Abstract
BackgroundThe U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups.Methods/FindingsParticipants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22−1.62), and intention to quit (OR = 1.30, 95% CI = 1.10−1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057).ConclusionsFindings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.
Highlights
The U.S Family Smoking Prevention and Tobacco Control Act (FSPTCA) [1] of 2009 required nine new health warning statements to be placed on cigarette packages and in cigarette advertisements by September 2012
Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations
Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, within vulnerable communities
Summary
The U.S Family Smoking Prevention and Tobacco Control Act (FSPTCA) [1] of 2009 required nine new health warning statements to be placed on cigarette packages and in cigarette advertisements by September 2012. The new warning labels, which are under ongoing litigation as a result of multiple challenges by the tobacco industry, are designed to update the current text-only statements on cigarette packages, which have been in effect in the U.S since 1984 These text warnings have been consistently characterized as ‘‘worn out’’– unlikely to be noticed and rated as ineffective by smokers. Survey and experimental research in the U.S and other countries supports the effectiveness of pictorial health warning labels (HWLs) compared with text-only HWLs. Data from the International Tobacco Control (ITC) Policy Evaluation Project, a prospective longitudinal panel study of smokers in multiple countries, [7,8] demonstrate that pictorial HWLs are more likely to be noticed than text-only HWLs, [3,9,10,11] more effective in informing viewers of the risks of smoking, [10,12] and more likely to motivate cessation-related activity. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S adult smokers from diverse racial/ethnic and socioeconomic subgroups
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