Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position

Abstract

Rationale Graphic health warnings (GHWs) on cigarette packages present an important tobacco control opportunity, particularly for vulnerable populations suffering a disproportionate tobacco burden. One mechanism by which GHWs may influence smoking outcomes is by prompting interpersonal discussions within health discussion networks (the set of personal contacts with whom an individual discusses health issues). Objective The study examined the association between GHW-prompted conversations within health discussion networks and key tobacco-related outcomes, with attention to valence and content of the discussions. Method Between August 2013 and April 2014, we recruited 1200 individuals from three communities in Massachusetts, emphasizing recruitment of individuals of low socioeconomic position (SEP) and members of other selected vulnerable groups. Respondents were exposed to the nine GHWs proposed by the FDA in 2011, asked a series of questions, and assessed at follow-up a few weeks later. Results A total of 806 individuals were included in this analysis. About 51% of respondents reported having a health discussion network, with significantly lower reports among African-Americans and Hispanics compared to Whites. Around 70% of respondents (smokers and nonsmokers) with health discussion networks reported having one or more conversations about the GHWs with network members, the bulk of which were negative and focused on warning others about smoking. For smokers, we found a small but positive association between the percentage of network conversations that were negative and reports of quit attempts. Conclusion The results point to a potential mechanism by which GHWs may impact tobacco-related outcomes, prompting further inquiry into the role of health discussion networks (and discussion networks, more broadly) in tobacco control among low SEP individuals.

Evaluation of graphic messages to promote human papillomavirus vaccination among young adults: A statewide cross-sectional survey

“…Consistent with research suggesting that responses differ by the media consumer's background (Ramanadhan et al, 2017), in the present study, we found that gender, race, HPV vaccination status and eHealth literacy showed small but statistically significant effects on graphic response. Additionally, we did not assess effects of vaccine framing in the present study, but it is possible that message framing may have a greater effect on message appeal and persuasion than graphic type.…”

Frequency and Content of Conversations About Pictorial Warnings on Cigarette Packs

“…Those that have primarily examined the frequency rather than the content of these interactions. [23][24][25][26][27] In our trial, we sought to describe the frequency, content, and nature of adult smokers' social interactions about pictorial cigarette pack warnings in the context of a randomized controlled trial that allowed for a robust comparison with text-only warnings. Characterization of social interactions about pictorial cigarette pack warnings with a large sample studied longitudinally can provide tobacco control policy makers and health communication theorists with a better understanding of how social interactions triggered by warnings may affect smoking.…”

Conversations about pictorial cigarette pack warnings: Theoretical mechanisms of influence

“…In practice, countries often put multiple pictorial warnings in circulation, to capture people’s attention and lessen wear-out. Also, warnings on the packs of other smokers in their social networks may increase the opportunities for both conversations and secondary diffusion of the messages, presenting an additional way for conversations to impact behavior (Ramanadhan et al, 2017; Southwell and Yzer, 2007).…”

“…Furthermore, smoking behavior frequently happens in social settings (Moran et al, 2004; Schane et al, 2009), offering openings for conversations to take place. Several studies have found face-to-face or online social interactions were positively associated with motivation to stop smoking (Depue et al, 2015; Dunlop et al, 2008a, 2008b; Durkin and Wakefield, 2006; Hafstad et al, 1997, 1996; Ramanadhan et al, 2017; Schuster et al, 2006; Van Den Putte et al, 2011).…”