Abstract
Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population.Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model.Results: Participants (N = 150; Age = 15–18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67–4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72–6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks.Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.
Highlights
Experimenting with tobacco products during adolescence increases the likelihood of developing long-term nicotine addiction, with the majority of active adult smokers having started using tobacco before the age of 20 years [1]
Tobacco experimentation at this age often occurs as a result of cigarette sharing in social settings [2], which can lead to a quick loss of autonomy, and addiction occurring more rapidly, and with lower levels of consumption compared to adults [3, 4]
Participants perceived the warnings used on cigarette packaging and cigarette sticks as significantly (p < 0.001) more effective in preventing non-smokers from smoking, than in encouraging current smokers to quit with an odds ratio (OR) of 4.71 (95% confidence interval [CI]: 2.83–7.84)
Summary
Experimenting with tobacco products during adolescence increases the likelihood of developing long-term nicotine addiction, with the majority of active adult smokers having started using tobacco before the age of 20 years [1] Tobacco experimentation at this age often occurs as a result of cigarette sharing in social settings [2], which can lead to a quick loss of autonomy, and addiction occurring more rapidly, and with lower levels of consumption compared to adults [3, 4]. Adolescent experimentation with tobacco products is influenced by their limited experience and understanding of the nature of addiction, and their beliefs in being personally able to avoid or control addictive behaviors at will [7, 8] This is in spite of their awareness of the general addictive potential of nicotine, and smoking as being a leading cause of death [9]. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population
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