Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs

Abstract

Purpose Pictorial cigarette pack warnings are a promising policy solution to increase smoking cessation among adults. However, little is known regarding adolescents' responses to pictorial warnings, particularly in real-world settings. Methods Participants were 112 adolescent children, ages 13–17, whose parents received either text-only warnings on the side of their cigarette packs or pictorial warnings on the top half of the front and back of their cigarette packs for 4 weeks as part of a trial. We measured adolescents' recall and recognition of these warnings, negative emotional reactions to the warnings, perceived effectiveness of the warnings, social interactions about the warnings, and smoking risk beliefs. Results Adolescents accurately recalled pictorial warnings more often than text-only warnings (82% vs. 19%, p < .001). Recognition of warnings was also higher for pictorial than text-only warnings (82% vs. 34%, p < .001). Pictorial warnings drew greater attention (p < .001), elicited greater negative emotional reactions (p < .05), and sparked more social interactions (p < .01) than text-only warnings. Conclusions Pictorial warnings on cigarette packs may have important effects on adolescent children of smokers. Future research should further investigate the impact of such messages on adolescents' susceptibility to smoking initiation and interest in quitting smoking, particularly as the United States and other countries work to implement pictorial warning regulations.

“That’s probably what my mama’s lungs look like”: how adolescent children react to pictorial warnings on their parents’ cigarette packs

“…We found that pictorial warnings cued conversations among adolescents [ 15 ], building on previous research that pictorial warnings spark conversations among adults [ 5 , 26 – 28 ] (Morgan JC, Golden SD, Noar SM, Ribisl KM, Southwell BG, Jeong M, Hall MG, Brewer NT: Conversations about pictorial cigarette pack warnings: Theoretical mechanisms of influence impact quit attempts, submitted). Pictorial warnings offered an important opportunity for adolescents to broach the topic of smoking cessation with their parents (and sometimes with their friends).…”

“…Another found that strong negative emotions mediate the relationship between perceived graphicness of cigarette warning labels and increased negative beliefs about smoking [ 14 ]. One limitation of past research on adolescents’ responses to pictorial warnings is that studies have been conducted almost exclusively in laboratory settings [ 15 ]. Also, there is a lack of research that specifically investigates how the vulnerable population of children of smokers react to pictorial warning labels.…”

“…The RCT presented a unique opportunity to interview adolescent children of parents who participated in the trial. A quantitative study of these adolescents found that exposure to pictorial warnings was associated with more attention and greater recall [ 15 ]. Here, we examine the qualitative findings from in-depth interviews with a subset of these adolescents to understand their reactions to and experiences with pictorial warnings, advancing the science of how pictorial warning labels work.…”

Influence of Health Warnings on Beliefs about the Health Effects of Cigarette Smoking, in the Context of an Experimental Study in Four Asian Countries

“…Health warnings on tobacco packaging are among the most cost-effective policy interventions to communicate health information, given their reach and frequency of exposure [ 13 , 14 ]. Although text-only warnings can be effective at informing smokers of health effects [ 13 ], pictorial warnings are acknowledged as superior to text-only warnings on most metrics [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], particularly if they are prominent and feature graphic, emotion-arousing images [ 13 , 20 ]. A recent meta-analysis of experimental studies concluded that, compared to text-only warnings, pictorial warnings were more effective for attracting and holding attention, eliciting stronger cognitive and emotional reactions, eliciting more negative attitudes toward packs/brands and to smoking, and increasing intentions to quit or not start smoking [ 14 ].…”

The Prototypes of Tobacco Users Scale (POTUS) for Cigarette Smoking and E-Cigarette Use: Development and Validation

“…Finally, we recruited 112 adolescent children of adults (age range: 13–17 years) who participated in the RCT for an ancillary study of responses to pictorial warnings on the parents’ cigarette packs. A full description of the study design, recruitment, and procedures appears elsewhere [ 35 ]. We conducted phone interviews with the adolescents and provided a $40 incentive.…”