Graphic Health Research Articles

Perception of Cigarette Graphic Health Warnings and Its Impact on Smoking Behavior: A Cross-Sectional Study among Current Smokers of Western Part of Nepal.

Globally, tobacco use (smoked, secondhand, and chewing) accounted for 8.71 million deaths, which is 15.4% of all deaths in 2019. Tobacco was ranked first among males and sixth among female in terms of level 2 risk factor for attributable deaths globally. The objective of this study was to identify the perception of cigarette graphic health warnings and their impact on smoking behavior in Nepal. A cross-sectional study using purposive sampling technique was done. Out of 169 respondents, 79.9% were male, 49.1% were illiterate, and 37.9% were above 60 years of age. Eighty-four percent had initiated smoking before the age of 20, and 39.6% had smoked cigarettes for more than 40 years. All the respondents had noticed the graphic health warning on cigarette packages. The majority (80.5%) of the respondents reported that the warning informs about specific health consequences of smoking, and the percentage of respondents believing that warning motivates smokers to quit smoking, encourages smokers to reduce the number of cigarettes smoked per day, and deters potential smokers from starting to smoke was 40.2%, 33.1%, and 30.8%, respectively. More than half of the respondents (50.9%) attempted to quit smoking because of the warning. The implementation of graphic health warnings had favorable perception from majority of smokers and positive impact on smoking behavior of the respondents. Further large-scale research on impact on smoking behavior through repeated cross-sectional studies can be future research priority.

Graphic Health Warnings and Plain Packaging in the Philippines: Results of Online and Household Surveys

Graphic Health Warnings and Plain Packaging in the Philippines: Results of Online and Household Surveys

Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial.

Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: −56, −1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.

Impact of images and text designs on the effectiveness and reactance to graphic health warnings on cigarette packages in Colombia

ABSTRACT In some countries (e.g. Colombia), graphic health warnings (GHWs) for cigarette packages include both implicit and explicit images and certain keywords bolded in the text. The purpose of this study was to evaluate how these factors impact both perceived message effectiveness and message reactance in a group of non-smokers. We conducted an on-line experiment with a sample of 221 non-smoking young adults (ages 18–22 years). Participants were randomly divided into three groups (i.e. GHWs with regular font, GHWs with keywords in bold font and GHWs with keywords in bolder font). Each group was presented with four GHWs (two with implicit pictures and two with explicit pictures). The participants were asked a series of questions as a pre- and post-measure of attitudes toward smoking, smoking intentions, confidence in their ability not to smoke and crave. After viewing each image, participants were asked to answer questions pertaining to perceived message effectiveness, attention, message reactance and motivation not to smoke. A main effect of the picture was found for perceived message effectiveness, attention, reactance, and motivation not to smoke, pointing out that explicit pictures lead to significantly greater scores in all these measures. No significant effect was found for the alterations in font weight. GHWs containing explicit images proved to be more effective in preventing cigarette smoking in young adults. The results suggest that the change in the text design does not have an effect on the motivation not to smoke.

Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100

Starting in 2022, the US Food and Drug Administration (FDA) plans to require all cigarette packages in the US to display graphic health warnings depicting health harms associated with smoking. The FDA originally planned to implement such warnings in 2012, but tobacco industry litigation delayed the effort. To assess the estimated population health outcomes associated with a policy requiring graphic health warnings on cigarette packages in the US and with a 10-year delay in implementation. This decision analytical model used simulation modeling of smoking prevalence and smoking-attributable mortality in the US from 2012 to 2100, using the Cancer Intervention and Surveillance Modeling Network smoking population model. The study was conducted from October 2020 to July 2021. The primary outcomes were annual adult smoking prevalence, smoking-attributable deaths averted, and life-years gained vs the baseline scenario. A baseline scenario assuming no graphic health warnings was compared with expected outcomes of implementing graphic health warnings in 2022 vs 2012. Policy effects were considered under varying assumptions of the association of the policy with smoking initiation and cessation, ranging from most conservative to most optimistic. A maximum smoking reduction scenario in which all smoking would stop by the end of 2022 was evaluated. In the baseline scenario, an estimated 13.2 million smoking-attributable deaths would have occurred from 2012 to 2100. Under a maximum smoking-reduction scenario, 5.5 million of these deaths would be averted. Implementation of graphic health warnings from 2022 to 2100 would be associated with 539 000 (range, 275 000-794 000) smoking-attributable deaths averted and 7.9 million (range, 4.0-11.6 million) life-years gained, representing less than 10% of the 5.5 million estimated smoking-attributable deaths averted and 81.8 million life-years gained in the maximum smoking-reduction scenario. Implementation from 2012 to 2100 would be associated with 33.2% (range, 32.9%-33.5%) more deaths averted (718 000; range, 365 000 to 1.1 million) and 42.7% (range, 42.3%-43.1%) more life-years gained (11.2 million; range, 5.7-16.6 million) compared with implementation in 2022. This decision analytical model estimated that FDA cigarette graphic health warnings, if implemented in 2022, would be associated with public health benefits. The model also estimated that more smoking-attributable deaths would have been averted if the policy had been implemented in 2012. Industry litigation and delays to implementing tobacco regulations may have been harmful for public health.

Less Harmful ¹ Safe: Effects of Cigarette Graphic Health Warnings on E-Cigarette Evaluations

As mandated by the FDA, color graphics depicting some of the lesser-known negative health consequences of smoking will soon be required on all cigarette packaging and advertising. Extensive prior research has demonstrated that Graphic Health Warnings (GHW) are a highly cost-effective way to demarket cigarettes. However, the results of this study suggest that GHW may have unintended negative health implications for consumers. While e-cigarette Addiction Warnings (AW) increased fears about the negative health effects of vaping, cigarette GHW decreased fears and beliefs about the negative health effects of vaping. GHW also had an indirect effect on consumers’ beliefs about the negative health risks of vaping. Consumers’ mindfulness (low vs. high) moderated these effects. The results provide initial insight into the inter-relationships between cigarette GHW, e-cigarette AW, and individual differences.

Standard packaging to ensure effective enforcement of graphical health warning on smokeless tobacco products: Current status and gaps in Bangladesh

Standard packaging to ensure effective enforcement of graphical health warning on smokeless tobacco products: Current status and gaps in Bangladesh

Graphical health warning on bidi packets in Bangladesh: Current gaps and way forward

Graphical health warning on bidi packets in Bangladesh: Current gaps and way forward

Influence of graphical health warnings in process of smoking cessation among adult smokers

Influence of graphical health warnings in process of smoking cessation among adult smokers

Smokers' Affective Responses to COVID-19-Related Health Warnings on Cigarette Packets: The Influence of Delay Discounting.

IntroductionThe addition of graphic health warnings to cigarette packets can facilitate smoking cessation, primarily through their ability to elicit a negative affective response. Smoking has been linked to COVID-19 mortality, thus making it likely to elicit a strong affective response in smokers. COVID-19-related health warnings (C19HW) may therefore enhance graphic health warnings compared to traditional health warnings (THW). Further, because impulsivity influences smoking behaviors, we also examined whether these affective responses were associated with delay discounting.MethodsIn a between-subjects design, 240 smokers rated the valence and arousal elicited by tobacco packaging that contained either a C19HW or THW (both referring to death). Participants also completed questionnaires to quantify delay discounting, and attitudes towards COVID-19 and smoking (eg, health risks, motivation to quit).ResultsThere were no differences between the two health warning types on either valence or arousal, nor any secondary outcome variables. There was, however, a significant interaction between health warning type and delay discounting on arousal ratings. Specifically, in smokers who exhibit low delay discounting, C19HWs elicited significantly greater subjective arousal rating than did THWs, whereas there was no significant effect of health warning type on arousal in smokers who exhibited high delay discounting.ConclusionThe results suggest that in smokers who exhibit low impulsivity (but not high impulsivity) C19HWs may be more arousing than THWs. Future work is required to explore the long-term utility of C19HWs, and to identify the specific mechanism by which delay discounting moderates the efficacy of tobacco health warnings. ImplicationsThe study is the first to explore the impact of COVID-19-related health warnings on cigarette packaging. The results suggest that COVID-19-related warnings elicit a similar level of negative emotional arousal, relative to traditional warnings. However, COVID-19 warnings, specifically, elicit especially strong emotional responses in less impulsive smokers, who report low delay discounting. Therefore, there is preliminary evidence supporting COVID-19 related warnings for tobacco products to aid smoking cessation. Additionally, there is novel evidence that, for some warnings, high impulsiveness may be a factor in reduced warning efficacy, which may explain poorer cessation success in this population.

Why Do Graphic Health Warnings Fail: An Explanatory Case Study on the Persistence of Smoking Behavior among Male Adult Smokers in a Rural and Low-Income Setting in the Philippines

Why Do Graphic Health Warnings Fail: An Explanatory Case Study on the Persistence of Smoking Behavior among Male Adult Smokers in a Rural and Low-Income Setting in the Philippines

Emotional impact of graphic health warnings on tobacco packages in Colombia.

Emotional impact of graphic health warnings on tobacco packages in Colombia.

Understanding the patterns of Influence exerted by tobacco industries to disrupt implementation of tobacco control policies and endanger public health in Bangladesh

Objective: Tobacco industry (TI) exaggerates their economic importance; discredits proven science and uses litigation to intimidate governments in order to undermine tobacco control efforts. TI hampers the government s efforts to fully implement public health policies of a country. Hence it is essential to investigate the strategies they use to undermine tobacco control polices. This study explored the role tobacco industries play in influencing tobacco control efforts in Bangladesh. Methods: A cross-sectional study was carried out during April to November 2019. Data were collected from both primary and secondary sources. Thirty (30) key informant interviews (KII) were conducted with relevant Government of Bangladesh (GoB) officials and media personnel, and tobacco control activists. Secondary data were collected from various tobacco control organizations as well as related reports, publications and news reports. Results: The study revealed that GoB officials hold various meetings informally with TI, but content and outcome of the meetings have never been made public. Tobacco control activists have strong evidence to believe that the TI officials are influencing the Ministry of Finance to stop them from raising taxes on tobacco products. The TI is consistently arguing that if strong policies are adopted, then tobacco users switching to other drugs; an increase in illicit trade of tobacco; an increase in unemployment and a loss in tax revenue from tobacco products. Multinational tobacco companies are also using foreign missions and high officials to influence government machineries to protect their tobacco business. Conclusion: Ministry of Health and Family Welfare should take the initiative to make the relevant ministries aware that tobacco industries cannot be allowed to influence policy decisions. The government should immediately develop and implement a guideline including Code of Conduct for government officials dealing with the TI and take appropriate measures to ensure the enforcement of the tobacco control policy in Bangladesh.</br></br> Key Words: Tobacco Control Policy, Tobacco Industry influence, graphic health warnings, policy implementation

Why don\u2019t illiterate women in rural, Northern Tanzania, access maternal healthcare?

BackgroundIn 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services.MethodsAn exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant’s native language. The interviews were coded, then triangulated.ResultsTwo themes emerged from the analysis: 1) a communication gap arising from a) the women’s inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare.ConclusionsThese women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.

The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions

BackgroundExamination of the format and framing of the graphic health warnings (GHWs) on tobacco products and their impact on tobacco cessation has received increasing attention. This review focused on systematically identifying and synthesizing evidence of longitudinal studies that evaluate different GHW formats and specifically considered GHW influence on perceived risk of tobacco use and quit intentions.MethodsTen databases were systematically searched for relevant records in December 2017 and again in September 2019. Thirty-five longitudinal studies were identified and analyzed in terms of the formatting of GHWs and the outcomes of perceived risk and quit intentions. Quality assessment of all studies was conducted.ResultsThis review found graphics exceeding 50% of packs were the most common ratio for GHWs, and identified an ongoing reliance on negatively framed messages and limited source attribution. Perceived harms and quit intentions were increased by GHWs. However, wear-out effects were observed regardless of GHW format indicating the length of time warnings are present in market warrants ongoing research attention to identify wear out points. Quit intentions and perceived harm were also combined into a cognitive response measure, limiting the evaluation of the effects of each GHW format variables in those cases. In addition, alternative GHW package inserts were found to be a complimentary approach to traditional GHWs.ConclusionsThis review demonstrated the role of GHWs on increasing quit intentions and perceptions of health risks by evaluating quality-assessed longitudinal research designs. The findings of this study recommend testing alternate GHW formats that communicate quit benefits and objective methodologies to extend beyond self-report.

Shock and awe or incentive-compatible harm reduction? Graphic health warnings on tobacco packages

BackgroundGraphic Health Warnings (GHWs) on cigarette packages were first introduced in Canada in 2001 and will become mandatory in the US as of January 2022. While previous studies have evaluated the impacts of GHWs, the data used in these studies have several shortcomings. The objective of this paper was to investigate the likely impact of such warnings in the US based upon the experience of Canada using hitherto unexplored monthly cigarette sales data, and to explore if alternative approaches involving risk-reduced products might be more successful in reducing smoking.MethodsWe used quasi-experimental segmented regression and difference-in-differences analyses. Data on monthly sales (i.e., shipments) of cigarettes from Canadian manufacturers to Canadian retailers during 1995–2005 were obtained from Statistics Canada.ResultsWe found that GHWs did not have a significant impact on the sales of cigarettes in Canada. We propose an alternative type of graphical health messaging that actively combines information on how to quit with the legally required messaging. The novelty of the proposal is that it is incentive compatible for the supply side of the market and if adopted in several states, the measure could be tested by using a suitable treatment–control design.ConclusionsOur findings imply that we should not expect any notable decline in sales or consumption as a result of implementation of GHWs in the US. The main impact of GHWs will be to add to the anti-smoking culture that has grown steadily over several decades, and this may impact smoking in the longer term.

'Money up in smoke': The financial benefits of smoking cessation may be more motivating to people who are homeless than potential health gains.

High rates of tobacco smoking among people who are homeless or living in temporary accommodation exacerbate poor health outcomes and financial disadvantage. There is limited research on this population's perceptions of smoking cessation benefits or support strategies. We conducted a cross-sectional survey of 68 male smokers living in a temporary accommodation hostel in Brisbane, Australia. The survey measured smoking and quit attempt history, perceptions of cessation aids and benefits of cessation, and awareness of the Intensive Quit Support program-a free Queensland government-funded program comprising 12 weeks of nicotine replacement therapy supplemented with weekly calls from Quitline. Participants (56% aged ≤40 years) spent a high proportion of their income on smoking (median $80/week). Although the most commonly reported perceived benefit of smoking cessation was improved health, more participants were interested in a campaign promoting the financial savings of quitting rather than the health benefits. Twice as many participants reported the high cost of smoking-provoked thoughts of quitting than graphic health warning labels on cigarette packs (70.6% vs. 30.9%). Participants reported a high level of interest in e-cigarettes as a cessation aid. There was a low level of awareness but moderate level of interest in the Intensive Quit Support program. Smoking cessation campaigns promoting the financial savings of cessation may be more salient than health-focused campaigns among relatively young men who smoke and experience homelessness. There is a clear need for innovative, targeted strategies promoting smoking cessation among this population.

PERCEIVED DISSUASIVENESS OF CIGARETTE HEALTH WARNING MESSAGES AMONG SMOKERS AND NONSMOKERS IN ANAMBRA STATE, NIGERIA

Findings from the 2012 Global Adult Tobacco Survey which is still the latest nationwide tobacco use research in Nigeria show that 5.6% (4.7 million) Nigerian adults aged 15 years or older used tobacco products: 10.0% (4.2 million) men and 1.1% (0.5 million) women. One of the strategies for the control of this rate of tobacco use is the mandatory text-only Health Warning Messages available on cigarette packs in the country. This study explored the perceived dissuasiveness of the Text-only Health Warning Messages on cigarette packs in Nigeriaand how smoking history can influence this perception. To achieve the set objectives, a mixed-method approach involving survey and Focus Group Discussion was adopted.The study analyzed data collected from a sample of 400 residents in Anambra State, Nigeria selected through simple random sampling and another 12 selected through snowballing, for Focus Group Discussion. Findings showed that the content of the Health Warning Message and smoking history were factors that could influence perceived dissuasiveness of cigarette Health Warning Messages. Additionally, the smokers were found to have become accustomed to the Text-only Health Warning Messages. Findings also showed that the smokers’ perception was in line with their smoking behaviour. Stated differently, they did not perceive the Text-only Health Warning Message as dissuasive and have therefore continued to smoke. However, Graphic Health Warning Messages (GHWMs) were perceived as more dissuasive than the text-only messages by both smokers and nonsmokers. Therefore, it is recommended that the federal government should introduce Graphic Health Warning Messages and make them mandatory for cigarette packaging and advertisements.

Identifying and selecting effective graphic health warnings to prevent perceptual wearout on tobacco packaging and in advertising

AbstractGraphic visual health warnings (GHWs) on cigarette packaging are used in more than 120 countries globally. Because there are concerns about the effectiveness of using the same visual warnings over many years due to wearout, a primary issue is how to identify the most effective visual stimuli. Adolescent smokers and nonsmokers provided more than 2000 ratings of different visual warnings. Cluster analysis and follow‐up analyses are used to identify a high‐performing visual stimuli group from the larger group of GHWs. Subsequent analyses also show that compared to other pictorial stimuli, the high‐performing group is perceived as effective in preventing adolescent smoking initiation and adolescent smokers' motivation to quit. These findings addressing the selection and evaluation of high‐performing visual warnings have implications for global health and public policy communities through identification of pictorial warnings that can be most effective in impacting smoking‐related outcomes for adolescents.

Motion Graphic Media Informasi Edukasi Penyakit Tuberculosis(TBC) Pada Klinik Karawaci Medika Tangerang

Tuberculosis or better known as TBC disease is a disease caused by the bacteria Mycobacterium Tuberculosis. This disease can be suffered by anyone, both young and old. Karawaci Medika Clinic, located in the Karawaci area of ​​Tangerang, is a clinic that provides health services for individuals and company employees by providing basic and / or specialist medical services. Karawaci Medika Clinic has handled various diseases, one of which is TBC. Currently, people do not know much about the spread and consequences of TBC disease so that the number of people affected by this disease continues to grow every year. The current TB information delivery at the Karawaci Medika Clinic is still using banners and brochures. The delivery media did not make the public interested in knowing information about TB. The community only read briefly and then threw away the brochures that had been given by the clinic. Based on the existing problems, a motion graphic video about TBC was made so that it could help the Karawaci Medika Clinic in conveying information about TB disease. The method used in making multimedia-based information media is data collection methods, media design and the concept of media production. The applications used in this research are Adobe Premiere pro CS6, Adobe After Effects CS6, Adobe Photoshop CS6, Adobe Audition CS6, and Adobe Media Encoder CS6. The final result is a video information motion graphic health education about TBC.