Severity and susceptibility: measuring the perceived effectiveness and believability of tobacco health warnings

Abstract

BackgroundPictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them.MethodsWe examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease.ResultsA 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs.ConclusionOur findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or ‘grotesque’ HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5385-x) contains supplementary material, which is available to authorized users.

Parental Perceptions of Children’s Exposure to Tobacco Smoke and Parental Smoking Behaviour

“…In an attempt to shed light on both the discrepancies between parental report and biochemical assessment of children's exposure, and on the reasons for children's continued exposure despite the well-known health risks [6], the parental perceptions of exposure measure (PPE) was developed, based on qualitative research with smoking parents [3]. Consistent with evidence that pictorial tobacco health warning labels are more effective and believable than text-only warnings [16], the PPE presents images and textual vignettes of adults smoking around children in different everyday circumstances and asks parents to rate the child's exposure in these hypothetical situations. Following validation of the measure [4], the current study aimed to test the PPE in a group of smoking parents of young children and to examine the relationship between perceptions of exposure and smoking behaviour around children.…”

Effectiveness of Mental Health Warnings on Tobacco Packaging in People With and Without Common Mental Health Conditions: An Online Randomised Experiment

“…To achieve 95% power at 5% alpha level to determine a small effect size of f = 0.1 on our primary outcome (effectiveness), we needed 608 participants. A study by Maynard et al ( 39 ) used to guide some measures in this study, examining the difference in perceived effectiveness of tobacco warning labels between smokers and non-smokers, reported a η2 of 0.04, which corresponds to an effect size of f = 0.2 ( 40 ). Given that mental health warnings are not established and are untested in this population, we implemented a more conservative effect size for this power calculation (f = 0.1).…”

“…Perceived effectiveness of tobacco health warning labels was assessed by a measure adapted from Maynard et al ( 39 ): “Overall, on a scale of 1–10, how effective is this health warning? (e.g., in encouraging smokers to quit, increasing concerns about smoking, and discouraging youth from starting to smoke)”, with 1 as not at all and 10 as extremely.…”

Impact of health warning labels on snack selection: An online experimental study

“…annoyance at or deliberately not engaging with the HWL) ( Maynard et al, 2014 ; McCloud, Okechukwu, Sorensen, & Viswanath, 2017 ), although these behaviours do not necessarily interfere with quitting behaviours ( Brewer et al, 2019 ; Cho et al, 2016 ). HWLs placed on alcoholic beverages that include shocking or explicit pictures are rated as more effective than those with less severe pictures ( Maynard, Gove, Skinner, & Munafò, 2018 ), but have been shown to increase reactance and avoidance behaviours ( Sillero-Rejon et al, 2018 ) and may be less acceptable ( Clarke et al, 2020b ; Pechey et al, 2020 ). Initial studies suggest that text-only HWLs on SSBs ( Roberto, Wong, Musicus, & Hammond, 2016 ) and image-and-text HWLs on energy-dense snacks are generally accepted ( Pechey et al, 2020 ).…”