Reactions to FDA-Proposed Graphic Warning Labels Affixed to U.S. Smokers’ Cigarette Packs

McQueen, Amy; Kreuter, Matthew W.; Boyum, Sonia; Thompson, Vetta L. Sanders; Caburnay, Charlene; Waters, Erika A.; Kaphingst, Kimberly A.; Rath, Suchitra; Fu, Qiang

doi:10.1093/ntr/ntu339

Cited by 32 publications

(42 citation statements)

References 75 publications

(96 reference statements)

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“…31 Another experiment with 202 smokers, published after the meta-analysis search, also showed no effect on behavior. 32 Most large observational studies evaluating smoking behavior before and after warning exposure have found increases in quit attempts and reductions in smoking prevalence in countries that implemented pictorial warnings, 18,19 although some studies have not 33 ; other studies indicate that some of the effects of warnings may partially wear out over time. 34,35 Such studies support only limited inferences about effect, however, because countries often change several policies at the same time; secular trends and historical events are difficult to account for; and potential comparison countries may differ in other important ways.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior

et al. 2016

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“…Syntheses of the GHW literature (Hammond, 2011; Noar et al, 2016a, 2016b), coupled with recent experimental evidence (Brewer et al, 2016; Gibson et al, 2015; McQueen et al, 2015), show that such exposure can produce important effects on smoking-related cognitive, affective, and behavioral outcomes. Moreover, our study, together with previous research (Hall et al, 2015; Thrasher et al, 2016), suggests that conversations stimulated by GHW exposure could serve to reinforce and amplify these effects.…”

Section: Discussionmentioning

confidence: 99%

Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position

Ramanadhan

Nagler

McCloud

et al. 2017

Social Science & Medicine

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Rationale Graphic health warnings (GHWs) on cigarette packages present an important tobacco control opportunity, particularly for vulnerable populations suffering a disproportionate tobacco burden. One mechanism by which GHWs may influence smoking outcomes is by prompting interpersonal discussions within health discussion networks (the set of personal contacts with whom an individual discusses health issues). Objective The study examined the association between GHW-prompted conversations within health discussion networks and key tobacco-related outcomes, with attention to valence and content of the discussions. Method Between August 2013 and April 2014, we recruited 1200 individuals from three communities in Massachusetts, emphasizing recruitment of individuals of low socioeconomic position (SEP) and members of other selected vulnerable groups. Respondents were exposed to the nine GHWs proposed by the FDA in 2011, asked a series of questions, and assessed at follow-up a few weeks later. Results A total of 806 individuals were included in this analysis. About 51% of respondents reported having a health discussion network, with significantly lower reports among African-Americans and Hispanics compared to Whites. Around 70% of respondents (smokers and nonsmokers) with health discussion networks reported having one or more conversations about the GHWs with network members, the bulk of which were negative and focused on warning others about smoking. For smokers, we found a small but positive association between the percentage of network conversations that were negative and reports of quit attempts. Conclusion The results point to a potential mechanism by which GHWs may impact tobacco-related outcomes, prompting further inquiry into the role of health discussion networks (and discussion networks, more broadly) in tobacco control among low SEP individuals.

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“…Future studies are needed to test the effect of multiple exposures over a long period of time. Indeed, a recently published protocol establishes a methodology for testing real-word exposure to cigarette package warnings over time (Brewer et al, 2015), and a study in which smokers carried packages with graphic warnings for one week found that smokers paid more attention to graphic than to text-only warnings, and that five of the nine warnings were associated with greater thoughts of health risks (McQueen et al, 2015). Third, race/ethnicity groups included in this study were limited to white, African American, and Hispanic.…”

Section: Discussionmentioning

confidence: 99%

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults

Macy

Chassin

Presson

et al. 2015

Psychology & Health

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Objective Test the effect of exposure to the U.S. Food and Drug Administration’s proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes toward smoking. Design and methods A two-session web-based study was conducted with 2192 young adults 18–25 years old. During session one, demographics, smoking behavior, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current U.S Surgeon General’s text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. Results Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p=.004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current U.S. Surgeon General’s text warnings (p=.014), but there was no difference compared to those who viewed text-only warnings. Conclusion Graphic health warnings on cigarette packages can influence young adult smokers’ implicit attitudes toward smoking.

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Reactions to FDA-Proposed Graphic Warning Labels Affixed to U.S. Smokers’ Cigarette Packs

Abstract: U.S. smokers' reactions to graphic warning labels on their own packs were similar to other, more controlled studies. Qualitative findings underscore the need for warning labels that encourage self-referential processing without increasing defensive reactions.

Cited by 32 publications

References 75 publications

Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior

Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior

Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults

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