Public support for pictorial warnings on cigarette packs: an experimental study of US smokers

Hall, Marissa G.; Marteau, Theresa; Sunstein, Cass R.; Ribisl, Kurt M.; Noar, Seth M.; Orlan, Elizabeth; Brewer, Noel T.

doi:10.1007/s10865-018-9910-2

Cited by 28 publications

(21 citation statements)

References 47 publications

(77 reference statements)

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“…Details of the trial including study protocols, questionnaire development, and participant recruitment have been previously published (4). Other papers using this dataset have explored the frequency and content of social interactions (36), reactance to warnings (37), and trajectories of pictorial warnings’ impact (38), as well as attitudes toward regulation of tobacco products (39, 40). From September 2014 to August 2015, we recruited English-speaking current smokers over the age of 18 to participate in the trial (see Table 1 for participant characteristics).…”

Section: Methodsmentioning

confidence: 99%

Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts

Brewer

Parada

Hall

et al. 2018

Annals of Behavioral Medicine

102

110

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Background Our randomized trial found that pictorial cigarette pack warnings elicited more quit attempts than text-only warnings. Purpose In the current study, we sought to identify psychological mechanisms that explain why pictorial cigarette pack warnings change behavior. Methods In 2014 and 2015, we recruited 2,149 adult smokers in North Carolina and California, US. We randomly assigned smokers to receive on their cigarette packs for 4 weeks either a text-only warning (one of the US’s current warnings on the side of cigarette packs) or a pictorial warning (one of the US’s proposed text warnings with pictures on the top half of the front and back of cigarette packs). Results Pictorial warnings increased attention to, reactions to, and social interactions about cigarette pack warnings (all p<.05). However, pictorial warnings changed almost no belief or attitude measures. Mediators of the impact of pictorial warnings included increased attention, negative affect, social interactions, thinking about the warning and harms of smoking, and intentions to quit (all p<.05). Analyses also found that pictorial warnings led to greater avoidance of the warnings, which was associated with more quit attempts (p<.05). Conclusions Pictorial warnings increased quit attempts by eliciting aversive reactions and by keeping the message vividly in smokers’ minds. Contrary to predictions from several theories of health behavior, the warnings exerted little of their influence through changes in beliefs and attitudes and none of their influence through changes in risk perception. We propose the Tobacco Warnings Model based on these findings.

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Section: Methodsmentioning

confidence: 99%

Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts

Brewer

Parada

Hall

et al. 2018

Annals of Behavioral Medicine

102

110

View full text Add to dashboard Cite

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“…The theory emphasizes that nudges are not mandatory, and their intervention design must be simple and inexpensive [80]. It was explored in previous studies that this theory had a positive impact on several behaviors, such as reducing tobacco use [81], changing adult dietary choices [82], and increasing physical activity [83]. For medication reminders, any intervention that directly asks participants about trial content should be excluded, as this would bias the participants.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

Wang¹,

Zhu²,

Cui³

2019

JMIR Mhealth Uhealth

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BackgroundElectronic health (eHealth) is increasingly used for self-management and service delivery of HIV-related diseases. With the publication of studies increasingly focusing on antiretroviral therapy (ART) adherence, this makes it possible to quantitatively and systematically assess the effectiveness and feasibility of eHealth interventions.ObjectiveThe purpose of this review was to explore the effectiveness of eHealth interventions on improving ART adherence in people living with HIV. The effects of different intervention characteristics, participant characteristics, and study characteristics were also assessed.MethodsWe systematically searched MEDLINE (via PubMed), EMBASE, the Cochrane Central Register of Controlled Trials, and 3 conference abstract databases using search terms related to HIV, ART, adherence, and eHealth interventions. We independently screened the studies, extracted the data, and assessed the study quality and then compared the information in pairs. Articles published in English that used randomized controlled trials to assess eHealth interventions to improve ART adherence of people living with HIV were identified. We extracted the data including study characteristics, participant characteristics, intervention characteristics, and outcome measures. The Cochrane risk-of-bias tool was used to assess the risk of bias and study overall quality. Odds ratios, Cohen d, and their 95% CIs were estimated using random-effects models. We also performed multiple subgroup analyses and sensitivity analyses to define any sources of heterogeneity.ResultsAmong 3941 articles identified, a total of 19 studies (including 21 trials) met the inclusion criteria. We found 8 trials from high-income countries and 13 trials from low- and middle-income countries. Furthermore, at baseline, the health status of participants in 14 trials was healthy. Of the trials included, 7 of 21 used personality content, 12 of 21 used a 2-way communication strategy, and 7 of 21 used medical content. In the pooled analysis of 3937 participants (mean age: 35 years; 47.16%, 1857/3937 females), eHealth interventions significantly improved the ART adherence of people living with HIV (pooled Cohen d=0.25; 95% CI 0.05 to 0.46; P=.01). The interventions were also correlated with improved biochemical outcomes reported by 11 trials (pooled Cohen d=0.25; 95% CI 0.11 to 0.38; P<.001). The effect was sensitive to sample size (Q=5.56; P=.02) and study duration (Q=8.89; P=.003), but it could not be explained by other moderators. The primary meta-analysis result was stable in the 3 sensitivity analyses.ConclusionsSome of the eHealth interventions may be used as an effective method to increase the ART adherence of people living with HIV. Considering that most of the trials included a small sample size and were conducted for a short duration, these results should be interpreted with caution. Future studies need to determine the features of eHealth interventions to better improve ART adherence along with long-term effectiveness of interventions, effecti...

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“…If policy influencers are taking a risk and looking to enact policy where public support is weaker, existing support is not always required prior to behaviour change, since support has been shown to increase over time following the enact ment of legislation. 14,23 Members of the general public in Alberta and Quebec had comparable levels of sup port for the majority of policy options (11/13). This finding is surprising, as pre vious research has shown that smokers in Quebec in particular had stronger support for tobacco control policies than their counterparts in Alberta.…”

Section: Guide Choices Through Changing the Default Policymentioning

confidence: 99%

“…12 Internation ally, recent research has explored public support for specific types of tobacco con trol interventions (i.e. antismoking media campaigns 13 and pictorial warnings on cigarette packs 14 in the United States of America); and support for tobacco control policies among specific population groups (i.e. smokers in Canada, 15 adolescents in Hong Kong 11 and adults in the USA, 16 Finland 17 and Malaysia 18 ).…”

mentioning

confidence: 99%

Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec

Kongats

McGetrick

Raine

et al. 2020

Health Promot Chronic Dis Prev Can

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Objective: To assess general public and policy influencer support for populationlevel tobacco control policies in two Canadian provinces. Methods:We implemented the Chronic Disease Prevention Survey in 2016 to a census sample of policy influencers (n = 302) and a random sample of members of the public (n = 2400) in Alberta and Quebec, Canada. Survey respondents ranked their support for tobacco control policy options using a Likertstyle scale, with aggregate responses presented as net favourable percentages. Levels of support were further analyzed by coding each policy option using the Nuffield Council on Bioethics intervention ladder framework, to assess its level of intrusiveness on personal autonomy.Results: Policy influencers and the public considered the vast majority of tobacco con trol policy options as "extremely" or "very" favourable, although policy influencers in Alberta and Quebec differed on over half the policies, with stronger support in Quebec. Policy influencers and the public strongly supported more intrusive tobacco control policy options, despite anticipated effects on personal autonomy (i.e. for policies target ing children/youth and emerging tobacco products like electronic cigarettes). They indi cated less support for fiscally based tobacco control policies (i.e. taxation), despite these policies being highly effective. Conclusion:Overall, policy influencers and the general public strongly supported more restrictive tobacco control policies. This study further highlights policies where support among both population groups was unanimous (potential "quick wins" for health advocates). It also highlights areas where additional advocacy work is required to communicate the populationhealth benefit of tobacco control policies.

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Public support for pictorial warnings on cigarette packs: an experimental study of US smokers

Abstract: Exposing people to a new policy through implementation could increase public support for that policy by increasing perceived effectiveness and by prompting conversations about the policy. Reactance may partially weaken the effect of policy exposure on public support.

Cited by 28 publications

References 47 publications

Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts

Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts

Electronic Health Interventions to Improve Adherence to Antiretroviral Therapy in People Living With HIV: Systematic Review and Meta-Analysis

Using the intervention ladder to examine policy influencer and general public support for potential tobacco control policies in Alberta and Quebec

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