Abstract
BackgroundCigarette pack health warning labels can elicit negative emotions among smokers, yet little is known about how these negative emotions influence behavior change. ObjectiveGuided by psychological theories emphasizing the role of emotions on risk concern and behavior change, we investigated whether smokers who reported stronger negative emotional responses when viewing warnings reported stronger responses to warnings in daily life and were more likely to try to quit at follow-up. MethodsWe analyzed data from 5439 adult smokers from Australia, Canada, Mexico, and the US, who were surveyed every four months from September 2012 to September 2014. Participants were shown warnings already implemented on packs in their country and reported negative emotional responses (i.e., fear, disgust, worry), which were averaged (range = 1 to 9). Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Models were adjusted for socio-demographic and smoking-related characteristics, survey wave, and the number of prior surveys answered. ResultsSmokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. There was no significant interaction of negative emotions with self-efficacy or nicotine dependence. ConclusionNegative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts.
Highlights
The World Health Organization's Framework Convention on Tobacco Control (FCTC) calls for nations to implement pictorial health warnings on tobacco packaging
This article examines how negative emotions aroused by health warnings are associated with key cognitive and behavioral responses to warnings
H4: Smokers who reported stronger negative emotional responses to warnings would be more likely to: (a) pay attention to health warnings, (b) perceive health risks, (c) avoid warnings; and (d) forgo planned cigarettes due to warnings; Lastly, we examine whether shorter-term cognitive and behavioral responses to warnings; H5: (a) attention to health warnings, (b) risk concern, (c) avoiding warnings, and (d) forgoing planned cigarettes because of warnings would mediate the relationship between negative emotions and quit attempts at follow up
Summary
The World Health Organization's Framework Convention on Tobacco Control (FCTC) calls for nations to implement pictorial health warnings on tobacco packaging. Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Results: Smokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. Conclusion: Negative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts
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