Analysis of Legal and Scientific Issues in Court Challenges to Graphic Tobacco Warnings

Kraemer, John; Baig, Sabeeh A

doi:10.1016/j.amepre.2013.05.004

Cited by 35 publications

(42 citation statements)

References 18 publications

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“…1 The implementation of PWLs in the USA has been delayed because of a lawsuit by tobacco companies. 2 One way to help to respond to legal challenges is by demonstrating that the images do not communicate a separate message but only reinforce the text, emphasise its salience and increase the likelihood that the risk message will be remembered. 2 However, the nine PWLs proposed by the FDA vary in their degree of congruency between visual and textual information.…”

Section: Introductionmentioning

confidence: 99%

“…2 One way to help to respond to legal challenges is by demonstrating that the images do not communicate a separate message but only reinforce the text, emphasise its salience and increase the likelihood that the risk message will be remembered. 2 However, the nine PWLs proposed by the FDA vary in their degree of congruency between visual and textual information. In congruent PWLs, visual and textual features reflect a common theme (eg, the image portrays a diseased lung, while the text states 'Cigarettes cause fatal lung disease').…”

Section: Introductionmentioning

confidence: 99%

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Effect of message congruency on attention and recall in pictorial health warning labels

et al. 2017

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Objective The nine pictorial health warning labels (PWLs) proposed by the US Food and Drug Administration vary in format and feature of visual and textual information. Congruency is the degree to which visual and textual features reflect a common theme. This characteristic can affect attention and recall of label content. This study investigates the effect of congruency in PWLs on smoker’s attention and recall of label content. Methods 120 daily smokers were randomly assigned to view either congruent or incongruent PWLs, while having their eye movements recorded. Participants were asked to recall label content immediately after exposure and 5 days later. Results Overall, the image was viewed more and recalled better than the text. Smokers in the incongruent condition spent more time focusing on the text than smokers in the congruent condition (p=0.03), but dwell time of the image did not differ. Despite lower dwell time on the text, smokers in the congruent condition were more likely to correctly recall it on day 1 (p=0.02) and the risk message of the PWLs on both day 1 (p=0.01) and day 5 (p=0.006) than smokers in the incongruent condition. Conclusions This study identifies an important design feature of PWLs and demonstrates objective differences in how smokers process PWLs. Our results suggest that message congruency between visual and textual information is beneficial to recall of label content. Moreover, images captured and held smokers’ attention better than the text.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of message congruency on attention and recall in pictorial health warning labels

et al. 2017

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“…Although one cannot be certain of the legal standard that the courts will apply in evaluating future efforts, one likely analysis hinges on whether GWs are judged to “directly advance” the government's interests in protecting Americans from the negative health effects of smoking [1]. This standard was applied by the DC Circuit, which argued that “The FDA has not provided a shred of evidence … showing that the graphic warnings will ‘directly advance’ its interest in reducing the number of Americans who smoke.” Some legal scholars believe that, if this standard is applied by the Supreme Court, “even without evidence of the impact of graphic warnings on behavior, strong evidence that they affect behavioral intent, and that intent predicts behavior, should be sufficient for the warnings to be upheld” [2] (p. 334). The current project speaks to this legal standard by utilizing experimental methods to examine the effects of GWs on behavioral intention.…”

Section: Introductionmentioning

confidence: 99%

“…Naturalistic investigations of this kind can provide insights into the potential influence of GWs in the US, but they can be limited in two important respects. First, in terms of legal standards, courts have at times have been hesitant to draw strong inferences from data generated in countries other than the US [2], a concern expressed by The DC Circuit. If international data are similarly dismissed or viewed critically in future decisions, data on behavioral intention may be the FDA's best option to establish a government interest.…”

Section: Introductionmentioning

confidence: 99%

Effect of Graphic Cigarette Warnings on Smoking Intentions in Young Adults

et al. 2014

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IntroductionGraphic warnings (GWs) on cigarette packs are widely used internationally and perhaps will be in the US but their impact is not well understood. This study tested support for competing hypotheses in different subgroups of young adults defined by their history of cigarette smoking and individual difference variables (e.g., psychological reactance). One hypothesis predicted adaptive responding (GWs would lower smoking-related intentions) and another predicted defensive responding (GWs would raise smoking-related intentions).MethodsParticipants were an online sample of 1,169 Americans ages 18–24, who were randomly assigned either to view nine GWs designed by the FDA or to a no-label control. Both the intention to smoke in the future and the intention to quit smoking (among smokers) were assessed before and after message exposure.ResultsGWs lowered intention to smoke in the future among those with a moderate lifetime smoking history (between 1 and 100 cigarettes), and they increased intention to quit smoking among those with a heavy lifetime smoking history (more than 100 cigarettes). Both effects were limited to individuals who had smoked in some but not all of the prior 30 days (i.e., occasional smokers). No evidence of defensive “boomerang effects” on intention was observed in any subgroup.ConclusionGraphic warnings can reduce interest in smoking among occasional smokers, a finding that supports the adaptive-change hypothesis. GWs that target occasional smokers might be more effective at reducing cigarette smoking in young adults.

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“…We randomly assigned participants to receive one of nine graphic warnings. In 2011, the US Food and Drug Administration (FDA) proposed these nine warnings for implementation, but the warnings were later challenged in court and are not currently in use 24. At the time of the study, US cigarette packs also included one of four text-only warnings on one side of the pack; these warnings have been in circulation since 1985.…”

Section: Methodsmentioning

confidence: 99%

Testing warning messages on smokers’ cigarette packages: a standardised protocol

et al. 2015

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Purpose Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers’ own packs. Methods We tested a cigarette pack labeling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers’ cigarette packs. Results Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p<.05). Conclusion Our findings suggest a feasible pack labeling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers’ cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomized controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labeling policy.

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Analysis of Legal and Scientific Issues in Court Challenges to Graphic Tobacco Warnings

Cited by 35 publications

References 18 publications

Effect of message congruency on attention and recall in pictorial health warning labels

Effect of message congruency on attention and recall in pictorial health warning labels

Effect of Graphic Cigarette Warnings on Smoking Intentions in Young Adults

Testing warning messages on smokers’ cigarette packages: a standardised protocol

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