Effectiveness Of Pictorial Health Warnings Research Articles

Evidence of the Effectiveness of Pictorial Health Warnings on Cigarette Packaging in Nepal

Tobacco Control Act of 2010 mandates government to implement at least 75% pictorial health warnings (PHWs) on tobacco packaging that was enforced in 2013. The purpose of the study was to assess the effectiveness of PHWs and its impact to the policy change.A cross-sectional study was conducted in 9 cities between September 2014 and March 2015. Direct interviews were made among 2250 randomly selected individuals. The effectiveness of PHWs were measured as perceived: i) scariness; ii) quit motivation iii) convincing youth not to start smoking; iv) encouraging ex-smokers to remain as quitters; v) building public awareness. Logistic regression analysis was used to determine the factors associated with the effectiveness of PHWs.Of the 2250 participants, 29.8% (670) were current smokers, 8.6% (193) were ex-smokers and 97.6% believed that smoking was addictive. PHWs made 83% of the participants scared. Participants believed that PHWs would be effective in motivating smokers to quit (80.2%), in convincing youth not to start smoking (86.8%), in encouraging ex-smokers to remain as quitters (89.1%) and in building public awareness on the dangers of smoking (94%). PHWs made 58% of the current smokers intended to quit smoking and reduced their daily intake of cigarettes from 11 to 5 on average. Current smokers preferred to purchase loose cigarettes rather than a pack. The covariates significantly associated with the effectiveness of PHWs were current smokers, ex-smokers and addiction.PHWs were found important to motivate smokers to quit smoking, to reduce consumption of cigarettes and to prevent relapse in ex-smokers. Evidence from the study had triggered policy changes which included enlargement of the size of PHW to 90% and the release of a notification to ban selling of loose cigarettes. Thus, the warning messages with pictures are required to be improved and rotated.

Effectiveness of Pictorial Health Warnings on Tobacco Products in Creating Awareness among 15-17 Years Old School Children in Lucknow

Aim: The present study was planned to assess the effectiveness of pictorial health warnings on tobaccoproducts in creating awareness among 15-17 years old school children in Lucknow.Materials and method: The present cross sectional study was conducted among 360 students studyingin rural schools of Lucknow. Information about schools was obtained from DEO’s. Sampling was doneusing multistage sampling technique. A specially designed questionnaire was administered to assess theeffectiveness of pictorial health warnings on tobacco products in creating awareness given on the reversepanel of smoked and smokeless tobacco. Statistical analysis was done using chi square and test.Results: The mean knowledge score among male and female was 6.37±1.56 and 6.50±1.73 respectivelywith statistically insignificant difference. Average and poor impact was reported among 21.11%, 1.94% and14.17%, 0.28% of the boys and girls respectively. When different attitude grading was compared statisticallyamong boys and girls, it was found to be statistically significant.Conclusion: The present study threw light on some of the aspects of the young students towards the PictorialHealth Warnings on tobacco packs. The finding also highlights to improve the quality of the PictorialWarnings and make them more robust and impactful

Do pictorial health warnings on waterpipe tobacco packs matter? Recall effectiveness among Egyptian waterpipe smokers & non-smokers.

IntroductionDespite the global rise in waterpipe tobacco smoking (WTS), the effectiveness of waterpipe tobacco health warnings remain understudied, especially in countries with high WTS rates. Egypt has been employing waterpipe tobacco labelling for a decade, however, their effectiveness is unknown. Our overall aim was to measure the effectiveness of pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) through participant memory recall and to investigate whether they induced behavioural responses in waterpipe smokers and deterred uptake of WTS in non-smokers, examining the differentials of effectiveness among socio-demographic subgroups.Subjects and methodsWe conducted two surveys including 1490 adult current waterpipe smokers, 73 former waterpipe smokers, and 451 non-smokers in Cairo and a rural village in Egypt between 2015–2017. Participants who noticed PHWs on WTPs were asked questions about salience, communication of health risks, public support, cognitive processing, and self-reported behavioural responses (current waterpipe smokers: reduce consumption, forgo a smoke, quit attempts; former waterpipe smokers: quit; non-smokers: deter WTS initiation). Univariate and multivariable statistical analyses were performed.ResultsParticipants’ mean age was 35 years, mostly males (90.4%), waterpipe smokers (74.0%) and rural residents (59.3%). Approximately two-thirds of participants noticed PHWs on WTPs. Salience was significantly less among females, urban residents and participants with high literacy. More than three-quarters of participants reported that WTS health risks were communicated through the warnings. At least half of participants cognitively processed the warnings: 56.3% thought of the warnings when WTPs were out of sight; non-smokers understood the warnings (83.2%) and discussed them with others (90.3%) significantly more than current (76.0% and 72.5%, respectively) and former waterpipe smokers (81.0% and 61.9%, respectively). Participants reported that PHWs on WTPs motivated 58.5% of waterpipe smokers to think about quitting; 64.5% to reduce their consumption; 42.2% to forgo a smoke; 24.5% to attempt to quit; 57.1% of former waterpipe smokers to successfully quit; and 59.3% of non-smokers to remain smoke-free.ConclusionsFindings suggest that inserting PHWs on WTPs is an effective waterpipe tobacco labelling policy. Countries with similarly high rates of WTS should consider adopting WTP PHWs within a comprehensive regulatory framework.

Perceived effectiveness of pictorial health warnings on changes in smoking behaviour in Asia: a literature review

BackgroundSeveral Asian countries have implemented pictorial health warnings on cigarette packs as suggested by the World Health Organization with various policies based on countries’ systems. The study is aimed to analyse multiple research studies on the perceived effectiveness of Pictorial Health Warnings as a deterrent to smoking intention and as a stimulant of smoking behaviour in smokers and non-smokers in Asian countries.MethodPeer-reviewed articles were identified through multiple science databases indexed by Scopus, MEDLINE or PubMed. The review was limited to articles that reported original research findings, were conducted in Asian countries and were available for review by January 2010. A PRISMA Flow diagram was used to identify the articles through the process of data screening and extractions.ResultA total of 14 original articles which met the criteria were included in the review, consisting of 12 quantitative studies and 2 studies with both quantitative and qualitative methods from 17 jurisdictions. The reviewed studies found that pictorial health warnings were associated with a greater perception of salience (reading and noticing the warning), emotional effects, and cognitive increase. Additionally, in the reviewed studies, pictorial health warnings were perceived as more effective in deterring smoking initiation and encouraging smoking cessation than text-only warnings. Several studies also evaluated the effectiveness of a new pictorial warning compared with the old one. However, the relevance of refreshing the pictures of pictorial health warnings and the length of the effective period of the implementation of pictorial health warnings were less frequently studied.ConclusionPictorial health warnings perceived as more effective in deterring smoking initiation among non-smokers and as well as in stimulating smoking cessation among smokers. Future studies on pictorial health warnings should study the relevance of changing or refreshing pictorial health warning on cigarette packages in a period of time.

Eksplorasi peringatan kesehatan bergambar pada kemasan rokok

Exploration of pictorial health warnings in cigarette packagesPurposeThis study conducted to examine effectiveness of pictorial health warnings in cigarette packages to reduce smoking intention.MethodA population-based, qualitative study, were used in this study. 20 partisipants were observed and indept-interviewed. ResultsThreats after seeing a picture warnings on cigarette packs is the perception of the dangers of images and feelings of fear, disgust, pity, worry, mediocre. Efficacy after seeing a picture warnings on cigarette packs is the belief of the image and the impact on individuals after viewing images.ConclusionThreat of pictorial warnings are not only affected by the warning image itself but also the experience of the viewer and aspects of the warning image such as color, clarity of image, and message content.

Effectiveness of pictorial health warnings on cigarette packs among adults in a rural Sri Lankan community

Effectiveness of pictorial health warnings on cigarette packs among adults in a rural Sri Lankan community

Effectiveness of pictorial health warnings on the waterpipe device and tobacco packs: a qualitative study

Effectiveness of pictorial health warnings on the waterpipe device and tobacco packs: a qualitative study

Multiple tobacco use among young adult waterpipe smokers in Egypt

The use of multiple tobacco products is an emerging trend. Studies on multiple use among waterpipe smokers are limited. We aimed to estimate the proportion of other tobacco products used by current adult waterpipe smokers in Egypt and identify the determinants of multiple tobacco product use. Population-based surveys were conducted using interview questionnaires during 2015-2017 in urban Cairo and rural Menoufia. Participants aged 18 years and older were selected using purposive quota non-random sampling. The total sample included 2 014 participants. We analysed the data on 1 490 current waterpipe smokers. Variables recorded included: tobacco use, health beliefs, waterpipe smoking behaviour, sociodemographic characteristics, and perceived effectiveness of pictorial health warnings on waterpipe tobacco packs. Current waterpipe smokers were classified as waterpipe-only users and multiple tobacco product users. Almost half (47.9%) of the current waterpipe smokers used multiple tobacco products; 93.4% were dual users and 6.6% poly-users. The other tobacco products used were cigarettes (86.4%), electronic nicotine delivery systems (ENDS) (7.0%) or both (6.6%). Multiple users were more likely to be younger than waterpipe-only users. Young adult female waterpipe smokers used ENDS 12 times more than young adult males (48.8% versus 4.1% respectively). Non-daily waterpipe smoking, usually smoking at cafes, higher education and knowledge of pictorial health warnings were independent predictors of multiple tobacco product use. Multiple tobacco product use was common among current waterpipe smokers in our study. Interventions to tackle non-cigarette and multiple tobacco use, especially in young adults, are urgently needed.

Factors Affecting the Perceived Effectiveness of Pictorial Health Warnings on Cigarette Packages in Gulf Countries: A Cross-sectional Study.

Objectives:To explore the perceived effectiveness of pictorial health warning (PHW) labels required by the Gulf Cooperation Council, to compare them with the Food and Drug Administration–approved PHW labels, and to determine factors affecting their perceived effectiveness.Methods:A cross-sectional study using a convenience sample of adult smokers and nonsmokers was conducted. The data were collected through a self-administered online questionnaire. The perceived effectiveness scores of PHW labels were calculated and compared among different subgroups using the Kruskal-Wallis test and the Dunn multiple comparison test at a .05 significance level.Results:Of the 90 people invited to participate in the survey, 77 (86%) completed it, with 39 (50%) nonsmokers, 22 (29%) smokers, and 16 (21%) former smokers. Overall, labels having graphic images of illness or pathology are perceived to be most effective. Smokers generally perceived labels significantly less effective compared with former smokers and nonsmokers. Also, 55 respondents (71%) suggested that the presence of a telephone quit-line would be effective.Conclusions:Smoking status and image type had the most effect on the perceived effectiveness of the PHW labels on cigarette packs. Pictorial health warning labels with graphic images of pathology and a telephone quit-line are perceived to be most effective.

Awareness of health warnings and factors predicting awareness and perceived effectiveness of pictorial health warnings on tobacco products among adults in rural Puducherry, India.

BACKGROUND:Limited information exists in India about the awareness and perception of the people regarding pictorial health warnings (PHWs) and text warnings on tobacco products, more so from rural areas. Objectives were to report the awareness of these warnings, factors predicting awareness and perceived effectiveness of PHWs, and understanding of their content in a rural population.MATERIALS AND METHODS:A community-based cross-sectional study was conducted in two villages (chosen randomly out of total four) in the rural field practice area of a tertiary care teaching hospital in Puducherry. Households were selected by systematic random sampling. All persons ≥18 years and residing in the area for at least 6 months were included. Data regarding awareness and perception of participants was collected through a semi-structured interview schedule.RESULTS:A total of 428 participants were recruited; 197 (46%) were male, and 231 (54%) were female. The mean age of the participants was 38.9 (standard deviation 15.0) years. Awareness of PHWs and text warnings was 39.5% (169/428) and 21% (90/428), respectively. Only 11.2% participants perceived PHWs as effective. Most (45%) of the participants had a vague understanding of the content of PHWs. On multivariate logistic regression, male gender, current tobacco use, and better education emerged as predictors of greater awareness of PHWs. Extended family predicted greater perceived effectiveness of PHWs, whereas, high socioeconomic class and middle school completion predicted lower perceived effectiveness of PHWs.CONCLUSION:Awareness and perceived effectiveness of adults in rural Puducherry regarding PHWs were low. There is a need to create awareness through education and using meaningful, larger pictures.

Investigating the effectiveness of pictorial health warnings in Mauritius: findings from the ITC Mauritius survey.

Health warnings on tobacco packages are an effective strategy for informing the public about the harms associated with tobacco use. Most studies investigating the effectiveness of pictorial health warnings (PHWs) on cigarette packages are from high-income countries. This study evaluated the impact of PHWs on smokers' perceptions and behavior in Mauritius, the first country in the World Health Organization African region to implement PHWs. Data were drawn from 3 waves of a nationally representative cohort of adult smokers from the International Tobacco Control (ITC) Mauritius Survey (n = 668). Wave 1 was conducted in 2009, 6 months prior to the implementation of PHWs. Waves 2 and 3 were conducted 10-12 months and 20-21 months, respectively, postimplementation. Six established indicators of warning effectiveness were used to evaluate the effect of PHWs on smokers' perceptions and behavior. All indicators of warning effectiveness (salience, cognitive, and behavioral reactions) and the Label Impact Index, a weighted combination of 4 indicators, increased significantly between Waves 1 and 2. However, between Waves 2 and 3, there was a significant decline in the proportion of smokers who reported "avoiding looking" at labels. This study found that implementation of PHWs in Mauritius significantly enhanced the effectiveness of warnings, illustrating their value for other countries, particularly in Africa, at an early stage in tobacco control. The study also demonstrates the importance of revising PHWs to counteract wearout. The introduction of PHWs in Mauritius clearly demonstrates the benefits of employing an evidence-based approach to strengthen tobacco control policies.

Effectiveness of pictorial health warnings on cigarette packs among Lebanese school and university students

BackgroundPictorial health warnings are more effective than text warnings in enhancing motivation to quit and not to start smoking among youth. In Lebanon, packs still have only a very small...

Exploring Perception of Indians about Plain Packaging of Tobacco Products: A Mixed Method Research

This study assessed perceptions and support among the Indian populace about plain packaging for all tobacco products. Twelve focus group discussions (n = 124), stakeholder analysis with 24 officials and an opinion poll with 346 participants were conducted between December 2011 and May 2012, Delhi. Plain packages for tobacco products were favored by majority of participants (69%) and key stakeholders (92%). The majority of participants perceived that plain packaging would reduce the appeal and promotional value of the tobacco pack (>80%), prevent initiation of tobacco use among children and youth (>60%), motivate tobacco users to quit (>80%), increase notice ability, and effectiveness of pictorial health warnings on tobacco packs (>90%), reduce tobacco usage (75% of key stakeholders). Majority of participants favored light gray color for plain packaging. This study provides key evidence to advocate with Indian Government and other countries in South Asia region to introduce plain packaging legislation for all tobacco products.

Perceived effectiveness of pictorial health warnings among Mexican youth and adults: a population-level intervention with potential to reduce tobacco-related inequities

Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message content and socio-demographic effects. This study tested message themes and content of pictorial warnings in Mexico. Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5-7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: "graphic" health effects, "lived experience", symbolic images, and testimonials. Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring "graphic" depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme. Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups.

Ineffective pictorial health warnings on tobacco products: Lessons learnt from India

Pictorial warnings are effective in promoting smoking cessation as shown by research in the developed countries. This study aims to determine perceptions of Indians about the effectiveness of pictorial health warnings on tobacco packs which existed from May 31, 2009, to December 1, 2011. A cross-sectional survey was undertaken in five states of India with 1897 participants (56% males; 54% tobacco users). More tobacco users expressed that the pictorial warnings are inadequate to convey the health impact of tobacco use when compared with nonusers (71.50% vs. 62.75%; P < 0.001). More illiterates when compared with literates expressed their concern that the current pictorial warnings will not motivate them to quit (61.17% vs. 51.01%; P < 0.001). The new warnings implemented from December 1, 2011, in India are also not field-tested. Field testing and assessment of effectiveness of health warnings should be a mandatory requirement for Parties reporting on Article 11 of Framework Convention on Tobacco Control (FCTC).

Smokers Respond to Pictorial Health Warnings

![Figure][1] CREDIT: U.S. HHS In the News & Analysis story “Antismoking drive tries cigarette ads, in reverse” (S. Reardon, 1 July, p. [23][2]), social psychologist Carol Tavris expressed doubts about the effectiveness of pictorial health warnings on tobacco packaging. However, there is