Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico / Impacto de advertencias sanitarias del empaquetado de cigarros: un an lisis comparativo en Brasil, Uruguay y M‚xico

ABSTRACT

Objective. To assess the impact of different health warning labels (HWL). Material and Methods. Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; ABSTRACT pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. Results. HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. Conclusions. This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking (AU)

RESUMEN

Objetivo. Evaluar el impacto de diferentes advertencias sanitarias (AS). Material y m‚todos. Se analizaron datos de la Encuesta Internacional para el Control del Tabaco (ITC Survey), un estudio de fumadores adultos en Brasil, Uruguay y M‚xico, tres pa¡ses con distintas AS (con im genes de sufrimiento humano y ¢rganos enfermos; con im genes abstractas del riesgo; mensajes de solo texto, respectivamente). Se analiz¢ prominencia e impacto cognitivo de las AS. Resultados. Las AS de Uruguay (que era el £nico pa¡s con AS en la parte frontal del paquete) tuvieron una mayor prominencia que en Brasil o M‚xico. En M‚xico, la gente que ten¡a un nivel de educaci¢n mayor eran mas propensos a leer mensajes de advertencia, mientras que educaci¢n no se asoci¢ con prominencia en Brasil o Uruguay. Las AS de Brasil tuvieron un mayor impacto cognitivo y conductual que las AS de Uruguay o M‚xico. Las AS de Uruguay generaron un menor impacto cognitivo y conductual que las AS de s¢lo texto en M‚xico. En Brasil, los impactos cognitivos fueron los m s fuertes entre fumadores con un bajo nivel educacional. Conclusiones. Este estudio sugiere que las AS tienen el mayor impacto cuando son prominentes (por ej. en el frente y la parte trasera del paquete) e incluyen im genes emocionalmente llamativas que muestran impactos negativos en el cuerpo o sufrimiento humano debido al fumar (AU)