Adolescents’ and Young Adults’ Aesthetics and Functionality Preferences for Online Tobacco Education

  • Allison J. LazardEmail author
  • Jessica Pikowski
  • Lindsey Horrell
  • Jennifer Cornacchione Ross
  • Seth M. Noar
  • Erin L. Sutfin


As cigarette use rates decline among adolescents and young adults, public health officials face new challenges with high use of non-cigarette tobacco products (NCTPs). Online tobacco education is a potential solution to discourage use, yet limited information is available for how online media should look and function. This study aims to fill this gap by conducting focus group interviews to identify adolescents and young adults’ aesthetic and functionality preferences for online tobacco education (phase 1) followed by interviews to assess a NCTP education website developed (phase 2). We found preferences for use of font and colors to highlight tobacco information in organized designs. Interactive features (quizzes) motivated engagement, and participants desired responsive designs that function similarly across devices. Public health researchers and educators should apply aesthetic and functionality preferences to reduce NCTP use and help create a tobacco-free future for youth.


eHealth Tobacco prevention and control Health communication Health promotion User experience 


Funding Information

Research reported in this publication was supported by P50CA180907 from the National Cancer Institute and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Compliance with Ethical Standards

This study was approved by [the University of North Carolina] IRB.


  1. 1.
    Singh T, Arrazola R, Corey CG et al (2016) Tobacco use among middle and high school students—United States, 2011–2015. Morb Mortal Wkly Rep 65:361–367CrossRefGoogle Scholar
  2. 2.
    Cornacchione J, Wagoner KG, Wiseman KD, Kelley D, Noar SM, Smith MH, Sutfin EL (2016) Adolescent and young adult perceptions of hookah and little cigars/cigarillos: implications for risk messages. J Health Commun 21:818–825CrossRefGoogle Scholar
  3. 3.
    Wagoner KG, Cornacchione J, Wiseman KD, Teal R, Moracco KE, Sutfin EL (2016) E-cigarettes, hookah pens and vapes: adolescent and young adult perceptions of electronic nicotine delivery systems. Nicotine Tob Res 18:2006–2012CrossRefGoogle Scholar
  4. 4.
    Montazeri Z, Nyiraneza C, El-Katerji H et al (2017) Waterpipe smoking and cancer: systematic review and meta-analysis. Tob Control 26:92–97CrossRefGoogle Scholar
  5. 5.
    Pisinger C, Døssing M (2014) A systematic review of health effects of electronic cigarettes. Prev Med 69:248–260CrossRefGoogle Scholar
  6. 6.
    Chang CM, Corey CG, Rostron BL, Apelberg BJ (2015) Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health 15:390CrossRefGoogle Scholar
  7. 7.
    Pew Research Center. 2018. Mobile fact sheet. February 5, 2018; Available from: Accessed 20 Oct 2018
  8. 8.
    Lindgaard G, Fernandes G, Dudek C, Brown J (2006) Attention web designers: you have 50 milliseconds to make a good first impression! Behav Inform Technol 25:115–126CrossRefGoogle Scholar
  9. 9.
    Sillence E, Briggs P, Harris P, Fishwick L (2007) Going online for health advice: changes in usage and trust practices over the last five years. Interact Comput 19:397–406CrossRefGoogle Scholar
  10. 10.
    Palmer JW (2002) Web site usability, design, and performance metrics. Inf Syst Res 13:151–167CrossRefGoogle Scholar
  11. 11.
    Seo K-K, Lee S, Chung BD, Park C (2015) Users’ emotional valence, arousal, and engagement based on perceived usability and aesthetics for web sites. Int J Hum Comput Interact 31:72–87CrossRefGoogle Scholar
  12. 12.
    Eysenbach G (2005) Design and evaluation of consumer health information web sites. In: Consumer health informatics. Springer, New York, pp 34–60CrossRefGoogle Scholar
  13. 13.
    Webster J, Ahuja JS (2006) Enhancing the design of web navigation systems: the influence of user disorientation on engagement and performance. MIS Q 30:661–678CrossRefGoogle Scholar
  14. 14.
    Yu N, Kong J (2016) User experience with web browsing on small screens: experimental investigations of mobile-page interface design and homepage design for news websites. Inf Sci 330:427–443CrossRefGoogle Scholar
  15. 15.
    King, BA, Patel, R, Nguyen, K, et al. 2014. Trends in awareness and use of electronic cigarettes among US adults, 2010-2013. Nicotine & Tobacco Research ntu191Google Scholar
  16. 16.
    Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK (1996) Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol 15:355–361CrossRefGoogle Scholar
  17. 17.
    Duke JC, Alexander TN, Zhao X, Delahanty JC, Allen JA, MacMonegle AJ, Farrelly MC (2015) Youth’s awareness of and reactions to the real cost national tobacco public education campaign. PLoS One 10:e0144827CrossRefGoogle Scholar
  18. 18.
    Farrelly MC, Davis KC, Duke J, Messeri P (2009) Sustaining ‘truth’: changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign. Health Educ Res 24:42–48CrossRefGoogle Scholar
  19. 19.
    Thomas DR (2006) A general inductive approach for analyzing qualitative evaluation data. Am J Eval 27:237–246CrossRefGoogle Scholar
  20. 20.
    Moshagen M, Thielsch MT (2010) Facets of visual aesthetics. Int J Hum Comput Stud 68:689–709CrossRefGoogle Scholar
  21. 21.
    Lazard AJ, Mackert M (2015) E-health first impressions and visual evaluations: key design principles for attention and appeal. Commun Des Quart 3:25–34Google Scholar
  22. 22.
    Nielsen, J. 2003. The ten most violated homepage design guidelines. Available from:
  23. 23.
    Minear M, Brasher F, McCurdy M, Lewis J, Younggren A (2013) Working memory, fluid intelligence, and impulsiveness in heavy media multitaskers. Psychon Bull Rev 20:1274–1281CrossRefGoogle Scholar
  24. 24.
    Seckler M, Opwis K, Tuch AN (2015) Linking objective design factors with subjective aesthetics: an experimental study on how structure and color of websites affect the facets of users’ visual aesthetic perception. Comput Hum Behav 49:375–389CrossRefGoogle Scholar
  25. 25.
    Richardson RT, Drexler TL, Delparte DM (2014) Color and contrast in E-learning design: a review of the literature and recommendations for instructional designers and web developers. J Online Learn Teac 10:657–669Google Scholar
  26. 26.
    Ralph BC, Thomson DR, Cheyne JA et al (2014) Media multitasking and failures of attention in everyday life. Psychol Res 78:661–669CrossRefGoogle Scholar
  27. 27.
    Juni S, Gross JS (2008) Emotional and persuasive perception of fonts. Percept Mot Skills 106:35–42CrossRefGoogle Scholar
  28. 28.
    Brumberger E (2003) The rhetoric of typography: the persona of typeface and text. Tech Commun 50:206–223Google Scholar
  29. 29.
    Anderson, J and Rainie, L. 2012. Main findings: teens, technology, and human potential in 2020. Available from: Accessed 20 Oct 2018
  30. 30.
    Scacco JM, Muddiman A, Stroud NJ (2016) The influence of online quizzes on the acquisition of public affairs knowledge. J Inform Tech Polit 13:311–325CrossRefGoogle Scholar
  31. 31.
    Lustria MLA (2007) Can interactivity make a difference? Effects of interactivity on the comprehension of and attitudes toward online health content. J Assoc Inf Sci Technol 58:766–776CrossRefGoogle Scholar
  32. 32.
    Ancker JS, Chan C, Kukafka R (2009) Interactive graphics for expressing health risks: development and qualitative evaluation. J Health Commun 14:461–475CrossRefGoogle Scholar
  33. 33.
    Oh J, Sundar SS (2015) How does interactivity persuade? An experimental test of interactivity on cognitive absorption, elaboration, and attitudes. J Commun 65:213–236CrossRefGoogle Scholar
  34. 34.
    McCleary-Sills JD, Villanti A, Rosario E, Bone L, Stillman F (2010) Influences on tobacco use among urban Hispanic young adults in Baltimore: findings from a qualitative study. Prog Community Health Partnersh 4:289–297PubMedPubMedCentralGoogle Scholar
  35. 35.
    Hou S-I, Cao X (2018) A systematic review of promising strategies of faith-based cancer education and lifestyle interventions among racial/ethnic minority groups. J Cancer Educ 33:1161–1175CrossRefGoogle Scholar
  36. 36.
    Sanders J, Munford R (2017) Hidden in plain view: finding and enhancing the participation of marginalized young people in research. Int J Qual Methods 16(1):–12 160940691770476Google Scholar
  37. 37.
    Ewing A, Thompson N, Ricks-Santi L (2015) Strategies for enrollment of African Americans into cancer genetic studies. J Cancer Educ 30:108–115CrossRefGoogle Scholar
  38. 38.
    Rait MA, Prochaska JJ, Rubinstein ML (2015) Recruitment of adolescents for a smoking study: use of traditional strategies and social media. Transl Behav Med 5:254–259CrossRefGoogle Scholar
  39. 39.
    Diviak KR, Wahi S, O’Keefe J et al (2006) Recruitment and retention of adolescents in a smoking trajectory study: who participates and lessons learned. Subst Use Misuse 41:175–182CrossRefGoogle Scholar
  40. 40.
    Unger JB, Cabassa L, Molina G et al (2000) English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms. Health Psychol 19:403–410CrossRefGoogle Scholar

Copyright information

© American Association for Cancer Education 2019

Authors and Affiliations

  1. 1.School of Media and JournalismUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Center for Health Policy Science & Tobacco Research, RTI InternationalResearch Triangle ParkUSA
  4. 4.Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  5. 5.School of NursingUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Wake Forest School of MedicineWinston-SalemUSA

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