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Consumers often inadvertently misperceive the health hazards associated with over-the-counter pesticides under the current textual labeling policy, potentially leading to improper use. We conducted an incentivized framed field experiment with eye tracking to evaluate the effectiveness of the current pesticide labels that convey risk using signal words (Caution, Warning, Danger) compared to two visually focused label alternatives: traffic light colors and skull intensity symbols. A total of 166 participants were randomly assigned to one of three label formats and asked to rank toxicity levels and make purchasing decisions within multiple price lists. Results show that signal words fail to adequately communicate toxicity levels. Specifically, participants' correct assessment of toxicity level dramatically improves from 54% under the existing signal word label to 95% under the traffic light and 83% under the skull intensity symbol labels. We also find that participants are more likely to choose the less toxic alternatives under the new labels, suggesting the current labeling system may affect choice and have unintended adverse effects on human health.
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Plaguicidas , Humanos , Plaguicidas/toxicidad , Femenino , Masculino , Adulto , Comportamiento del Consumidor , Adulto Joven , Persona de Mediana Edad , Comprensión , Adolescente , Etiquetado de Productos/métodosRESUMEN
OBJECTIVE: India has the highest number of smokeless tobacco (SLT) products available in different forms, consumed in various ways. The current study aimed to understand the pattern of daily SLT use according to different product categories and whether Quit intention and Quit attempts vary by SLT type and exposure to media messages. METHODS: Data from Global Adult Tobacco Surveys (GATS), 2016-17, was used to find access to media messages and warning labels by SLT type. Quit attempt and Quit intention were calculated for each of the SLT types. Logistic regression analyses were employed to identify whether access to media messages, warning labels influenced, quit intention and attempts vary by SLT type. RESULTS: Khaini or tobacco lime mixture was the most common SLT type consumed by 37% of SLT users, whereas SLT users consuming more than one product accounted for 23% of SLT users. Exposure to media messages and warning labels was high among Gutkha/ paan masala tobacco users (74.7% and 81.2%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (56.1% and 60.0%). Quit attempts and quit intention were high among Gutkha/ paan masala tobacco users (38.3% and 22.3%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (25.3% and 13.6%). Users of Oral tobacco and khaini or tobacco-lime mixture were significantly less likely to attempt quitting (AOR 0.806(95%CI: 0.676-0.962), 0.839(95%CI: 0.736-0.956), and have quit intention (AOR 0.681(95%CI: 0.702-0.976), 0.733(95%CI: 0.627-0.857) compared to Gutkha/ paan masala with tobacco users. CONCLUSION: The reach of media messages and warning labels varies by SLT type. Quit intention and attempts vary by SLT type and access to media messages and warning labels. There is a need to re-strategise the tobacco control Information, Education and Communication (IEC) to reach out with effective messaging to the most unreached.
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Tabaco sin Humo , Humanos , Adulto , Masculino , Femenino , Tabaco sin Humo/estadística & datos numéricos , Prevalencia , Encuestas y Cuestionarios , Persona de Mediana Edad , India/epidemiología , Adulto Joven , Adolescente , Etiquetado de Productos/métodos , Cese del Hábito de Fumar/psicología , Cese del Hábito de Fumar/métodos , Cese del Hábito de Fumar/estadística & datos numéricos , Estudios de Seguimiento , Medios de Comunicación de Masas/estadística & datos numéricos , Intención , Cese del Uso de Tabaco/métodos , Cese del Uso de Tabaco/psicología , Uso de Tabaco/epidemiología , Uso de Tabaco/psicología , Análisis de Datos SecundariosRESUMEN
BACKGROUND: Waterpipe tobacco smoking has increased tremendously at a global level among all age groups, particularly young people. Previous studies have examined the impact of waterpipe tobacco pictorial health warnings on adults but scarce studies were done on adolescents. The aim of this study was to assess the association of textual versus pictorial warnings on tumbac boxes and the motivation to quit waterpipe smoking among adolescents located in two Eastern Mediterranean countries Lebanon and Iraq. METHODS: A cross-sectional study was conducted between May and November 2022, involving 294 adolescents waterpipe smokers from Lebanon and Iraq. The questionnaire included the Lebanese Waterpipe Dependence Smoking-11, the Depression, Anxiety and Stress Scale, the Waterpipe Harm Perception Scale, Waterpipe Knowledge Scale, Waterpipe Attitude Scale, the Fagerstrom Test for Nicotine Dependence, and the Motivation to Stop Scale. RESULTS: When adjusting the results over confounding variables, the results showed that compared to finding the warnings to stop smoking not efficacious at all, adolescents who find the warnings moderately (aOR = 2.83) and very (aOR = 6.64) efficacious had higher motivation to quit. Compared to finding the warnings not increasing their curiosity for information about how to stop waterpipe smoking at all, participants who confessed that warnings increased their curiosity a little (aOR = 2.59), moderately (aOR = 3.34) and very (aOR = 3.58) had higher motivation to quit. Compared to not considering changing the tumbac brand if the company uses pictorial warnings, adolescents who would consider changing the tumbac brand (aOR = 2.15) had higher motivation to quit. CONCLUSION: Pictorial and textual warnings on waterpipe packs were associated with higher motivation to stop waterpipe smoking. Public health education programs for this purpose seem warranted.
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Cese del Hábito de Fumar , Productos de Tabaco , Tabaco para Pipas de Agua , Fumar en Pipa de Agua , Adulto , Humanos , Adolescente , Motivación , Cese del Hábito de Fumar/métodos , Irak , Estudios Transversales , Etiquetado de Productos/métodos , Prevención del Hábito de FumarRESUMEN
INTRODUCTION: The 2017 agreement between the U.S. Food and Drug Administration and the makers of Natural America Spirit (NAS) cigarettes restricted the use of "additive-free" (AF) in brand marketing, which the company replaced with "tobacco ingredients: tobacco & water" (TW), a phrase subsequently adopted by L&M. We tested how participants' perceptions differed when exposed to AF versus TW claims on NAS and L&M packs. AIMS AND METHODS: A between-subjects experiment was embedded within an online survey in August 2022 (nâ =â 2526). Participants were randomized to view one of three packs (NAS AF pack, NAS TW pack, L&M TW pack). Logistic regressions assessed differences (by pack exposure) in perceived pack attractiveness and relative chemical and harm perceptions compared to other cigarettes. Interactions by smoking status were explored. RESULTS: No significant differences were observed between the NAS AF and NAS TW packs on perceived attractiveness or relative harm, although never smokers had higher odds of having lower relative chemicals perceptions in response to the NAS AF versus NAS TW pack (ORâ =â 1.81). Compared to participants who saw the NAS TW pack, those who saw the L&M TW pack tended to have lower odds of perceiving the pack as attractive, believing that the product had fewer chemicals than other products, or believing the product was less harmful than other products compared to the NAS TW pack. CONCLUSION: Results suggest the more implicit "tobacco ingredients: tobacco & water" claim functions similarly to "additive-free" and as an unauthorized modified risk claim. NAS brand image also appears to contribute to higher perceived pack attractiveness and lower perceptions of chemicals and harm. Additional marketing regulations and corrective campaigns may be needed to reduce risk-related misperceptions about NAS cigarettes. IMPLICATIONS: Our findings show that replacing "additive-free" claims with "tobacco ingredients: tobacco & water" did not sufficiently address the illegal use of unauthorized modified risk claims by the makers of NAS cigarettes. Further regulatory action restricting the TW claim could potentially reduce inaccurate lower harm perceptions about NAS cigarettes. Educational campaigns may also be needed to mitigate NAS's history of marketing that implies reduced harm, given that the effects of implicit reduced risk claims like TW have a greater effect on pack perceptions for NAS than L&M.
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Mercadotecnía , Productos de Tabaco , Humanos , Masculino , Femenino , Mercadotecnía/métodos , Adulto , Persona de Mediana Edad , Estados Unidos , Adulto Joven , Adolescente , Encuestas y Cuestionarios , Etiquetado de Productos/métodosRESUMEN
As cannabis legalization expands and online marketing intensifies, this study examines whether online social cues can amplify youth-targeted cannabis advertising and whether cannabis warning labels (CWLs) can counteract these influences. A U.S. online sample of 970 adolescents and 1776 young adults susceptible to cannabis use were recruited from Qualtrics in summer 2022. Each participant was randomly assigned to one of the 3 (CWLs: none vs. textual vs. pictorial) by 3 (comments: none vs. anti-cannabis vs. pro-cannabis) conditions in an online experiment. Participants were exposed to three online marketing posts promoting marijuana edibles (randomly selected from a large pool, N = 1260), each with either no warning label, a textual warning, or a pictorial warning (text and picture), and with either five comments (pro- or anti-cannabis in valence) or none. Results showed that among adolescents, pro-cannabis comments increased product appeal (vs. anti-cannabis comments: b = 0.18, p = .025; vs. no comments: b = 0.21, p = .021), and did so more than young adults. For adolescents, only pictorial warnings reduced product appeal (b = -0.20, p = .028). For young adults, both pictorial (b = -0.18, p = .002) and textual warnings (b = -0.12, p = .029) reduced product appeal. Furthermore, both textual (adolescents: b = -0.20, p = .004; young adults: b = -0.15, p = .005) and pictorial (adolescents: b = -0.30, p < .001; young adults: b = -0.18, p = .001) warnings reduced cannabis use intentions. Findings support requiring enhanced CWLs accompany online marketing ads.
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Cannabis , Productos de Tabaco , Humanos , Adolescente , Adulto Joven , Cannabis/efectos adversos , Etiquetado de Productos/métodos , Mercadotecnía , Intención , PublicidadRESUMEN
INTRODUCTION: Many people remove the tobacco leaf from cigars and replace it with cannabis (ie, blunts), but few studies have examined whether messages about the risks of cigars, like warnings on cigar packages, can affect blunt use. METHODS: Participants were 438 U.S. adults who reported past 30-day cigar use and ever blunt use, recruited from a probability-based national panel to take an online survey. In a 2 × 2 experiment with a between-subjects design, we manipulated two cigar warning characteristics: (1) warning type: text-only versus pictorial (ie, text + image) and (2) warning size: 30% (smaller) versus 50% (larger) of the product package. Participants then viewed six different warnings on a fictious cigarillo package, within their randomly assigned condition. After evaluating all stimuli, participants were asked the extent to which the warnings discouraged them from wanting to use cigars to smoke cannabis (ie, blunt perceived warning effectiveness). Response options ranged from "not at all" (1) to "a great deal" (5). RESULTS: We observed no main effects of warning type or size on blunt perceived warning effectiveness. However, a significant interaction existed between the two experimental manipulations (p = .009). Whereas adding images made no difference to blunt perceived warning effectiveness when warnings were smaller (simple effect: -0.22, p = .28), images mattered for larger warnings. Specifically, adding images increased blunt perceived warning effectiveness when warnings were 50% of the product package (simple effect: 0.52, p = .008). CONCLUSIONS: This experiment provides preliminary evidence that larger pictorial cigar warnings may discourage blunt use relative to larger but text-only warnings. IMPLICATIONS: Blunts, which are hollowed out cigars with tobacco leaf wrappers that are filled with cannabis leaf, are one of the most common ways in which tobacco and cannabis are used simultaneously, yet few studies have examined whether messages about the risks of cigars can affect blunt use. We conducted an online experiment concerning the perceived effectiveness of cigar warnings among people who use blunts recruited from a probability-based panel. Results provide novel, preliminary evidence that larger pictorial cigar warnings may discourage blunt use, relative to larger but text-only warnings. More research evaluating cigar warnings on blunt use is needed.
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Cannabis , Etiquetado de Productos , Productos de Tabaco , Adulto , Humanos , Etiquetado de Productos/métodos , Encuestas y CuestionariosRESUMEN
The goal was to determine the effects of bilingual cigarette warning labels on the recall performance and attention of young bilingual Lebanese college students. Forty-eight students were shown English-only, Arabic-only, or bilingual cigarette warning labels in 2020. Participants recalled as many of the labels as they could after the experiment and then two weeks later. Eye tracking was used to determine attention to the label and subjective data were collected. Results showed that bilingual labels did not lead to better recall; participants needed more time to extract data from bilingual labels and first looked at them later in time, although bilingual labels were revisited more. However, participants believed that bilingual labels were better. It appeared that bilingual labels led to clutter rather than helped recall.
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Etiquetado de Productos , Productos de Tabaco , Humanos , Adolescente , Etiquetado de Productos/métodos , Líbano , Recuerdo Mental , EstudiantesRESUMEN
In line with Article 11 of the WHO Framework Convention on Tobacco Control, the Philippines has implemented graphic health warnings on cigarette packs. To date, there has been no published literature evaluating the perceived effectiveness of GHWs in the Philippines. This study aims to contribute to the evidence on the perceived effects of graphic health warnings (GHWs) in cigarette packaging and the potential impact of plain packaging in the Philippines. The study involved an online convenience survey and a nationwide household survey. Mock-up sets of cigarette packs based on the Philippines' law on GHWs, and Thailand's and Singapore's plain packaging were shown to respondents to rate their attractiveness, quality, taste, cost, social appeal, appeal to youth, noticeability, appeal to non-smokers, attempt to quit, ease of quitting, discouraging smoking, and perceived harm to health on a five-point Lickert scale. The online and household surveys recruited 2,701 respondents in total. Online and household survey respondents considered plain packaging with larger graphic health warnings and visible quitlines from Thailand and Singapore to be more effective in discouraging them from smoking. Both sets of survey respondents also found mock-ups from Thailand and Singapore more motivating for them to attempt quitting than cigarette pack mock-ups from the Philippines. The study concludes that current graphic health warnings in the Philippines are ineffective in instilling health consciousness among Filipinos. Policymakers should consider larger graphic health warnings and plain packaging of cigarettes to motivate smokers to quit and discourage Filipinos from smoking.
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Etiquetado de Productos , Prevención del Hábito de Fumar , Adolescente , Humanos , Etiquetado de Productos/métodos , Filipinas , Prevención del Hábito de Fumar/métodos , Embalaje de Productos/métodos , FumarRESUMEN
This study sought to understand reactions to very low nicotine (VLN) cigarette advertising compared with conventional cigarette advertising with consideration of warning labels and social media context. The online experimental study recruited young adult cigarette smokers and nonsmokers (N = 1,608). Participants completed a discrete choice task with a 2 × 2 × 3 mixed design: brand, (VLN, Marlboro), context (Ad only, Ad on social media), and warning (Text-only, Well-known risk pictorial, or Lesser-known risk pictorial). Participants made choices about attention, appeal, harm, buying, and quitting intentions. Social media context increased attention and appeal. A well-known risk pictorial warning outperformed a text-only warning. Smokers had increased odds of quit intentions for VLN ads, yet nonsmokers had increased intentions to buy cigarettes on social media with a text-only warning. Results indicate differences in how young adults react to cigarette ads on social media, especially with the warnings they portray.
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Sistemas Electrónicos de Liberación de Nicotina , Medios de Comunicación Sociales , Productos de Tabaco , Humanos , Adulto Joven , Nicotina , Fumar , Publicidad , Etiquetado de Productos/métodos , Productos de Tabaco/efectos adversosRESUMEN
While many countries require prominent pictorial health warning labels (PHWLs) on the outside of cigarette packs to communicate the harms of smoking, there is evidence that cigarette pack inserts that contain efficacy messages may enhance the effectiveness of PHWLs. The US Food and Drug Administration (FDA) has regulatory authority to communicate with smokers through inserts. While current labeling regulations do not require inclusion of inserts, the FDA could implement them in the future. This study assesses US smokers' perceptions of cigarette package inserts at the conclusion of a two-week randomized trial on cigarette labeling where half of participants were exposed to insert messages (two response-efficacy messages and two self-efficacy messages) in their packs. Participants (n = 359) completed a 30- to 60-min interview with both quantitative and qualitative assessments, including measures of recall and perceived message effectiveness (PME) for specific inserts. Correlates of recall and PME were estimated using mixed-effects regression models. Qualitative responses to PME items were analyzed using thematic analysis. Response-efficacy messages had higher PME and recall than self-efficacy messages. People had diverse responses to the inserts, including that they were positive, thought-provoking, and helpful. Reactions to and perceptions of the inserts indicate potential benefits of integrating efficacy messages into labeling policies.
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Cese del Hábito de Fumar , Productos de Tabaco , Adulto , Humanos , Fumadores , Cese del Hábito de Fumar/métodos , New York , South Carolina , Prevención del Hábito de Fumar/métodos , Etiquetado de Productos/métodosRESUMEN
INTRODUCTION: For cigars sold individually without packaging, including many premium cigars, the US Food and Drug Administration (FDA) proposed that retailers display six warning statements on a sign at the point-of-sale (POS). AIMS AND METHODS: To examine the potential effectiveness of cigar warning signs, we conducted a between-subjects online experiment. Participants were 809 U.S. adults who reported using cigars (78% ever large cigar use, 49% past 30-day large cigar use) recruited from a probability-based panel. Participants viewed an image of a cigar store countertop with randomization to one of four conditions: (1) no warning sign, (2) a sign with six FDA proposed text-only warnings, (3) a sign with six novel text-only warnings, or (4) a sign with six novel text + image warnings. We used analysis of variance (ANOVA) models and post hoc Tukey tests to examine the results. RESULTS: The FDA-proposed text-only warning sign was perceived as less effective in discouraging participants from smoking cigars (M: 3.26, SD: 1.39; scale range: 1-5, where five indicates higher discouragement) compared with the novel text-only warning sign (M = 3.38, SD = 1.40) and the novel text + image warning sign (M = 3.65, SD = 1.34). The novel text + image warning sign increased discouragement from smoking cigars versus the FDA-proposed text-only warning sign (p = .02) and decreased the perceived satisfaction of smoking cigars versus no warning sign (p = .04). In a sensitivity analysis, the novel text + image warning sign decreased the perceived satisfaction of smoking cigars (p = .01), decreased cigar purchase intentions (p = .03), decreased the urge to smoke (p = .03), and increased discouragement from smoking cigars (p = .006) compared with all other study conditions. CONCLUSIONS: Results provide new evidence that policymakers, such as the FDA, could use when proposing POS warning signs for cigars. IMPLICATIONS: The US FDA proposed that retailers display a warning sign at the POS for cigars sold individually without packaging. We conducted an online experiment concerning the potential effectiveness of this regulatory policy with people who use cigars recruited from a probability-based panel. Results provide the first evidence that the FDA-proposed text-only warning sign was perceived as less effective than other types of warning signs and that adding images could potentially increase the effectiveness of warning signs. These findings are particularly relevant for premium cigars, which are often sold individually in brick-and-mortar retail settings.
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Productos de Tabaco , Adulto , Humanos , Comportamiento del Consumidor , Intención , Mercadotecnía , Etiquetado de Productos/métodos , Embalaje de ProductosRESUMEN
This study compares the impact of pictorial health warning labels (HWLs) and their placements on waterpipe parts (device, tobacco and charcoal packages) on health communication outcomes between waterpipe smokers and nonsmokers in Lebanon. An online randomized crossover experimental study was conducted among young adults (n = 403, August 2021) who observed three conditions of HWLs: pictorial HWLs on the tobacco package, pictorial HWLs on all waterpipe's parts and text-only HWL on the tobacco package in random order. Participants completed post-exposure assessments of health communication outcomes after each image. Using linear mixed models, we examined the differences in the effect of HWL conditions on several outcomes (i.e. warning reactions) between waterpipe smokers and nonsmokers, controlling for confounders (i.e. age, sex). Nonsmokers reported greater attention (ß = 0.54 [95% confidence interval: 0.25-0.82]), cognitive elaboration (0.31 [0.05-0.58]) and social interaction (0.41 [0.18-0.65]) for pictorial HWLs on the tobacco packages than text-only compared with smokers. Pictorial HWLs on three parts versus one part elicited higher cognitive reactions and perceived message effectiveness in nonsmokers compared with waterpipe smokers. These findings provide valuable information for policymakers about the potential of implementing HWLs specific to waterpipes to prevent their use among young adults and limit tobacco-related morbidity and mortality in Lebanon.
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Cese del Hábito de Fumar , Productos de Tabaco , Fumar en Pipa de Agua , Humanos , Adulto Joven , Fumadores/psicología , Cese del Hábito de Fumar/métodos , No Fumadores , Líbano , Fumar en Pipa de Agua/efectos adversos , Etiquetado de Productos/métodosRESUMEN
OBJECTIVE: This article aims to examine the impact on adolescents of New Zealand's 2018 legislation introducing plain (standardised) packaging and enhanced pictorial warning labels (PWLs). METHODS: Data came from Year 10 (14-15 years old) students in the 2016 (2,884 participants) and 2018 (2,689 participants) Youth Insights Surveys conducted 2 years before and immediately after legislation implementation. We used binary and ordinal logistic regression to investigate changes in brand awareness and preference, brand and pack appeal, and PWL salience and impact. RESULTS: The proportion of all participants, and ever, ex/experimental and current smokers who could name one or five tobacco product brands decreased in 2018. There was a modest and nonstatistically significant decrease in the proportion of current smokers citing brand name and image, and a larger decrease in the proportion stating perceived harm to health, influenced preferred brand choice. Having a preferred brand among current smokers and pack appeal, and PWL salience and impact among ex/experimental and current smokers were largely unchanged. CONCLUSIONS: We found preliminary evidence that plain packaging and enhanced PWLs reduced tobacco brand awareness and salience, and misperceptions about tobacco brand harmfulness. Data collection occurred shortly after implementation. Additional studies are required to assess longer term impacts of these interventions. PUBLIC HEALTH IMPLICATIONS: The findings complement existing evidence documenting the impact of plain packaging and PWLs on adolescents. Given limitations due to the proximity of the 2018 survey to legislation implementation, further studies with longer follow-up are required.
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Fumar , Productos de Tabaco , Humanos , Adolescente , Estudios Transversales , Etiquetado de Productos/métodos , Nueva Zelanda , Embalaje de Productos/métodos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Little is known about the potential impacts of visible and up-to-date health warning labels on alcoholic beverage containers on a range of outcomes in low- and middle-income countries. We conducted an experimental study to test the potential impacts of visible health warning labels (on the principal panel of the package) on thinking about health risks, product attractiveness, visual avoidance, and intention to change alcohol use among students in Mexico aged 18-30 years. METHODS: A double-blind, parallel-group, online randomized trial was conducted from November 2021 to January 2022 in 11 states in Mexico. In the control group, participants were presented with the image of a conventional beer can with a fictional design and brand. In the intervention groups, the participants observed pictograms with a red font and white backgrounds (health warning label in red-HWL red) or with a black font and yellow backgrounds (health warning label in yellow-HWL yellow), located at the top, covering around one-third of the beer can. We used Poisson regression models -unadjusted and adjusted for covariates- to assess differences in the outcomes across study groups. RESULTS: Using intention-to-treat analysis (n = 610), we found more participants in groups HWL red and HWL yellow thought about the health risks from drinking beer compared to the control group [Prevalence Ratio (PR) = 1.43, CI95%:1.05,1.93 for HWL red; PR = 1.25, CI95%: 0.91, 1.71 for HWL yellow]. A lower percentage of young adults in the interventions vs control group considered the product attractive (PR 0.74, 95%CI 0.51, 1.06 for HWL red; PR 0.56, 95%CI 0.38, 0.83 for HWL yellow). Although not statistically significant, a lower percentage of participants in the intervention groups considered buying or consuming the product than the control group. Results were similar when models were adjusted for covariates. CONCLUSIONS: Visible health warning labels could lead individuals to think about the health risks of alcohol, reducing the attractiveness of the product and decreasing the intention to purchase and consume alcohol. Further studies will be required to determine which pictograms or images and legends are most contextually relevant for the country. TRIAL REGISTRATION: The protocol of this study was retrospectively registered on 03/01/2023: ISRCTN10494244.
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Bebidas Alcohólicas , Etiquetado de Productos , Humanos , Adulto Joven , Etiquetado de Productos/métodos , México , Proyectos Piloto , AlcoholesRESUMEN
BACKGROUND: Tailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants' intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices. METHODS: A cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data. RESULTS: After viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01-1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14-1.69) and 1.29 (95% CI 1.04-1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample. CONCLUSIONS: Findings of this study provide evidence of an association between all four pictorial HWL themes and smokers' intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.
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Política para Fumadores , Cese del Hábito de Fumar , Productos de Tabaco , Contaminación por Humo de Tabaco , Niño , Adulto , Humanos , Femenino , Fumadores , Intención , Cese del Hábito de Fumar/métodos , Estudios Transversales , Pueblos del Este de Asia , Contaminación por Humo de Tabaco/efectos adversos , Contaminación por Humo de Tabaco/prevención & control , Etiquetado de Productos/métodos , China , Evaluación de Resultado en la Atención de SaludRESUMEN
The United States (US) Food and Drug Administration (FDA) requires health warning labels on all cigarette packages as part of a campaign to reduce tobacco smoking. Prior research has revealed the mixed effectiveness of these health warning labels. The present study used nationally representative, longitudinal data from the Population Study of Tobacco and Health (PATH) Study to assess whether reported reactions to health warning labels on cigarette packs predict smoking frequency and smoking cessation two years later. We hypothesized that individuals who reported strong reactions to health warnings at Wave 1 of the PATH Study would engage in less frequent smoking behavior and would be more likely to have completely quit cigarette smoking two years later (Wave 3), compared with individuals who did not report strong reactions. Multinomial and binary logistic regressions were used to estimate the associations between attitudes toward health warning labels and later smoking frequency and smoking cessation. Our hypotheses were partially supported; results indicated that several attitudes toward health warnings predict later smoking behaviors. These findings indicate general effectiveness of health warning labels and support the FDA's initiative to require more attention-grabbing health warning labels on cigarette packs.
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Fumar Cigarrillos , Productos de Tabaco , Humanos , Fumadores , Etiquetado de Productos/métodos , Prevención del Hábito de Fumar , Fumar Cigarrillos/epidemiologíaRESUMEN
BACKGROUND: Cigarette pack design plays a crucial role in attracting customers, especially when other marketing methods are limited by policy. University students who engage in casual smoking take the risk of developing an addiction. The objective of this study was to assess the effects of plain packaging (PP) and graphic health warnings (GHWs) on cigarette packages on three outcome variables (negative affect, avoidant responses, and intentions to quit) among ever-smoker university students in Ankara, Turkey, where youth smoking prevalence is high. METHODS: An online survey-based experiment was used to collect data. The respondents were randomly assigned to one of the five conditions that contained images of cigarette packs with specific design elements. Regression analyses (n = 623) were used to compare across conditions and to estimate the effects of combined warnings (versus text-only warnings), stronger GHWs (versus old GHWs), and PP (versus branded packages) on the outcome variables, accounting for potential confounders. RESULTS: Stronger GHWs generated more negative affect (0.31 points out of 5, p = 0.010) and avoidant responses (0.42 points out of 5, p = 0.002) than old warnings (when brand logos were visible). Plain packages generated more negative affect (0.48 points out of 5, p < 0.001) and avoidant responses (0.46 points out of 5, p = 0.001) than branded packages (with old warnings). Disentangling the effects of PP and new GHWs revealed that neither had individual differential effect on intentions to quit within 6 months. CONCLUSIONS: Although no differential effect of PP or harsher GHWs was found on intentions to quit when respondents were exposed to images on screen, both design elements were found to be effective in generating negative affect and avoidant responses. More work is needed to design effective tobacco control measures among youth during critical years of tertiary education.
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Etiquetado de Productos , Productos de Tabaco , Humanos , Etiquetado de Productos/métodos , Embalaje de Productos/métodos , Prevención del Hábito de Fumar/métodos , Estudiantes , Turquía , Universidades , Adulto JovenRESUMEN
OBJECTIVE: Many countries have adopted warning labels for combustible tobacco products, yet little research exists describing tobacco warning characteristics globally and to what extent they meet the WHO Framework Convention for Tobacco Control (FCTC) Guidelines. This study evaluates characteristics of combustible tobacco warnings. DESIGN: We conducted a content analysis to describe the overall landscape of warnings using descriptive statistics and compared to the WHO FCTC Guidelines. SETTING: We searched existing warning databases for combustible tobacco warnings from English-speaking countries. We compiled warnings meeting inclusion criteria and coded for message and image characteristics using a pre-defined codebook. PRIMARY AND SECONDARY OUTCOMES MEASURES: Characteristics of combustible tobacco warning text statements and warning images were the primary study outcomes. There were no secondary study outcomes. RESULTS: We identified a total of 316 warnings from 26 countries or jurisdictions worldwide. Of these warnings, 94% included warning text and an image. Warning text statements most often described health effects to the respiratory (26%), circulatory (19%) and reproductive systems (19%). Cancer was the most frequently mentioned health topic (28%). Fewer than half of warnings included a Quitline resource (41%). Few warnings included messages about secondhand smoke (11%), addiction (6%) or cost (1%). Of warnings with images, most were in colour and showed people (88%), mostly adults (40%). More than 1 in 5 warnings with images included a smoking cue (ie, cigarette). CONCLUSIONS: While most tobacco warnings followed WHO FCTC guidance on effective tobacco warnings, such as communicating health risks and inclusion of images, many did not include local Quitline or cessation resources. A sizeable minority include smoking cues that could inhibit effectiveness. Full alignment with WHO FCTC guidelines will improve warnings and better achieve the WHO FCTC objectives.
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Productos de Tabaco , Adulto , Humanos , Etiquetado de Productos/métodos , Prevención del Hábito de Fumar , Productos de Tabaco/efectos adversos , Organización Mundial de la SaludRESUMEN
BACKGROUND: Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes. METHODS: Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18-34 years). In the survey, participants rated the HWLs on several communication outcomes (e.g., reaction, harm perception, effectiveness) and were then instructed to view all HWLs in each theme and rank them in the order of overall perceived effectiveness, from the most to the least effective. Afterward, participants provided in-depth feedback on HWLs and avenues for improvement. Mean effectiveness rating scores and percentages of participants' top-ranked HWLs were calculated. Discussions were audio-taped, transcribed verbatim, and analyzed thematically. RESULTS: The top-ranked HWLs were those showing oral cancers, orally transmitted diseases, and a sick child. Focus group discussion illustrated that these selections were based on participants' reactions to the direct impact of WP on a person's physical appearance and evoking guilt over children's exposure to WP smoke. Suggestions for improvement highlighted the need to use the local dialect and more affirmative statements (e.g., avoiding "may" or "can"). CONCLUSIONS: This study is the first in North Africa to attempt to advance HWLs policy as the World Health Organization recommended. The results of this study can be used as a basis for implementing WP-specific health messages in the Eastern Mediterranean Region.
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Fumar Cigarrillos , Productos de Tabaco , Fumar en Pipa de Agua , Niño , Humanos , Adolescente , Adulto Joven , Adulto , Etiquetado de Productos/métodosRESUMEN
Warning sign plays an important role in risk avoidance. Many studies have found that images are better warnings than text, while others have revealed flaws of image-only warning signs. To better understand the factors underlying the effectiveness of different types of warning signs (image only, text only, or image and text), this study adopted event-related potential technology to explore the differences at the neurocognitive level using the oddball paradigm and the Go/No-go paradigm. Together, the behavioral and electroencephalogram results showed that text-only warnings had the lowest effectiveness, but there was little difference between the image-only and image-and-text warnings. The differences in the effects of the three warning signs were mainly in the areas of attention and cognitive control, implying differences in the underlying cognitive processes. Therefore, in the design of warning signs, the effects of different design attributes on cognitive processing should be taken into account based on actual needs in order to improve the effectiveness of the signs.