Evaluation of Graphic Cigarette Warning Images on Cravings to Smoke

Abstract

While health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.

Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments

“…29 While few studies reported validity data, some studies indicated that measures were validated in previous research. 30,49 Newer studies were more likely to report reliability data for multi-item measures, sources of measures, and theories.…”

“…Warning reactions were measured in 42 studies. 21,[26][27][28][29][30][31][36][37][38][39][41][42][43][44][45][46][47][48][49][50][51][52]54,55,[57][58][59][60][61][62][63][64][65][66][67][68] Affective reactions were assessed in 24 of those studies, mostly with multi-item scales (α range = 0.74-0.98). 21,27,36,38,39,[41][42][43]45,47,48,54,[58][59][60...…”

“…30 Three of the 5 studies assessing smoking cravings (the extent to which one desires a cigarette) used multiple items (r = 0.33-0.35). 21,49,61,64,66 Lin, for example, used a 10-item questionnaire to assess smoking cravings. 49 Three studies also assessed clarity, 2 of which used multiple items (r = 0.65).…”

Antismoking Advertisements and Price Promotions and Their Association With the Urge to Smoke and Purchases in a Virtual Convenience Store: Randomized Experiment

“…After the warning signs were posted, visitors to New York City retail stores who viewed the warning signs (and protobacco advertising) were significantly more likely to report that the signs made them think about the health risks of smoking or quitting smoking compared with those who visited the stores before the warning signs were posted [9]. Similarly, graphic warning labels on cigarette packs have been associated with lower cravings to smoke [16].…”

“…Given the evidence establishing a relationship between warning images and cravings to smoke [16], we hypothesized that participants exposed to antismoking ads would report lower urges to smoke and purchase fewer tobacco products in iShoppe. We also hypothesized that participants exposed to price promotions would report greater urges to smoke and be more likely to purchase tobacco products than those who were not exposed to promotions.…”