Severity and susceptibility: measuring the perceived effectiveness and believability of tobacco health warnings

Olivia M Maynard,Andrew L Skinner,Harry Gove,Marcus R Munafò

doi:10.1186/s12889-018-5385-x

Abstract

BackgroundPictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them.MethodsWe examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease.ResultsA 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs.ConclusionOur findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or ‘grotesque’ HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.

Highlights

Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only Health warning label (HWL) in changing smoking attitudes and intentions
A 2 × 3 × 3 Analysis of variance (ANOVA) was run for both believability and effectiveness ratings
A 2 × 3 ANOVA was conducted on the ratings of perceived susceptibility to the three diseases

Summary

Introduction

Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. There is contradictory evidence regarding how the severity of the content of HWLs influences responses to them. Understanding how the features of tobacco health warning labels (HWLs) influence overall message believability and effectiveness is politically important. Pictorial tobacco HWLs have consistently been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions [2, 3]. While graphic or ‘gruesome’ pictorial HWLs are generally found to be effective [4], there is contradictory evidence regarding how the severity of the content of HWLs and the diseases presented influences their effectiveness and believability. High emotion HWLs have been shown to elicit greater emotional reaction than lower-emotion HWLs, with emotional reaction to HWLs

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