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Not Applicable
Date applied
Date assigned
Last edited
Retrospectively registered
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Recruitment status

Plain English Summary

Background and study aims
Attitudes that are consciously controlled are called explicit attitudes and are often measured using surveys or questionnaires. However, people may sometimes respond to these types of measures in a way that is socially desirable rather than indicating what they may actually think. For example, smoking is now stigmatized in society and people might be reluctant to show any positive attitudes towards cigarettes. Additionally, people also have implicit attitudes, these are reactions which are automatic and unconscious and cannot be controlled. Therefore, implicit and explicit attitudes may sometimes differ. This study will investigate the relationship between implicit and explicit attitudes toward e-cigarettes and whether these attitudes are linked to people’s attitudes towards tobacco cigarettes. Furthermore, it will determine whether smokers, vapers and non-smokers have different attitudes towards e-cigarettes. Since the introduction of e-cigarettes, sales have escalated and advertising of these products is a growing market. E-cigarette companies can advertise nicotine in ways in which tobacco cigarette companies have been banned from doing in recent years. However, the effect of advertising a nicotine product on smokers and vapers is yet unknown and there is a concern that viewing adverts of people using e-cigarettes may normalise tobacco smoking thus promoting the use of tobacco cigarettes as well as e-cigarettes. This study will investigate whether viewing an image of an on-line e-cigarette changes people’s implicit and explicit attitudes towards tobacco and e-cigarettes. Additionally, this study will investigate whether viewing an image of an anti-smoking message will change attitudes towards tobacco or e-cigarettes. It has been shown that anti-smoking media campaigns are successful in encouraging quit attempts and reducing smoking. However, it has unknown what effect these images may have on attitudes towards e-cigarettes and whether these differ in smokers, vapers and non-smokers.

Who can participate?
Students, staff and people from the local community, between the ages of 18 to 25 years old, can volunteer.

What does the study involve?
Participants are randomly allocated into an advert group or a control group. On the first day of testing all the participants complete two on-line computer based tasks which measure implicit and explicit attitude and fill in a questionnaire about their smoking history. Two days later the participants return. The advert group is shown an image of an on-line e-cigarette advert or an anti-smoking image for 30 seconds. The control group is shown a very similar image to either the advert or anti-smoking message, with some words and pictures changed so that the participant does not associated the image with smoking or vaping. After viewing the image the participants complete the same two computer based attitude tasks. The same tests are repeated one week later.

What are the possible benefits and risks of participating?
Participants will receive £30 cash if they complete all 3 parts of the task. Alternatively, psychology students can take credits instead which are required to pass their psychology modules. There are no risks involved.

Where is the study run from?
London South Bank University (UK)

When did the study start and how long is it expected to run for?
September 2015 to February 2017

Who is funding the study?
Cancer Research UK

Who is the main contact?
Dr Paula Booth

Trial website

Contact information



Primary contact

Dr Paula Booth


Contact details

Division of Psychology (School of Applied Sciences)
London South Bank University
103 Borough Road
United Kingdom
020 7815 5467



Additional contact

Dr Daniel Frings


Contact details

Division of Psychology (School of Applied Sciences)
London South Bank University
103 Borough Road
United Kingdom
44 (0)20 7815 5888

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

The effects of on-line E-cigarette advertising on implicit and explicit attitudes towards tobacco and E-cigarettes and public health message efficacy in young adults.


Study hypothesis

1. Explicit measures of attitude are consciously controlled and are often measured using questionnaires or surveys. In contrast, implicit attitudes are based on automatic associations and reaction times. It is argued that responses to explicit attitude measures may be influenced by social desirability bias. For example, people may be reluctant to show positive attitudes towards behaviours such as smoking cigarettes which are stigmatized. Conversely, implicit attitudes are more strongly associated with behaviour, for example tobacco smokers have a more positive response (or a less negative response) towards cigarettes than non-smokers. Results from previous literature show that often outcomes from measures of implicit and explicit attitudes towards tobacco cigarettes differ. To date little research has been carried out on the relationship between explicit and implicit attitudes towards e-cigarettes, the effect of attitudes towards e-cigarettes on tobacco cigarette attitudes and if these attitudes differ in non-smokers, vapers and smokers.
1.1. That there will be a positive association between explicit and implicit attitudes towards e-cigarettes.
1.2. The association between e-cigarettes and tobacco attitudes will be positive, but the effect may be moderated by sample – being higher for smokers than for vapers. Researchers will test for an association between these constructs for non-smokers, but there is insufficient a-priori evidence to make a directional hypothesis for this group.

2. Research into the effects of e-cigarette advertising on e-cigarettes shows that it encourages more positive explicit attitudes towards e-cigarettes. However, findings are more inconsistent for the effect of e-cigarette adverts on attitudes towards tobacco cigarettes. Some research suggests that viewing e-cigarette adverts may encourage greater use of tobacco smoking as well as e-cigarette use. Conversely, other research has shown that e-cigarette advertisements increase disapproval of tobacco cigarettes.
2.1. Viewing an on-line e-cigarette advertisement will change attitudes towards tobacco and e-cigarettes in smokers and vapers. Positive changes are expected in the case of e-cigarettes. There is insufficient consistent evidence to make predictions for the effects of e-cigarettes on tobacco. Researchers will also test these effects for non-smokers, but insufficient evidence is available to make directional hypotheses for this group.
2.2. Changes in attitudes towards tobacco and e-cigarettes, after viewing an on-line advert, will be sustained after a week.

3. Previous literature has shown that mass anti-smoking marketing campaigns have effectively encouraged quit attempts and reduced tobacco smoking prevalence in adults. It has not been tested whether anti-smoking campaigns may have an effect on attitudes towards e-cigarettes. Alternatively e-cigarette advertising may undermine the positive effect of health messages on tobacco smokers.
3.1. Attitudes towards e-cigarettes at baseline may moderate the effects of message efficacy on post message tobacco attitudes, with higher e-cigaratte attitudes being linked to lower levels of tobacco attitude change.

Ethics approval

London South Bank University Research Ethics Committee, 2 March 2016. ref: UREC 1602

Study design

Single-centre study with a pre and post interventional, between participant design.

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use contact details to request a participant information sheet


Implicit and Explicit Attitudes


In each experiment, participants will be stratified into a smoking, vaping or non-smoking group. Each participant will then be randomly assigned to either the advert or control condition using an Excel-based covariate adaptive randomization program. In Experiment 1 the advert group is shown an image of an on-line e-cigarette advert and the control group a similar image of a toothpaste advertisement. In Experiment 2, the advert group will view an anti-smoking image and the control group a similar image advertising train travel. After viewing the image the participants complete the same two computer based attitude tasks. The same tests are repeated one week later.

Intervention type



Drug names

Primary outcome measures

1.Measures of implicit attitude based on reaction time will be collected using two Single Target, Personalised, Implicit Attitude Tests (SC-IAT-P) for E-cigarettes and tobacco cigarettes
2.Measures of explicit attitude will be collected based on ratings from a 7 point Likert scale (strongly agree to strongly disagree) of 10 different bi-polar statements (For example,‘thinking about e-cigarettes/tobacco cigarettes, please indicate if you think they are: bad/good)

All data will be collected pre-intervention, 48-72 hours later post intervention and at a 1 week follow-up.

Secondary outcome measures

Information will be gathered for experimental control at baseline.
1. Current usage and dependence on cigarettes
2. Strength of beliefs about e-cigarettes
3. Motivation to quit and the number of previous quit attempts
4. Awareness of e-cigarette advertising and anti-smoking campaigns

Overall trial start date


Overall trial end date


Reason abandoned


Participant inclusion criteria

1.18 to 25 years old
2. smoker, vaper or non-smoker but not a dual user (i.e. both smoker and vaper).

Participant type

Healthy volunteer

Age group




Target number of participants

E-cigarette online advert intervention n=150; On-line anti-smoking message intervention n=150

Participant exclusion criteria

1. Breastfeeding
2. Pregnant
3. Serious medical condition
4. Both a smoker and a vaper
5. Outside the age range of 18 to 25 years old

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

London South Bank University
103 Borough Road
United Kingdom

Sponsor information


London South Bank University

Sponsor details

Division of Psychology (School of Applied Sciences)
London South Bank University
103 Burrough Road
United Kingdom

Sponsor type




Funder type


Funder name

Cancer Research UK

Alternative name(s)


Funding Body Type

private sector organisation

Funding Body Subtype

other non-profit


United Kingdom

Results and Publications

Publication and dissemination plan

1. Planned publication in a peer reviewed journal.
Planned presentation at an international conference.

Intention to publish date


Participant level data

To be made available at a later date

Results - basic reporting

Publication summary

Publication citations

Additional files

Editorial Notes