The Role of Negative Emotions Pre- and Post-Implementation of Graphic Health Warnings: Longitudinal Evidence from South Korea.

Seon Min Lee,Seungwoo Chun,Jin Suk Lee

doi:10.3390/ijerph17155393

Abstract

This longitudinal study investigated the factors that determine the effectiveness of graphic health warnings (GHWs) by comparing 246 South Korean smoker’s responses before and after the introduction of the country’s new tobacco control policy wherein GHWs were placed on all cigarette packaging. Even though introducing GHWs did not cause immediate changes in smokers’ intention to quit smoking or perception of smoking’s health risk, GHWs eventually motivated smokers to quit smoking when they experienced negative emotional responses to the newly introduced graphic warnings on cigarette packaging. More importantly, this study found that positive changes in smokers’ perceived risk associated with smoking due to the introduction of GHWs mediated a positive relationship between changes in smokers’ negative emotions (NE) from text-only warnings to graphic warnings and changes in their intention to quit smoking during the same period. Based on these results, the authors suggest that, for GHW policy to be more effective in motivating smoking cessation, the warnings need to convey images sufficiently unpleasant to induce negative emotional responses among smokers.

Highlights

Smoking is a well-known cause of preventable premature deaths [1] and public health risk
To detect attrition bias caused by extinction of 122 participants, we conducted t tests to compare those subjects responding to pre- and post-introduction surveys with those responding to only the pre-introduction survey
To the best of our knowledge, this is the first longitudinal study to demonstrate the role of perceived risk of smoking to motivate smokers to attempt smoking cessation since they experience relatively more negative emotions toward graphic health warnings (GHWs) than text-only warnings

Summary

Introduction

Smoking is a well-known cause of preventable premature deaths [1] and public health risk. In 2015, the daily smoking rate of adult males in South Korea was 31.4%, which was one of the top countries in terms of the smoking rate among the 36 member countries of the Organization for Economic. The estimated cost of smoking prevalence in South Korea was approximately 1% of the country’s gross domestic product (GDP) [3]. On 23 December 2016, South Korea introduced their graphic health warning (GHW) anti-tobacco campaign. They unveiled 10 full-color pictorials along with text warnings that are mandated to cover at least 50% (i.e., 30% graphic and 20% text) of the front side of every cigarette pack (see Supplementary Table S1). Before GHWs were introduced, cigarette packs carried text warnings that covered only 20% of the pack’s front side

Methods

Results

Discussion

Conclusion