Framing Pictorial Cigarette Warning Labels to Motivate Young Smokers to Quit

Abstract

Introduction: The Family Smoking Prevention and Tobacco Control Act requires new pictorial warnings for U.S. cigarette packs, but enactment has been delayed by tobacco industry lawsuits. Research can inform implementation of the pictorial warning requirement and identify ways to optimize their public health impact post-implementation. This study investigated the impact of warning label message framing on young smokers' motivation to quit, examining cessation selfefficacy, and perceived risks as moderators of message framing impact. Methods: Smokers ages 18-30 (n = 740) completed baseline measures and were randomized to view 4 images of cigarette packs with pictorial health warnings featuring gain-or loss-framed messages. Motivation to quit was assessed after participants viewed the pack images. Linear models accounting for repeated measures and adjusting for baseline covariates examined the impact of message framing and interactions with baseline self-efficacy to quit and perceived risks of smoking. Results: Loss-framed warnings prompted significantly greater motivation to quit among smokers with high self-efficacy compared with smokers with low self-efficacy. Among smokers with low self-efficacy, gain-framed messages were superior to loss-framed messages. Gain-framed warnings generated significantly greater motivation to quit among smokers with high perceived risks compared with smokers with low perceived risks. Among smokers with high perceived risks, gainframed messages were superior to loss-framed messages. Conclusions: A combination of pictorial warnings featuring risk-based (i.e., loss-framed) and efficacy-enhancing (i.e., gain-framed) information may promote better public health outcomes. Research is needed to investigate how strategically framed warning messages impact smokers' behaviors based on their pre-existing attitudes and beliefs in real-world settings.

The influence of framed messages and self-affirmation on indoor tanning behavioral intentions in 18- to 30-year-old women.

“…Then, participants completed outcome measures of behavioral intentions and their cognitive and emotional responses to the framed messages. All measures used items that were validated in prior research, including studies examining the effects of self-affirmation and message framing on related cancer risk behaviors (Mays, et al, 2014; Mays & Tercyak, 2015; Zhao & Nan, 2010). Outcome measures of behavioral intentions were similar to assessments of intentions to IT and intentions to quit IT administered before participants viewed the messages but were slightly adapted to avoid habituation that may occur due to the short timeframe of the experiment (Mays et al, 2014).…”

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults

“…The study conducted to inform the U.S. Food and Drug Administration’s (FDA) selection of the final graphic warnings utilized self-reported emotional and cognitive reactions, recall, beliefs about the health risks of smoking, and intention to quit as outcomes, which are all explicit measures (Nonnemaker, Choiniere, Farrelly, Kamyab, & Davis, 2015). One small experimental study reported that exposure to the graphic warning labels that were high in emotional reactivity reduced the electrophysiological brain response to smoking cues (Wang, Lowen, Romer, Giorno, & Langleben, 2015), but other recent studies on the impact of the FDA’s final proposed graphic warnings have relied on self-reported explicit outcome measures (Cameron, Pepper, & Brewer, 2013; Cantrell et al, 2013; Hammond, Reid, Driezen, & Boudreau, 2013; Mays et al, 2014; Nonnemaker et al, 2015; Villanti, Cantrell, Pearson, Vallone, & Rath, 2014). …”

A Review on the Effects of Health Warnings Printed on Cigarette Packages on Smokers

“…Konu ile ilgili çalýþmalarýn bulgularý zarar çerçeveli sigara uyarýlarýnýn yarar çerçeveli uyarýlara göre daha etkili olduðuna iþaret etse de, bu etkinin öz-yeterlilik ve sigara içmekle iliþkili risk algýsýna göre deðiþebileceði de öne sürülmektedir (31). Bulgular, bu öneriyi destekleyecek þekilde, yarar çerçeveli mesajlar (örn., sigarayý býrakmak kanser riskini azaltýr) yerine zarar çerçeveli mesajlara (örn., sigara içmek kansere neden olur) maruz kaldýk-larýnda, öz yeterliliði yüksek olan katýlýmcýlarýn düþük olanlara göre sigarayý býrakma niyetlerinin daha yüksek olduðunu göstermiþtir.…”

“…Bulgular, bu öneriyi destekleyecek þekilde, yarar çerçeveli mesajlar (örn., sigarayý býrakmak kanser riskini azaltýr) yerine zarar çerçeveli mesajlara (örn., sigara içmek kansere neden olur) maruz kaldýk-larýnda, öz yeterliliði yüksek olan katýlýmcýlarýn düþük olanlara göre sigarayý býrakma niyetlerinin daha yüksek olduðunu göstermiþtir. Yarar çerçeveli mesajlara maruz kaldýklarýnda ise sigara ile ilgili risk algýsý yüksek olan katýlýmcýlarýn düþük olanlara göre sigarayý býrakma niyetlerinin daha yüksek olduðu bulunmuþtur (31)…”

“…Bu mesajlarýn çerçevesine iliþkin yürütülen çalýþmalar genellikle zarar çerçeveli mesajlarýn (örn., sigara içmek akciðer kanserine yakalanma riskini arttýrýr) yarar çerçeveli mesajlara (örn., sigarayý býrakmak akciðer kanserine yakalanma olasýlýðýný azaltýr) göre daha etkili olduðuna iþaret etmektedir (23,29,30). Ancak, yakýn dönemde yürütülen bir çalýþmada zarar çerçeveli mesajlarýn öz yeterliliði yüksek bireylerde daha etkili olduðu bildirilmektedir (31). Buradan yola çýkarak, zarar çerçeveli sigara uyarýlarýnýn öz-yeterliliði arttýracak þekilde hazýrlanmasý öne-rilmektedir.…”