Testing warning messages on smokers’ cigarette packages: a standardised protocol

Abstract

Purpose Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers’ own packs. Methods We tested a cigarette pack labeling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers’ cigarette packs. Results Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p<.05). Conclusion Our findings suggest a feasible pack labeling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers’ cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomized controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labeling policy.

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

“…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.…”

“…Finally, the current study focused on attitudes, just one predictor of subsequent behavior. Studies of the type described by Brewer et al (2015) that measure smoking behavior are needed to fully evaluate the effectiveness of graphic health warnings on cigarette packages. Even in countries where graphic health warnings have been in place, more data are needed to establish their utility in promoting smoking cessation.…”

Do cigarette graphic warnings encourage smokers to attend a smoking cessation programme: a quasi-experimental study

“…A meta-analysis of experimental studies of GWLs up to 201325 found only one study assessing behavioural outcomes,21 one study using multiple-exposure protocols26 and no studies that affixed warning labels onto participant cigarette packs. Recent studies address these limitations by using multiple exposure protocols and assessing behavioural outcomes,27 28 including quit attempts lasting for at least 1 day 26 29. Brewer et al 30 recently published an experimental study assessing the effect of GWLs on quit attempts during a 30-day exposure to GWLs placed on participant cigarette packs.…”

“…Brewer et al 30 recently published an experimental study assessing the effect of GWLs on quit attempts during a 30-day exposure to GWLs placed on participant cigarette packs. However, the growing number of experimental studies that measured behavioural outcomes relied on self-report 26 30 31. The current paper reports on an experimental study using multiple exposures to GWLs on cigarette packs over 30 days, with a directly observed behavioural outcome (attending a smoking cessation group).…”

Placing Health Warnings on E-Cigarettes: A Standardized Protocol

“…In the protocol, smokers bring a supply of cigarette packs to weekly appointments; then, study staff label the cigarette packs while smokers take a survey [29]. In the current proof of principle study, we aimed to adapt the UNC protocol for evaluating warnings for e-cigarette devices and refills.…”