences between adults and young people,” Niederdeppe says. “For adults, the full-color photographic warning labels covering 50 percent of the package offer advantages over either text only, black-and-white images, or labels that only cover 30 percent of the package. The test subjects looked at the larger, full-color labels longer and reported higher negative emotions in response, and we know negative emotions are important in motivating quitting behavior.”

For the middle school students, the larger, full-color labels reduce the appeal of cigarette brand marketing. “The warning label taints the brand imagery,” Niederdeppe says. “It undoes some of the marketing-created perceptions that cigarettes are fun, social, cool products for young people to try.” The researchers also found, however, that a prominent message in black text against a white background on a cigarette pack has the potential to work just as well with middle school students, at least in promoting emotional responses to the message.

Niederdeppe and his colleagues have published more than 12 papers on their studies. In 2018, the FDA cited three of their studies as part of the justification for a proposed new set of graphic warning labels covering 50 percent of a cigarette package’s front. “We’re excited about that,” he says. “It’s rare that you can actually trace your work to a specific outcome, but when they cite your research directly, you know you had impact.”

Currently Niederdeppe and Byrne are co-leading another project testing warning labels for e-cigarettes. Evidence points to the possibility of e-cigarettes helping smokers of combustible cigarettes successfully quit smoking, but at the same time, 25 percent of high school–age youth are using vaping products regularly. “Our job is try to understand if there’s a messaging sweet spot where we can convince young people not to vape tobacco products but also not scare adult smokers into increasing their smoking of combustible cigarettes,” Niederdeppe says.

Messaging Strategies Promoting Early Childhood Education

In another project, Niederdeppe explores messaging strategies to convince the general public and state legislators that investing in early childhood education (from birth to five years) is important for the health of society. Joining with Yiwei Xu, PhD ’24 Communication, and Liana Winett of Oregon Health Sciences University–Portland State University, Niederdeppe tested various types of messages on members of the general public and on state legislators from across the country.

Among the researchers’ findings: one of the test messages—a narrative that told the story of young parents struggling to deal with lack of access to quality childcare—triggered significant differences in the two groups’ reactions. “Things that worked for the general public appear to backfire with legislators,” Niederdeppe says. “The narrative strategy seemed to resonate with average citizens who are ambivalent or even initially opposed to these kinds of policies, while state legislators were less likely to support the policy if they saw the narrative message than if they received no message at all.”

The difference in reactions between the two groups could lie with different priorities and levels of abstract thinking about the issue, Niederdeppe says. “State legislators have to make concrete decisions about policy proposals on a daily basis,” he explains. “Whereas, if you ask me whether I support a policy, I might say, ‘Sure, that sounds like a good thing.’ I’m not having to prioritize that over something else, and I don’t have to come up with how to pay for it or sell it to my constituents, either.”

Learning from Collaboration

In all his projects, Niederdeppe relies on plenty of collaboration with students, postdoctorate fellows, and colleagues at Cornell and in other institutions. “I love collaborative research,” he says. “I think that’s one of the things that makes the work exciting. You learn things from other perspectives. Every single project I’ve ever been part of has improved via collaboration.”