Abstract
Background: While pictorial health warning labels (HWLs) are evidence-based, the different messaging strategies are understudied. Methods: We analyzed 2014 national survey data from 1163 Georgian adults to examine: (1) perceived effectiveness of pictorial vs. text-only HWLs; (2) pictorial HWL themes; and (3) correlates of perceived effectiveness of different pictorial themes. Participants were randomized to evaluate the effectiveness of either Set A or Set B of HWLs (each contained half pictorial, half text-only). Results: All but 2 pictorial HWLs were perceived as more effective than text-only. Factor analyses identified one factor among Set A (“benign”) and two in Set B pictorial HWLs (“benign”, “gruesome”). Among Set A pictorial HWLs, correlates of greater perceived effectiveness included being female, rural residence, not having children, and nonsmoker status. Among smokers, correlates included being female and unmarried, fewer smoking friends, and higher quitting importance. Among Set B, 43.8% rated gruesome pictorial HWLs more effective, 12.9% benign more effective, and 43.4% equally effective. Correlates of perceiving benign more effective included fewer smoking friends and higher income. Among smokers, lower income predicted gruesome being perceived as more effective; fewer smoking friends and higher quitting importance predicted perceiving benign as more effective. Conclusion: A variety of pictorial HWL strategies should be used.
Highlights
The tobacco epidemic is one of the biggest public health threats globally, killing more than 7 million people a year [1]
Factor Analysis Examining Themes Emerging from Pictorial health warning labels (HWLs)
Analyses regarding Set A pictorial HWLs indicated that females reported greater perceived effectiveness of the benign HWLs, which may reflect literature suggesting that women are more likely to consider quitting after viewing labels [31,42,43] and may be responsive to a broader range of pictorial HWLs, those not using gruesome imagery [33]
Summary
The tobacco epidemic is one of the biggest public health threats globally, killing more than 7 million people a year [1]. Smoking rates in former Soviet Union countries are among the highest in the world [2]. Control (WHO FCTC) has provided a major impetus for all countries to adopt comprehensive policies to counter the global tobacco epidemic [5,6]. HWL themes; and (3) correlates of perceived effectiveness of different pictorial themes. Participants were randomized to evaluate the effectiveness of either Set A or Set B of HWLs (each contained half pictorial, half text-only). Results: All but 2 pictorial HWLs were perceived as more effective than text-only. Among Set A pictorial HWLs, correlates of greater perceived effectiveness included being female, rural residence, not having children, and nonsmoker status
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