Non-Smoking Male Adolescents' Reactions to Cigarette Warnings

Abstract

BackgroundThe U.S. Food and Drug Administration (FDA) is working to introduce new graphic warning labels for cigarette packages, the first change in cigarette warnings in more than 25 years. We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age.MethodsA national sample of 386 non-smoking American males ages 11–17 participated in an online experiment during fall 2010. We randomly assigned participants to view warnings using a 2×2 between-subjects design. The warnings described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette package warnings. Analyses tested whether age moderated the warnings' impact on risk perceptions and smoking motivations.ResultsThe warnings discouraged most adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings did (60% vs. 34% were “very much” discouraged, p<.001). Including an image had no effect on discouragement. The warnings affected several beliefs about the harms from smoking, and age moderated these effects. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They also believed that their true likelihood of experiencing any harm was lower than what an expert would say.ConclusionsOur findings suggest that warnings focusing on lung cancer, rather than addiction, are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking. Including images on warnings had little effect on non-smoking male adolescents' discouragement or beliefs, though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels.

Government Efforts to Aid Consumer Well-Being

“…Evoked fear is found to have a stronger effect than beliefs in mediating the effects of GHWs on quit thoughts for adolescent smokers, yet this is reversed in a longitudinal study of young adult smokers. A recent examination of male, adolescent nonsmoker data (Pepper et al, 2013) reveals that the GHWs discouraged most male adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings. Finally, moderators can have an important impact on the effectiveness of the GHWs.…”

Pictorial cigarette pack warnings: a meta-analysis of experimental studies

“… 10 15–21 However, while some studies find that smokers and non-smokers rate pictorial warnings as more effective than text-only warnings, 22–26 other studies have reported conflicting findings. 27–29 For instance, studies have found that graphic, pictorial warnings result in poorer recall than less graphic or non-graphic warnings, 28 do not increase youth's expectations to be non-smokers a year later, 29 have no effect on beliefs about cancer or addiction among non-smoking adolescent boys, 26 and are effective in lowering smoking intentions for Canadians but not for Americans. 27 …”

Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs

“…Experimental studies have yielded mixed findings among adolescents. For example, several studies have found pictorial warnings engendered higher perceived effectiveness and quit intentions than text warnings [10–12], whereas others showed no difference in discouragement from smoking [13] or demonstrated higher intentions to smoke in response to pictorial warnings [12]. However, each of these studies relied on brief exposures to warnings in artificial settings.…”