Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019

• Published in: BMJ open 2021-01, Vol.11 (1), p.e041324-e041324
• Main Authors: Lee, Joseph G L, Cristello, Julie V, Buckton, Christina H, Carey, Rachel N, Trucco, Elisa M, Schenk, Paulina M, Ikegwuonu, Theresa, Hilton, Shona, Golden, Shelley D, Conway, David I
• Format: Article
• Language: English
• Subjects: Adult; Advocacy; Alcohol; Cancer; Child; Commerce; Costs and Cost Analysis; Delivery of Health Care - economics; Excise taxes; Factorial experiments; Food; Health care expenditures; Health Communication - economics; Health Policy; Humans; Interviews; Medical research; Neoplasms - prevention & control; Prevention; preventive medicine; Preventive Medicine - economics; Pricing policies; Public Health; Taxation; Taxes; Tobacco; United Kingdom
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-041324

ObjectivesTo advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products.DesignWe designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products.SettingOnline survey panel (Qualtrics) in 2019.ParticipantsAdults (N=1850) from the UK and USA.InterventionsParticipants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods).Primary and secondary outcome measuresWe assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one’s freedom limited.ResultsWe found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies.ConclusionsCancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.