Factors Affecting the Perceived Effectiveness of Pictorial Health Warnings on Cigarette Packages in Gulf Countries: A Cross-sectional Study

Abstract

Objectives:To explore the perceived effectiveness of pictorial health warning (PHW) labels required by the Gulf Cooperation Council, to compare them with the Food and Drug Administration–approved PHW labels, and to determine factors affecting their perceived effectiveness.Methods:A cross-sectional study using a convenience sample of adult smokers and nonsmokers was conducted. The data were collected through a self-administered online questionnaire. The perceived effectiveness scores of PHW labels were calculated and compared among different subgroups using the Kruskal-Wallis test and the Dunn multiple comparison test at a .05 significance level.Results:Of the 90 people invited to participate in the survey, 77 (86%) completed it, with 39 (50%) nonsmokers, 22 (29%) smokers, and 16 (21%) former smokers. Overall, labels having graphic images of illness or pathology are perceived to be most effective. Smokers generally perceived labels significantly less effective compared with former smokers and nonsmokers. Also, 55 respondents (71%) suggested that the presence of a telephone quit-line would be effective.Conclusions:Smoking status and image type had the most effect on the perceived effectiveness of the PHW labels on cigarette packs. Pictorial health warning labels with graphic images of pathology and a telephone quit-line are perceived to be most effective.

Perceived Dissuasiveness of Cigarette Health Warning Messages Among Smokers and Nonsmokers in Anambra State, Nigeria

“…Their perception gives a hint that the GHWMsare likely to have a boomerang effect on smokers. These findings are similar to those from the study conducted by Mansour and Bakhsh (2017) which showed that smokers generally perceived labels as significantly less effective compared with former smokers and nonsmokers. Qualitative data which showed that the smokers perceive the Health Warning Messages as exaggerated and unable to make smokers quit, gave a deeper insight into their perception.…”

“…Graphic warnings, on the other hand, were given higher effectiveness ratings than symbolic or testimonial warnings (p<0.001). In a similar study, Mansour and Bakhsh (2017) found that overall, the labels that had graphic images of illness or pathology were perceived to be most effective. However, some Text-only Health Warning Messages have been found to be perceived as more effective than others.…”

“…This is also the same for perceived dissuasiveness. In a study conducted by Mansour and Bakhsh (2017), smokers generally perceived labels as significantly less effective compared with former smokers and nonsmokers.…”

Perceived Effectiveness of Differing Health Warning Label Messaging Strategies among Adults in the Republic of Georgia: One Size Does Not Fit All

“…While pictorial HWLs have been shown to be effective in general, the impact of images and messaging differs based on the content. For example, graphic images displaying pathology of illness have been shown to be more effective than abstract images [ 24 ]. In fact, benign or abstract pictorial warnings that do not provoke emotional reaction (e.g., images depicting a skull or burned fingertips) may be less effective than text-only labels [ 24 ].…”

“…For example, graphic images displaying pathology of illness have been shown to be more effective than abstract images [ 24 ]. In fact, benign or abstract pictorial warnings that do not provoke emotional reaction (e.g., images depicting a skull or burned fingertips) may be less effective than text-only labels [ 24 ]. However, when faced with pictorial HWLs vividly depicting the threat of tobacco-related illness, smokers may have an “optimistic bias,” unrealistically believing they are not susceptible to illness [ 25 ].…”