Differences in smokers’ awareness of the health risks of smoking before and after introducing pictorial tobacco health warnings: findings from the 2012–2017 international tobacco control (ITC) Netherlands surveys

Abstract

Background As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups. Methods We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses. Results Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p < 0.001) and knowledge about the health risks of smoking (β = 0.184, p < 0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012–2015 (p values of interactions: p = 0.002 and p < 0.001 respectively). Compared to high educated smokers, low educated smokers (β = − 1.137, p < 0.001) and moderate educated smokers (β = − 0.894, p < 0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017. Conclusions Introducing PHWs coincided with an increase in smokers’ knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers’ awareness of the health risks of smoking even more, especially among low educated smokers.

Awareness of Common Cancer Risk Factors and Symptoms in Saudi Arabia: A Community-Based Study

“…This is supported by Al-Azri et al, (2014) and Schliemann et al, (2020) which mentioned smoking as the highest risk factor for cancer. The public generally has a high level of knowledge of the dangers of smoking due to ongoing campaigns to raise awareness about smoking's consequences on people's health (Van Mourik, 2020). An unhealthy diet was the second most identified risk factor (37.2%) in this study.…”

Why are anti‐smoking health‐information interventions less effective among low‐socioeconomic status groups? A systematic scoping review

“…Cognition [22,26,35,47,52] involves factors related to an individual's capacity to absorb and understand a HII's message. Cantrell et al .…”

“…Springvloet et al [47] suggested that educational differences may have affected their participants' awareness and memory of the HII message, which could explain why it was ineffective among those from low-SES groups. Similarly, Van Mourik et al [52] suggest that more-educated individuals have more experience with health information, and thus understand it better. The central argument of these studies, thus, is that low-SES individuals generally have more difficulties to understand or absorb the HII message.…”

“…Cognition. Cognition [22,26,35,47,52] involves factors related to an individual's capacity to absorb and understand a HII's message. Cantrell et al [22], for example, stated that 'cognitive processing may be enhanced by visceral graphic pictures designed to clearly illustrate the meaning of text messages by reducing potential variation across groups in interpretation of textual information due to differences in literacy, culture, language or prior health knowledge'.…”

Subjective knowledge of Brazilian adolescent students about the health effects of smoking: association with smoking status / Conhecimento subjetivo dos estudantes adolescentes brasileiros sobre os efeitos do fumo na saúde: associação com o status de fumante

“…Noticing health warning labels on cigarette packages has been associated with increased cognition about the harms of smoking [28][29][30][31][32][33] Health Organization to help countries controlling the smoking epidemics worldwide 1 .…”