Addiction Treatment Clients’ Reactions to Graphic Warning Labels on Cigarette Packs

Abstract

Graphic warning labels (GWLs) on cigarette packs have been tested among diverse groups at high risk for tobacco use. However, little is known about the effectiveness of GWL interventions for persons with substance use disorders, whose smoking prevalence is 3 to 4 times that of the general population. After an experimental study which exposed clients in residential addiction treatment to GWLs for 30 days, we conducted five focus groups with trial participants (N = 33) to explore how exposure to the labels may have impacted their readiness to quit smoking. Focus group interviews were analyzed thematically. Interviewees reported that GWLs were more effective than text-based warnings for increasing quit intentions due to greater cognitive and emotional impact. Male and female interviewees expressed gender-specific reactions to the labels. Addiction treatment programs are a strategic site for GWL and other tobacco interventions due to the tobacco-vulnerable populations they serve.

Sex Differences in Graphic Warning Label Ratings by Addictions Clients

“…The image evoked memories and negative feelings, indicative of its personal relevance for some female respondents. 34 This finding, within a vulnerable, high-smoking group, corresponds with quantitative studies in the general population of smokers showing women’s heightened responses to images of babies relative to men’s responses. 24–27…”

“…The present study found no differences between male and female smokers in SUD treatment in ratings of images of women and/or babies versus other images. The research on responses to images of babies on GWLs in general samples of smokers is mixed; some have not shown sex-based differences, 23 although others have shown women reporting personal relevance 34 and rating the images more strongly than men. 25,26,46 Numerous factors may contribute to different findings across studies, ranging from differences in participant samples (eg, smokers with SUDs vs. general smoking samples) to variations in methods (eg, ratings measures, types of analyses conducted, such as comparisons of difference scores as was done in our study).…”

“…The current study examined ratings of GWLs by male and female smokers as part of a tobacco use and attitudes survey of adult clients in SUD treatment across the United States. Based on prior studies, including the qualitative study findings of Pagano et al (2017), 34 we sought to identify potential sex-related differences in ratings of GWLs. Survey respondents viewed FDA-selected GWLs depicting a woman and/or a baby, tobacco-related disease or male images.…”

Global Evidence on the Association between Cigarette Graphic Warning Labels and Cigarette Smoking Prevalence and Consumption

“…This study has some limitations. First, while GWLs have been shown to have differential effects on different subpopulations [ 11 , 18 , 37 ], our study could not confirm this argument by investigating the impact of GWLs on different subpopulations using the aggregate data at the national level. Second, smoking prevalence was measured as a single outcome variable.…”

“…In recent years, growing evidence demonstrates that GWLs are more effective in decreasing smoking than text-only warnings [ 4 , 9 , 10 , 11 , 12 ]. GWLs have been found to attract greater attention and greater recall of health warning messages among rural male smokeless tobacco users than text-based warnings [ 12 ].…”