Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment

Abstract

BackgroundThe U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups.Methods/FindingsParticipants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22−1.62), and intention to quit (OR = 1.30, 95% CI = 1.10−1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057).ConclusionsFindings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.

Perceptions and Perceived Impact of Graphic Cigarette Health Warning Labels on Smoking Behavior Among U.S. Young Adults

“…Hispanic ethnicity, however, remained an important predictor of anticipated behavior among specific subgroups of young adult cigarette smokers. Cantrell et al (2013) found that graphic HWLs were similarly effective across racial/ethnic subgroups among an adult population of smokers. Our findings suggest that graphic labels may be more effective among 18-to 34-year-old Hispanic lighter, nondaily, and "social" smokers, suggesting there may be subgroups within the smoking population among whom graphic warning labels will have greater impact.…”

“…Graphic HWLs also lead some viewers to forego cigarettes, a behavioral reaction that, along with cognitions about quitting, is one of the strongest predictors of subsequent quitting . A recent randomized controlled trial showed that the nine FDA graphic warning labels had a consistently greater impact than text-only labels on message salience, perceived impact, credibility, and intention to quit across diverse populations (Cantrell et al, 2013).…”

Assessing the Consequences of Implementing Graphic Warning Labels on Cigarette Packs for Tobacco-Related Health Disparities

“…Cantrell and colleagues 18 found no significant interaction between race/ethnicity or education and treatment condition (GWLs or TWLs) on salience, perceived impact, credibility, or quit intentions. In similar studies, Hammond and colleagues 19 found no significant condition-by-education interaction on overall perceived effectiveness of the warnings and Thrasher and colleagues 20 found no significant condition-by-race interactions on credibility, believability, or personal relevance of the warnings.…”

“…Other studies suggest that GWLs are as effective among disadvantaged groups as among the general population [18][19][20][21] and thus have a neutral effect on disparities. Cantrell and colleagues 18 found no significant interaction between race/ethnicity or education and treatment condition (GWLs or TWLs) on salience, perceived impact, credibility, or quit intentions.…”

Eye-Tracking Analysis of the Figures of Anti-Smoking Health Promoting Periodical’s Illustrations1

“…In the same year University of South Carolina: terrifying images are more effective then informing pictures by a study done in Canada, Mexico, Brazil (Cantrell et al, 2013). A cross-sectional study in England in 2008 and in 2011, including 11-16 year-old, about 1400 people, where groups were: non-smokers, experimental and regular smokers.…”