The role of theory-driven graphic warning labels in motivation to quit: a qualitative study on perceptions from low-income, urban smokers.

Erin L Mead,Joanna E Cohen,Carl A Latkin,Joseph Gallo,Caitlin E Kennedy

doi:10.1186/s12889-015-1438-6

Abstract

BackgroundUse of communication theories in the development of pictorial health warning labels (graphic warning labels) for cigarette packaging might enhance labels’ impact on motivation to quit, but research has been limited, particularly among low socioeconomic status (SES) populations in the U.S. This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers.MethodsA cross-sectional qualitative study was conducted with 25 low-income adult smokers in Baltimore, Maryland, who were purposively sampled from a community-based source population. Semi-structured, in-depth interviews were conducted from January to February 2014. Participants were asked about the motivational impact of 12 labels falling into four content categories: negative depictions of the health effects of smoking to smokers and others, and positive depictions of the benefits of quitting to smokers and others. Data were coded using a combined inductive/deductive approach and analyzed thematically through framework analysis.ResultsLabels depicting negative health effects to smokers were identified as most motivational, followed by labels depicting negative health effects to others. Reasons included perceived severity of and susceptibility to the effects, negative emotional reactions (such as fear), and concern for children. Labels about the benefits of quitting were described as motivational because of their hopefulness, characters as role models, and desire to improve family health. Reasons why labels were described as not motivational included lack of impact on perceived severity/susceptibility, low credibility, and fatalistic attitudes regarding the inevitability of disease.ConclusionsLabels designed to increase risk perceptions from smoking might be significant sources of motivation for low SES smokers. Findings suggest innovative theory-driven approaches for the design of labels, such as using former smokers as role models, contrasting healthy and unhealthy characters, and socially-oriented labels, might motivate low SES smokers to quit.

Highlights

Use of communication theories in the development of pictorial health warning labels for cigarette packaging might enhance labels’ impact on motivation to quit, but research has been limited, among low socioeconomic status (SES) populations in the U.S This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers
Role in motivation to quit Participants were asked about the labels’ influence on their motivation to quit. They most often identified labels depicting the negative consequences of smoking to smokers, regardless of whether the label portrayed high or low threat, because of the influence on their risk perceptions: Because you look at which way you going
You going to [get] a messed up heart and you going to your throat cancer or whatever he got

Summary

Introduction

Use of communication theories in the development of pictorial health warning labels (graphic warning labels) for cigarette packaging might enhance labels’ impact on motivation to quit, but research has been limited, among low socioeconomic status (SES) populations in the U.S This qualitative study explored perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income smokers. The U.S ranks among the highest in income inequality among high-income countries [1], and income inequality continues to grow [2]. Smoking prevalence is highest in low SES neighborhoods, which may be due to targeted marketing [7,8,9] and the use of smoking as a coping mechanism for stress and as a shared behavior that fosters norms favorable toward smoking and significant barriers to quitting [10,11]. The global fiscal crisis of 2008 contributed to increased smoking prevalence among the unemployed in the U.S, increasing health inequities [13]. Public health interventions that effectively promote cessation among low SES smokers are needed to help close the health equity gap, in light of the growing socioeconomic inequality in the U.S

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