Health Warning Messages Research Articles

Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving.

Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products. A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall. Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08). GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users. Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.

Alcohol health warnings can influence the speed of consumption

AimRecent research has shown that adopting strong (i.e. high fear) visual health-warning messages can increase the perceived health risks and intentions to reduce alcohol consumption. Separately, it is known that the speed at which alcohol is consumed has dramatic effects on the level of intoxication. In the present study we aimed to combine these two separate areas to understand whether the speed of alcohol consumption is influenced by the type of alcohol health warning contained on the beverage.Subject and methodsIn the present study, female participants (N = 45) consumed an alcoholic beverage in a relaxed environment in one of three conditions: no health-warning label, a text-only health-warning label or a pictorial health-warning label with text.ResultsWe found that compared with the control condition, the beverage was consumed at a slower rate in the two health-warning conditions, which surprisingly did not differ from each other. Despite these effects, product acceptability did not differ between the text-only and control conditions.ConclusionThese are the first set of results to demonstrate how the use of strong health warnings on alcoholic beverages can influence actual drinking rate and further suggest that the beneficial effects of slowed consumption are possible in the absence of any reduction in consumer acceptability.

Eliciting preferences for waterpipe tobacco smoking using a discrete choice experiment: implications for product regulation

ObjectivesWaterpipe smoking is highly prevalent among university students, and has been increasing in popularity despite mounting evidence showing it is harmful to health. The aim of this study was to...

Women and smoking — Prices and health warning messages: Evidence from Spain

ObjectiveIn Spain, fewer men are smoking every year yet the number of women smokers remains relatively high. This paper examines the impact of two anti-smoking policies (increased prices and obligatory pictorial health warning labels) on womens smoking decisions; generation cohorts are used to elucidate the determinants of those decisions. Data sourceWe have drawn 48,755 observations of women living in Spain from the Spanish National Health Surveys of 2001, 2003, 2006 and 2011. Data synthesisAmong the main results, we highlight that belonging to a particular generation modulates the manner in which individual characteristics and tobacco policies determine smoking decisions. For example, women's smoking was not considered as socially acceptable until the 1960s and therefore older women have lower smoking rates. However, for the younger female cohorts (generations X and Y) smoking was seen as an act of rebellion and modernity, so women belonging to these groups, irrespective of educational level, are more likely to smoke. ConclusionsThe price of cigarettes and pictorial health warning labels on cigarette packets also influence the smoking behaviour of Spanish women.

Effect of Graphic Images in Cigarette Health Warning: A Call for Stricter Packaging Regulation in Japan

ABSTRACTThis study examined the impact of unexpectedness, novelty, and relevance when including a shocking picture on cigarette packages in Japan. An experimental design compared reactions of Japanese smokers exposed to a health warning including a picture versus the current text-based health warning message. A health warning with a graphic image was confirmed as more effective in attracting attention and easier to understand, with some limited impact in persuading smokers to act on the information. Overall, the findings provide support for regulations in Japan to require health warnings featuring novel imagery, such as those found in Europe, Canada, and Australia.

Risk perceptions and smoking decisions of adult Chinese men

This study analyzes effects of changes in risk perceptions of smoking's health harms on actual and attempted quits and quitting intentions of male smokers in China. Our survey of 5000+ male smokers was conducted two years after their neighbor's lung cancer diagnosis. We use proximity to a lung cancer neighbor as an exogenous determinant of individual's smoking risk perception. We show that learning of a neighbor's lung cancer diagnosis substantially affects smokers’ subjective beliefs about smoking's harms, which in turn affects decisions about continued smoking and intentions to quit. Our study findings offer important public policy implications in indicating the importance of designing health-warning messages that fit smokers’ personal circumstances as opposed to warnings solely based on edicts from scientific experts and/or epidemiological evidence.

Tobacco health warning messages on plain cigarette packs and in television campaigns: a qualitative study with Australian socioeconomically disadvantaged smokers.

Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health risk and cessation benefit messages. Six focus groups were conducted over September 2012-April 2013 with adult clients of welfare organizations in regional New South Wales, Australia who were current smokers (n = 51). Participants discussed HWLs, plain packaging and anti-smoking television advertisements. Discussions were audio-taped, transcribed verbatim and analysed using thematic analysis. Highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco. Careful consideration of message content and medium is required to communicate the anti-smoking message to disadvantaged smokers who consider themselves desensitized to warnings. Health communication strategies should continue to address false beliefs about smoking and educate on cessation services that are currently underutilized.

Country tobacco laws and article 11 of the WHO Framework Convention on Tobacco Control: a review of tobacco packaging and labeling regulations of 25 countries

BackgroundUrgent, evidence-based tobacco control efforts have been advocated by the WHO through the Framework Convention on Tobacco Control (FCTC) articles and guidelines. The level of implementation of these guidelines varies by country and region. This paper identifies areas of alignment and non-alignment of country tobacco laws with respect to the FCTC’s article 11 requirements, which lists guidelines for regulating tobacco packaging and labeling.MethodsCountries from each of the six WHO regions were ranked by number of smokers and 25 countries were selected, representing countries from all WHO regions with the highest number of smokers. A scoring guide based on the FCTC article 11 requirements was created and used to rank country tobacco laws and assess levels of alignment as well as identify common areas of weakness and strength.ResultsAcross the countries examined, laws were generally strong in mandating the display of health warning messages on the front and back of cigarette packs and cartons. However, they were deficient in prohibiting the display of emission yields, and placing warnings at the top of the principal display area, as well as requiring health messages on tobacco’s negative social and economic outcomes.ConclusionCountry tobacco packaging and labeling laws can be strengthened by greater compliance with the FCTC article 11 guidelines.

Developing a risk-based air quality health index

We developed a risk-based, multi-pollutant air quality health index (AQHI) reporting system in Hong Kong, based on the Canadian approach. We performed time series studies to obtain the relative risks of hospital admissions for respiratory and cardiovascular diseases associated with four air pollutants: sulphur dioxide, nitrogen dioxide, ozone, and particulate matter with an aerodynamic diameter less than 10 μm (PM10). We then calculated the sum of excess risks of the hospital admissions associated with these air pollutants. The cut-off points of the summed excess risk, for the issuance of different health warnings, were based on the concentrations of these pollutants recommended as short-term Air Quality Guidelines by the World Health Organization. The excess risks were adjusted downwards for young children and the elderly. Health risk was grouped into five categories and sub-divided into eleven bands, with equal increments in excess risk from band 1 up to band 10 (the 11th band is ‘band 10+’). We developed health warning messages for the general public, including at-risk groups: young children, the elderly, and people with pre-existing cardiac or respiratory diseases. The new system addressed two major shortcomings of the current standard-based system; namely, the time lag between a sudden rise in air pollutant concentrations and the issue of a health warning, and the reliance on one dominant pollutant to calculate the index. Hence, the AQHI represents an improvement over Hong Kong's existing air pollution index.

Perceptions of anti-smoking messages amongst high school students in Pakistan

BackgroundSurveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages.MethodsThis study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers.ResultsPicture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers.ConclusionGraphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.

Estratégia de recrutamento de fumantes no metrô do Rio de Janeiro, Brasil, para ampliar o acesso a linhas telefônicas de apoio à cessação: impacto da novidade

Creative and innovative strategies to recruit smokers are essential for improving tobacco control activities. Currently in Brazil, through health warning messages on cigarette packs, there is a permanent and intense spread of messages that provoke feelings of loss associated with smoking, which is important to encourage access to smoking quitlines. The study analyzed the call rate for telephone counseling after introducing a new strategy for reactive recruitment focused on the theme 'smoking causes shortness of breath', adapted to the subway setting in Rio de Janeiro, as compared to the rates for two existing reactive strategies. Regardless of age bracket, there was a higher response to the new proposed strategy. Despite the major awareness-raising in Brazil concerning the ills of tobacco, new communications formats approaching personally relevant themes can increase the number and range of smokers recruited for telephone counseling to support cessation.

Pictorial Health Warnings on Cigarette Packs: A Population Based Study Findings from India

Introduction Although tobacco is the leading preventable cause of the death among adults in India, the general public including tobacco users has little awareness about possible consequences of tobacco use. One way of bringing more awareness is to place more information on tobacco products in the form of pictorial warnings. Strong pictorial warnings were mandated by the Indian government but were diluted later on. The question that needs to be investigated whether general public in India needs pictorial warnings on tobacco products and how the warnings would look like? Material and Method A survey of 712 individuals was conducted in Mumbai and Thane. A structured questionnaire was designed and data were collected by trained field investigators. The questionnaire contains several questions on awareness of health warnings on tobacco products, opinion on strength of the warnings and on delays in implementing warnings. Results Among 712 respondents, 89.9% were aware about health warning messages on cigarettes pack. 88.5% of people were strongly agreed for strengthening the pictorial health warnings. Strong pictorial health warnings would make 23.2% male tobacco users thinking to quit smoking and 33.1% never tobacco users will think twice before starting smoking. Conclusion Positive response was shown by general population for implementation of pictorial warnings on tobacco products. Majority of the people were strongly agreed for strong pictorial warnings which were diluted by government notifications in year 2008.

Why Is Such a Smart Person Like You Smoking? Using Self-Affirmation to Reduce Defensiveness to Cigarette Warning Labels1

When researchers communicate the negative health risks of smoking, smokers are likely to minimize such effects. This experiment addressed a way to reduce this defensiveness: allowing smokers to affirm aspects of the self. Smokers (n= 100) and nonsmokers (n= 30) viewed eight health-warning messages about smoking. Smokers were randomly assigned to view (a) warnings without a self-affirmation manipulation, (b) warnings after a self-affirmation manipulation, or (c) warnings that had a positive self-statement attached to it. Analyses indicated that compared to nonsmokers, no-affirmation smokers rated the warning messages as: (a) communicating less serious consequences, (b) less accurate, and (c) less likely to influence smokers. However, compared to no-affirmation smokers, smokers who affirmed the self were no more likely to rate the messages as serious, accurate, or effective. These data suggest that affirming the self before, or using a self-affirmation within a warning message may not encourage smokers to be more accepting of risk information.

The role of health consciousness in predicting attention to health warning messages.

Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption. Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. Cross-sectional survey using telephone interview data. A representative nationwide sample of adults was interviewed in 1993 (n = 1026), with a response rate of 63%. Key variables include exposure to warning labels on alcoholic beverages, to point-of-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. In the total sample, over a third had seen a warning label or poster and almost all had seen an advertisement about the risks associated with alcohol consumption in 1993. Survey respondents scored very high on five individual items that make up the health consciousness scale introduced here, with 69% endorsing all items. The scale demonstrated good internal reliability (alpha = .70) and was significantly correlated (p < .01) with not enjoying getting drunk and with usually reading product warning labels, suggesting construct validity. Yet the hypothesized strong relationships between health consciousness and attention to health warnings about drinking were not observed; nor was salience of messages a predictor of recall. Importantly, high proportions of underage drinkers and young adults at elevated risk for drinking problems are reached by container warning label messages. Mechanisms of exposure recall vary based on message source, with "container label recall" associated with heavier drinking, younger age, and purchasing patterns; "poster recall" associated with purchasing and health consciousness; and "advertisement recall" associated with heavy consumption and younger age. These results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consumption. These data suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers. Future research in predicting attention to impersonal health warnings in the environment should continue to improve the assessment of constructs such as salience and health consciousness, and should further test the applicability of available theoretical models. Subsequent research should also consider additional measures to tap mechanisms of exposure to impersonal health messages to enable a better understanding of the population that is not being reached by such public health interventions.

The effectiveness of health warning messages

The effectiveness of health warning messages