Perceived effectiveness of graphic health warnings as a deterrent for smoking initiation among adolescents in selected schools in southwest Nigeria

Abstract

BackgroundThere has been a sustained increment in young people initiating smoking in low middle income countries like Nigeria. Health warnings on cigarette packages are a prominent source of health information and an effective means of communicating specific disease risks to adolescents and young adults alike. This study evaluated the perceived effectiveness of selected graphic warnings on smoking initiation amongst in-school adolescents.MethodsThis was a cross-sectional study conducted amongst secondary school students aged 13–17years in Igbo-Ora, Nigeria. A two-stage sampling technique with the school classes as the final sampling unit was used to select the students. An interviewer assisted questionnaire was used to obtain information on students demographic characteristics and their perception of graphic warnings using four images from the pictorial health warning galleries of the World Health Organization showing: ‘cigarette smoking causes cancer of the airways, harms children, causes stroke and causes impotence respectively'.ResultsA total of 544 senior secondary students were included in this study with a male female ratio of 0.8:1. Of those interviewed, 40 (7.4 %) indicated that they had ever considered smoking, nine (1.7 %) responded that they had ever smoked and two students indicated that they were current smokers.With all the images, fear was the dominant emotion expressed by the respondents. This was expressed by 307 (56.4), 215 (39.5), 203 (37.3) and 228 (41.9 %) respondents to images 1, 2, 3, and 4 respectively. Furthermore, 76.7, 44.7, 58.5 and 62.1 % of respondents felt Images 1, 2, 3 and 4 respectively will to a large extent prevent people from initiating smoking. There was no association between perceived effectiveness and gender. However, those younger than 15 years rated images on cancer of the airway and impotence as probably effective to a larger extent than did those who were 15 years and older (p = 0.032).ConclusionIntroduction of graphic health warnings, especially with an imagery depicting cancer and impotence may influence non-smokers to remain abstinent. Therefore, this study provides a template for a future policy-relevant study on graphic health warning in Nigeria.

Australian community pharmacist experiences with smoking cessation and opinions of health warnings on individual cigarette sticks

“…Participants in this study also suggested warnings which focus on pregnant women and children, and the impact of tobacco use on these vulnerable populations, and the effects of tobacco use on personal appearance, which are themes reported elsewhere . As smoking during adulthood is most often the result of experimentation during adolescence, taking advantage of the vanity of this younger age group through depicting the appearance‐related consequences of tobacco use has been theorised to be more effective than the eventual development of chronic diseases, which feel less relevant to adolescents . Ageing skin, reduced physical fitness, oral diseases and body odour were all identified by participants in this study as potentially effective messages in reducing adolescent tobacco use.…”

“…[30][31][32] As smoking during adulthood is most often the result of experimentation during adolescence, taking advantage of the vanity of this younger age group through depicting the appearancerelated consequences of tobacco use has been theorised to be more effective than the eventual development of chronic diseases, which feel less relevant to adolescents. [33][34][35][36] Ageing skin, reduced physical fitness, oral diseases and body odour were all identified by participants in this study as potentially effective messages in reducing adolescent tobacco use.…”

A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes

“…Pairs of packaging for three brands were presented. Packs were either branded or plain, with identical GHWs (lung damage).Participants chose one pack (or indicated ‘no difference’) from each pair based on pack attractiveness, perceived health risks, perceptions of popular smoker attributes, and pack preference.2016 Adebiyi [32]Nigeria n = 54413–17 years44.755.398.3–1.7In-school surveys in two schools in a single community, with participants viewing four GHWs: smoking harming children, and causing airway cancer, stroke, and impotence.Participants indicated if each warning evoked: fear; shock, anxiety, or indifference. They also utilised a 3-point Likert scale on the effectiveness of each GHWs in preventing smoking initiation.2016 Andrews [44]USA, Spain, France n = 106613–18 years50.050.0––100An online survey with participants viewing one of eight packs (four plain and four branded) with varying levels of graphicness of GHWs, depicting the risks of smoking causing mouth cancer (2 × 4 model).Participants rated using 6- and 7-point scales in response to the pack their: cigarette cravings, evoked fear (4 items), pack feelings (3 items e.g.…”

“…Sixteen studies were assessed by the JBI ‘Checklist for Analytical Cross Sectional Studies’ and scored out of eight, with four or below indicating low quality, five to six as moderate quality, and seven to eight as high quality [24]. Fourteen were found to be of high quality, and two of moderate quality [30, 32]. Three studies were assessed by the JBI ‘Checklist for Randomized Controlled Trials’ and scored out of 13, with seven or below indicating low quality, eight to ten as moderate quality, and ten and above as high quality [25].…”

Analysis of tobacco control policies in Nigeria: historical development and application of multi-sectoral action

“…However, compliance with this directive is inconsistent [31]. Furthermore, Nigeria relies only on the mandatory text-only warning and graphics are not placed on the tobacco packs [29, 32]. …”