Adolescent’s perception of textual and pictorial warnings on cigarette packs in Sicily (south Italy): a cross-sectional survey

Abstract

Introduction: Italy is going to use a selection of pictorial warnings on May 20, 2016. We examined the perception of warnings on cigarette packs among youths comparing the impact of textual and pictorial warnings. Methods: we carried out a cross-sectional survey involving 488 (53.3% females) middle-school students aged 11-14 years. The students filled in a validate international questionnaire on-line. We examined a dichotomized version of four measures of health warning effectiveness (Warning salience, Thoughts of harm, Thoughts of quitting, Forgoing of cigarettes) and a composite warning Adolescent Label Impact Index (ALII), higher scores signifying grater impact. Results: the individual measures of health warning effectiveness and ALII median scores differ significantly between textual and pictorial warnings. We found differences between gender only for textual Warning salience (F>M; p=0.032) and for pictorial Thoughts quitting (M>F; p= 0.038). There was substantially evidence of differences in odds for age and smoking parents in ALII for pictorial and textual health warning as shown by 95% CI reported. The majority (82%) of the students indicated the pictorial warning related to “gangrene” and “infant” images as the most shocking. Both genders thought that cigarette smoking is absolutely harmful (M: 89%, F: 84%; p= 0.408). Conclusions: the results of the present study add information to the general international literature on the impact of textual and pictorial warnings on youth. The findings have implications for warning design.