Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments

Francis, Diane B.; Hall, Marissa G.; Noar, Seth M.; Ribisl, Kurt M.; Brewer, Noel T.

doi:10.1093/ntr/ntx082

Cited by 24 publications

(24 citation statements)

References 92 publications

(368 reference statements)

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“…One potential explanation of the low LII score observed in Hungary could be that almost half of smokers in Hungary reported using roll-your-own (RYO) tobacco, while packaging of RYO rolling papers and filters had no health warning information prior to August 2016 26 . At the same time, the impact might vary between countries also as a consequence of type (only text or text and pictorials) and dimension of the health warning, and the type of messages 2-9 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys

Trofor

Papadakis

Lotrean³

et al. 2019

Tob. Induc. Dis.

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INTRODUCTION The aim of this study was to examine knowledge of health effects of smoking and the impact of cigarette package warnings among tobacco users from six European Union (EU) Member States (MS) immediately prior to the introduction of the EU Tobacco Products Directive (TPD) in 2016 and to explore the interrelationship between these two factors. METHODS Cross-sectional data were collected via face-to-face interviews with adult smokers (n=6011) from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) between June–September 2016. Sociodemographic variables and knowledge of health risks of smoking (KHR) were assessed. Warning salience, thoughts of harm, thoughts of quitting and foregoing of cigarettes as a result of health warnings were assessed. The Label Impact Index (LII) was used as a composite measure of warning effects. Linear and logistic regression analyses were used to examine sociodemographic predictors of KHR and LII and the inter-relationship between knowledge and LII scores. RESULTS The KHR index was highest in Romania and Greece and lowest in Hungary and Germany. While the majority of smokers knew that smoking increases the risk for heart diseases, lung and throat cancer, there was lower awareness that tobacco use caused mouth cancer, pulmonary diseases, stroke, and there were very low levels of knowledge that it was also associated with impotence and blindness, in all six countries. Knowledge regarding the health risks of passive smoking was moderate in most countries. The LII was highest in Romania and Poland, followed by Spain and Greece, and lowest in Germany and Hungary. In almost all countries, there was a positive association between LII scores and higher KHR scores after controlling for sociodemographic variables. Several sociodemographic factors were associated with KHR and LII, with differences in these associations documented across countries. CONCLUSIONS These data provide evidence to support the need for stronger educational efforts and policies that can enhance the effectiveness of health warnings in communicating health risks and promoting quit attempts. Data will serve as a baseline for examining the impact of the TPD.

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Section: Discussionmentioning

confidence: 99%

“…Evidence shows that combined written and graphic health messages are more effective than text-only warnings 2-4 . Pictorial warnings have been shown to increase levels of knowledge regarding the health effects of smoking, as well as increase motivation for smoking cessation behavior among smokers 2-9 .…”

Section: Introductionmentioning

confidence: 99%

Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys

Trofor

Papadakis

Lotrean³

et al. 2019

Tob. Induc. Dis.

View full text Add to dashboard Cite

show abstract

“…Our ratings measured constructs commonly used in GWL research, but which may not provide a comprehensive assessment of message impact. 61 The 4 measures of GWL responses likely covary, however we examined them separately to facilitate interpretation. We were interested in the first order question of whether men and women may respond differently to FDA-selected GWL labels.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Graphic Warning Label Ratings by Addictions Clients

Campbell¹,

Le²,

Yip³

et al. 2019

tobacco reg sci

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Objectives: Research on sex differences in responses to cigarette graphic warning labels (GWLs) has been limited despite tobacco-related, health disparities for women. We examined whether women had stronger responses to certain labels than to others, whether this pattern differed from men’s, and whether there were overall sex ratings differences. Methods: Smokers (N = 881) in 24, addictions treatment programs rated 3 of 9 Food and Drug Administration-developed labels on credibility, message reactance, quit motivation, and negative emotions. Participants rated one label depicting a woman and/or baby, and 2 depicting tobacco-related disease or male images. Results: Women’s (n = 432) ratings of labels depicting women/babies versus other labels did not differ from men’s (n = 449) ratings. Women had higher ratings than men across all labels combined on credibility (p < .001), quit motivation (p = .007), and negative emotions (p < .001). Individual labels were analyzed for sex differences. Women’s ratings were higher on credibility for 3 of 9 labels, and on negative emotions for 7 of 9 labels. Conclusions: Female smokers in addictions treatment had generally stronger responses to GWLs than men, supporting GWL implementation in the United States to help close the sex gap in smoking cessation.

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“…The databases were: Medline, PsycINFO, Communication and Mass Media Complete, Web of Science, and Business Source Complete. We chose these databases because they were used in previous reviews to locate relevant PWL studies 9,17 . As the systematic review initially focused on PWLs for all tobacco products, we used the following search string: (cigarette* OR tobacco OR smok* OR smokeless OR waterpipe OR hookah OR shisha OR cigar* OR snuff OR pipe OR e-cig OR vape OR little cigar OR snus OR e-cigarette OR electronic cigarette OR electronic nicotine delivery system OR ENDS OR chewing tobacco OR chew OR loose leaf OR dip OR dissolvable tobacco OR novel tobacco) AND (warning* OR label* OR packag* OR pictorial OR graphic) AND (youth* OR adolescent* OR young OR teen* OR student* OR kid* OR children OR young adult*).…”

Section: Methodsmentioning

confidence: 99%

Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies

Francis¹,

Mason²,

Ross³

et al. 2019

Tob. Induc. Dis.

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INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.

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Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments

Abstract: Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the need for standardized, theory-based measures.

Cited by 24 publications

References 92 publications

Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys

Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys

Sex Differences in Graphic Warning Label Ratings by Addictions Clients

Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies

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