Graphic Health Research Articles

A randomized trial of computer-based communications using imagery and text information to alter representations of heart disease risk and motivate protective behaviour

Advances in web-based animation technologies provide new opportunities to develop graphic health communications for dissemination throughout communities. We developed imagery and text contents of brief, computer-based programmes about heart disease risk, with both imagery and text contents guided by the common-sense model (CSM) of self-regulation. The imagery depicts a three-dimensional, beating heart tailored to user-specific information. A 2 × 2 × 4 factorial design was used to manipulate concrete imagery (imagery vs. no imagery) and conceptual information (text vs. no text) about heart disease risk in prevention-oriented programmes and assess changes in representations and behavioural motivations from baseline to 2 days, 2 weeks, and 4 weeks post-intervention. Sedentary young adults (N= 80) were randomized to view one of four programmes: imagery plus text, imagery only, text only, or control. Participants completed measures of risk representations, worry, and physical activity and healthy diet intentions and behaviours at baseline, 2 days post-intervention (except behaviours), and 2 weeks (intentions and behaviours only) and 4 weeks later. The imagery contents increased representational beliefs and mental imagery relating to heart disease, worry, and intentions at post-intervention. Increases in sense of coherence (understanding of heart disease) and worry were sustained after 1 month. The imagery contents also increased healthy diet efforts after 2 weeks. The text contents increased beliefs about causal factors, mental images of clogged arteries, and worry at post-intervention, and increased physical activity 2 weeks later and sense of coherence 1 month later. The CSM-based programmes induced short-term changes in risk representations and behaviour motivation. The combination of CSM-based text and imagery appears to be most effective in instilling risk representations that motivate protective behaviour.

Effects of dissuasive packaging on young adult smokers

BackgroundTobacco industry documents illustrate how packaging promotes smoking experimentation and reinforces existing smokers' behaviour. Plain packaging reduces the perceived attractiveness of smoking and creates an opportunity to introduce larger pictorial...

Adolescents' Perceptions of Cigarette Brand Image: Does Plain Packaging Make a Difference?

To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs. We used a 5 (degree of plain packaging and graphic health warning)x 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings. When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers. Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced.

Awareness of smoking risks and attitudes towards graphic health warning labels on cigarette packs: a cross-cultural study of two populations in Singapore and Scotland

Little is known about the level of awareness of blindness as a smoking-related condition, although the relationship has been well established. To compare the awareness of smoking risks and the impact of graphic health warning labels on cigarette packs in discouraging smoking among adults in Singapore and Scotland. A cross-sectional survey using a structured interview of adults in ophthalmic, general medical, and general surgical outpatient clinics in Singapore and Scotland. One hundred and fifteen out of 163 (70.6%) outpatients in Singapore and 105 out of 112 (93.8%) outpatients in Scotland responded to the study. In both samples, awareness levels for smoking-related diseases such as lung cancer, mouth and throat cancer, heart disease, and stroke were all greater than 85%. These were found to be significantly higher than the level of awareness of blindness as a smoking-related condition (chi (2)-test, P<0.001). Although the awareness of blindness as a smoking-related condition was greater in Singapore (36.5%) than in Scotland (30.5%), this difference was not statistically significant. More than half of the respondents indicated that graphic health warning labels would be effective in discouraging them from smoking. Graphic health warning labels reading 'Smoking causes blindness' printed on cigarette packs may be useful in raising public awareness of blindness as a smoking-related condition and discouraging the habit of smoking in Singapore and Scotland.

Scare' Em or Disgust 'Em: The Effects of Graphic Health Promotion Messages

This study experimentally tested the effects of 2 types of content commonly found in anti-tobacco television messages—content focused on communicating a health threat about tobacco use (fear) and content containing disgust-related images—on how viewers processed these messages. In a 2 × 2 within-subjects experiment, participants watched anti-tobacco television ads that varied in the amount of fear and disgust content. The results of this study suggest that both fear and disgust content in anti-tobacco television ads have significant effects on resources allocated to encoding the messages and on recognition memory. Heart-rate data indicated that putting fear- or disgust-related content into anti-tobacco ads led to more resources allocated to encoding compared to messages without either feature. However, participants appeared to allocate fewer resources to encoding during exposure to messages featuring both fear and disgust content. Recognition was most accurate for messages that had either fear or disgust content but was significantly impaired when these 2 message attributes occurred together. The results are discussed in the context of motivated processing and recommendations about message construction are offered to campaign designers.

Confirmed Recall and Perceived Effectiveness of Tobacco Countermarketing Media in Rural Youth

This study was the first to examine rural youth's responses to ten television and radio tobacco countermarketing ads aired during a 13-week field campaign conducted in a U.S. Northern Plains state. A post-campaign survey of 391 girls and boys aged 12-17 years and including 58 American Indian youth provided information about their confirmed recall (CR) of the ads; and for recalled ads, their ratings of the ads' perceived effectiveness (PE). Results were that controlling for age and smoking risk, both American Indian and white girls and boys had the highest CR for the television ad Artery and for the radio ad ABC. Artery shows fatty deposits being squeezed from a deceased smoker's aorta, and ABC presents a former smoker speaking through his electro-larynx. Among the television ads, PE ratings were highest for the ad Artery in both boys and girls. Among the radio ads, boys rated ABC highest, whereas girls rated Joe DoBoer highest-an ad that discusses mouth lesions that developed from using smokeless tobacco. An analysis of race/ethnicity differences in PE for the ad Artery and ABC indicated American Indian and white youth considered these ads equally effective. These findings indicate certain TV and radio ads depicting graphic health harms from tobacco-especially the TV ad Artery and the radio ad ABC-are highly recalled and perceived as effective by both American Indian and white girls and boys from a rural region. Future research is needed to better understand which individual- and media-level factors increase the likelihood that anti-tobacco ads will be effective in reducing youth tobacco use.

Socioeconomic Inequalities in the Prevalence and Management of Childhood Diarrhoea: Potential Health Gains to be Achieved

Background: Diarrhoea represents a major burden of childhood disease in countries with low and middle in- comes. The need for targeting poorer socioeconomic groups has been forwarded as a priority in diarrhoea control. The aim of this study was to determine the role of socioeconomic inequalities in the control of childhood diarrhoea. Methods: Household data on prevalence and case management of diarrhoea in children aged 0-4 years from 93 Demo- graphic Health Surveys (DHS) in 55 countries in 1990-2005 were analysed by wealth quintiles. Socioeconomic dispari- ties and trends in inequalities were assessed. Findings: Households in the poorest socioeconomic group consistently showed higher morbidity attributable to diarrhoea and less frequent use of oral rehydration therapy (ORT) when compared with households in the richest socioeconomic group. If the prevalence of diarrhoea in all households were the same as that in the best-performing wealth quintiles, the prevalence of diarrhoea would be reduced by 22.8%. If all socioeconomic groups had adopted the ORT-use rates achieved by the best-performing wealth quintiles, overall use of ORT would have increased by 21.5%. This corresponds to an in- crease in treated episodes of diarrhoea of 481 million annually in the study population. Trend analysis did not show sig- nificant changes in inequalities over time. Interpretations: To increase efficiency in the control of diarrhoeal diseases, preventive measures should be targeted to the poor, rehydration products should be made more affordable and information on the importance of using ORT should be disseminated more intensively to disadvantaged groups.

Distribution of new graphic warning labels: Are tobacco companies following regulations?

ObjectiveTo test the hypothesis that tobacco companies would not follow a regulation that required seven new graphic health warnings (GHWs) to be evenly distributed on cigarette packs and that they would distribute fewer packs featuring warnings regarded by smokers as being more disturbing.MethodsCross-sectional survey of purchased packs (n = 168) and street-collected discarded packs (convenience sample of New Zealand cities and towns, n = 1208 packs) with statistical analysis of seven types of new GHWs. A priori warning impact was judged using three criteria, which were tested against data from depth interviews with retailers.ResultsThe GHWs on the purchased packs and street-collected packs both showed a distribution pattern that was generally consistent with the hypothesis ie, there were disproportionately more packs featuring images judged as "least disturbing" and disproportionately fewer of those with warnings judged "more disturbing". The overall patterns were statistically significant, suggesting an unequal frequency of the different warnings for both purchased (p < 0.0001) and street-collected packs (p = 0.035). One of the least disturbing images (of a "corpse with toe-tag") dominated the distribution in both samples. Further analysis of the street-collected packs revealed that this image appeared disproportionately more frequently on manufactured cigarettes made by each of the three largest New Zealand tobacco companies. Although stock clustering could explain the purchase pack result, there were no obvious reasons why the same uneven warning distribution was also evident among the street-collected packs.ConclusionThese results suggest that tobacco companies are not following the regulations, which requires even distribution of the seven different GHWs on cigarette packs; further monitoring is required to estimate the extent of this non-compliance. As an immediate measure, governments should strictly enforce all regulations applying to health warnings, particularly given that these are an effective tobacco control intervention that cost tax payers nothing.

Patient demand for smoking cessation advice in dentist offices after introduction of graphic health warnings in Australia

The effectiveness of smoking cessation intervention by dentists has not been conclusively established. This study aimed to investigate whether the inclusion of graphic health warning pictures (including mouth and throat cancer) as part of the Australian National Tobacco Campaign strategy would elicit measurably increased demand for smoking cessation advice in dental practices. A cross-sectional survey of private dental practices in New South Wales, Australia. Separate questionnaires were answered by dentists and patients from their practice. Questions comprised smoking practices and attitudes toward smoking cessation activities in dental practice. The majority of dentists (85.7 per cent; n = 29) and dental patients (92.4 per cent; n = 800) recalled seeing the graphic health warnings, with mouth and throat cancer the most commonly observed. Television was the main medium. Nineteen per cent of dental patients (n = 152) reported themselves as current smokers. Half of them were planning to quit within six months (49.7 per cent) and agreed that graphic health warnings made them more likely to quit (47.7 per cent). Dentists showed positive attitudes toward cessation activities but believed many patients lacked motivation to quit smoking; a perception that was seen to be the main barrier in offering smoking cessation advice. Forty per cent of smokers would try to quit if asked by their dentists, but only 28.4 per cent preferred a dentist for cessation advice. In general, dentists found no change in demand for smoking cessation advice since the launch of the National Tobacco Campaign in 2006. Health warning pictures seemed to increase the patients' awareness and intention to quit smoking, however it did not appear to generate more demand for smoking cessation advice from their dentists. Dentists had low expectations about their patients' motivation to stop smoking.

Do graphic health warning labels have an impact on adolescents’ smoking‐related beliefs and behaviours?

To assess the impact of the introduction of graphic health warning labels on cigarette packets on adolescents at different smoking uptake stages. School-based surveys conducted in the year prior to (2005) and approximately 6 months after (2006) the introduction of the graphic health warnings. The 2006 survey was conducted after a TV advertising campaign promoting two new health warnings. Secondary schools in greater metropolitan Melbourne, Australia. Students in year levels 8-12: 2432 students in 2005, and 2050 in 2006, participated. Smoking uptake stage, intention to smoke, reported exposure to cigarette packs, knowledge of health effects of smoking, cognitive processing of warning labels and perceptions of cigarette pack image. At baseline, 72% of students had seen cigarette packs in the previous 6 months, while at follow-up 77% had seen packs and 88% of these had seen the new warning labels. Cognitive processing of warning labels increased, with students more frequently reading, attending to, thinking and talking about warning labels at follow-up. Experimental and established smokers thought about quitting and forgoing cigarettes more at follow-up. At follow-up intention to smoke was lower among those students who had talked about the warning labels and had forgone cigarettes. Graphic warning labels on cigarette packs are noticed by the majority of adolescents, increase adolescents' cognitive processing of these messages and have the potential to lower smoking intentions. Our findings suggest that the introduction of graphic warning labels may help to reduce smoking among adolescents.

Thinking about the unthinkable: a de facto prohibition on smoked tobacco products

Thinking about the unthinkable: a <i>de facto</i> prohibition on smoked tobacco products

C8-06: Impact of a graphic health warnings tobacco campaign in Australia

C8-06: Impact of a graphic health warnings tobacco campaign in Australia

Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian National Tobacco Campaign

Objectives: To examine adolescents’ awareness of and response to an adult focused anti-smoking advertising campaign. Design and setting: Data were obtained from two cross sectional surveys of adolescents. The first...

Spain: youth, leisure, and alcohol consumption.

Spain: youth, leisure, and alcohol consumption.

Graphic design and health education

Graphic design and health education