Which type of tobacco product warning imagery is more effective and sustainable over time? A longitudinal assessment of smokers in Canada, Australia and Mexico

Anshari, Dien; Yong, Hua‐Hie; Borland, Ron; Hammond, David; Swayampakala, Kamala; Thrasher, Jim

doi:10.1136/bmjopen-2018-021983

Cited by 15 publications

(22 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results have important implications for warning design, and supports previous research which found that responses differed by warning content [1,54]. Visual attention was greater for long‐ versus short‐term warnings (study 1) but did not differ by warning framing (study 2) or severity (study 3).…”

Section: Discussionsupporting

confidence: 88%

Avoidance of tobacco health warnings? An eye‐tracking approach

et al. 2020

View full text Add to dashboard Cite

Aims Among three eye‐tracking studies, we examined how cigarette pack features affected visual attention and self‐reported avoidance of and reactance to warnings. Design Study 1: smoking status × warning immediacy (short‐term versus long‐term health consequences) × warning location (top versus bottom of pack). Study 2: smoking status × warning framing (gain‐framed versus loss‐framed) × warning format (text‐only versus pictorial). Study 3: smoking status × warning severity (highly severe versus moderately severe consequences of smoking). Setting University of Bristol, UK, eye‐tracking laboratory. Participants Study 1: non‐smokers (n = 25), weekly smokers (n = 25) and daily smokers (n = 25). Study 2: non‐smokers (n = 37), smokers contemplating quitting (n = 37) and smokers not contemplating quitting (n = 43). Study 3: non‐smokers (n = 27), weekly smokers (n = 26) and daily smokers (n = 26). Measurements For all studies: visual attention, measured as the ratio of the number of fixations to the warning versus the branding, self‐reported predicted avoidance of and reactance to warnings and for study 3, effect of warning on quitting motivation. Findings Study 1: greater self‐reported avoidance [mean difference (MD) = 1.14; 95% confidence interval (CI) = 0.94, 1.35, P < 0.001, ηp2 = 0.64] and visual attention (MD = 0.89, 95% CI = 0.09, 1.68, P = 0.03, ηp2 = 0.06) to long‐term warnings, but not for reactance (MD = 0.14, 95% CI = –0.04, 0.32, P = 0.12, ηp2 = 0.03). Increased visual attention to warnings on the upper versus lower half of the pack (MD = 1.8; 95% CI = 0.33, 3.26, P = 0.02, ηp2 = 0.08). Study 2: higher self‐reported avoidance of (MD = 0.70; 95% CI = 0.59,0.80, P < 0.001, ηp2 = 0.61) and reactance to (MD = 0.37; 95% CI = 0.27, 0.47, P < 0.001, ηp2 = 0.34) loss‐framed warnings but little evidence of a difference for visual attention (MD = 0.52; 95% CI = –0.54, 1.58, P = 0.30, ηp2 = 0.01). Greater visual attention, avoidance and reactance to pictorial versus text‐only warnings (all Ps < 0.001, ηp2 > 0.25). Study 3: greater self‐reported avoidance of (MD = 0.37; 95% CI = 0.25, 0.48, P < 0.001, ηp2 = 0.33) and reactance to (MD = 0.14; 95% CI = 0.05, 0.23, P = 0.003, ηp2 = 0.11) highly severe warnings but findings were inconclusive as to whether there was a difference in visual attention (MD = –0.55; 95% CI = –1.5, 0.41, P = 0.24, ηp2 = 0.02). Conclusions Subjective and objective (eye‐tracking) measures of avoidance of health warnings on cigarette packs produce different results, suggesting these measure different constructs. Visual avoidance of warnings indicates low‐level disengagement with warnings, while self‐reported predicted avoidance reflects higher‐level engagement with warnings.

show abstract

Section: Discussionsupporting

confidence: 88%

Avoidance of tobacco health warnings? An eye‐tracking approach

et al. 2020

View full text Add to dashboard Cite

show abstract

“…While this innovation may have added value to smoking that helped to offset the cost of the last tax increase in 2011, further periodic increases in taxes may be necessary, especially given the evidence for the effectiveness of earlier tax increases. Also, the relatively small health warning on the front of the pack (30%) should be increased to align with FCTC guidelines 28 43 44…”

Section: Discussionmentioning

confidence: 99%

Smoking trends in Mexico, 2002–2016: before and after the ratification of the WHO’s Framework Convention on Tobacco Control

et al. 2020

View full text Add to dashboard Cite

IntroductionMexico was the first Latin American country to ratify the Framework Convention on Tobacco Control (FCTC) in 2004, after which it implemented some key FCTC policies (e.g., taxes, smoke-free, pictorial warnings and ad bans). This study assessed trends in the prevalence of current, daily and non-daily smoking in Mexico before and after the implementation of key FCTC policies.MethodsData were analysed from two comparable, nationally representative surveys (i.e., the National Survey on Addictions 2002, 2011 and 2016, and the Global Adult Tobacco Survey 2009 and 2015). The pooled sample comprised 100 302 persons aged 15–65 years. Changes in the prevalence of current, daily and non-daily smoking were assessed.ResultsFrom 2002 to 2016, the prevalence of current smoking fell 11% in relative terms (from 21.5% to 19.0%). The decrease was registered between 2002 and 2009, and after that, a slight increase was observed (from 16.5% in 2009 to 19% in 2016). The prevalence of daily smoking decreased by about 50% between 2002 and 2016 (from 13.5% to 7.0%) with most of the decrease occurring by 2009. Conversely, the prevalence of non-daily smoking increased by 35% between 2009 and 2016 (from 8.8% to 11.9%).ConclusionsFull implementation of the FCTC is necessary to further reduce smoking. Specific interventions may be needed to target non-daily smokers, who now comprise more than half of current smokers in Mexico.

show abstract

“…In the second step, the team reviewed existing HWLs for cigarettes (www.tobaccolabels.org), including those initially proposed by the US Food and Drug Administration for cigarettes39 to identify the most effective HWLs (images of bodily harm, people suffering the consequences of smoking)40–43 that could be adapted for WP, as well as HWLs that had already been developed and tested for WP 12. As suggested by ‘semantic priming’, where the editorial context acts as a prime and activates viewers’ related knowledge and memory,44 for each HWL, the text content was adapted based on WP-specific evidence, consistent with theme, and was designed to convey a clear, simple and direct message.…”

Section: Methodsmentioning

confidence: 99%

Delphi study among international expert panel to develop waterpipe-specific health warning labels

et al. 2019

View full text Add to dashboard Cite

BackgroundWaterpipe (WP) smoking is increasing globally. The rise of WP has been fuelled by widespread misperception of reduced-harm compared to cigarettes. Health warning labels (HWLs) are one strategy to communicate smoking-related risks and address reduced-harm misperceptions. Therefore, the development of WP-specific HWLs represents a priority for WP control.MethodsA panel of experts in WP science developed 28 WP-specific HWLs corresponding to five themes (health risks, addiction, harm to others, WP-specific harm, WP harm compared to cigarettes). Subsequently, a three-round Delphi study was conducted among international expert panel to reach consensus on a set of the most effective HWLs for each theme. Levels of agreement between participants were assessed using interquartile deviations, and the rank between the tied HWLs was based on the median.ResultsStarting with 28 candidate HWLs stratified according to five WP-related themes, our international expert panel reached consensus on the 13 most important WP-specific HWLs. Labels with the highest agreement were related to oral and heart disease, WP’s harmful effects on newborn children and the amount of smoke inhaled from WP compared to cigarettes.ConclusionThis study is the first to systematically develop and evaluate potential WP-specific HWLs based on the scientific evidence about WP’s harmful effects, scientific understanding of HWL for cigarettes and the opinions of experts in WP science, tobacco control and health communication. The final selected HWLs can be adapted based on the context and policy landscape of the target country and can be further fine-tuned based on feedback from WP smokers and non-smokers.

show abstract

Which type of tobacco product warning imagery is more effective and sustainable over time? A longitudinal assessment of smokers in Canada, Australia and Mexico

Cited by 15 publications

References 25 publications

Avoidance of tobacco health warnings? An eye‐tracking approach

Avoidance of tobacco health warnings? An eye‐tracking approach

Smoking trends in Mexico, 2002–2016: before and after the ratification of the WHO’s Framework Convention on Tobacco Control

Delphi study among international expert panel to develop waterpipe-specific health warning labels

Contact Info

Product

Resources

About