Tool to assess appeal–aversion response to graphic warning labels on cigarette packs among US smokers

IntroductionGraphic warning labels on cigarette packaging are mandated in 118 countries and are under consideration in the USA. We propose an appeal–aversion assessment tool to help regulators choose among graphic packaging options.MethodsAfter familiarisation with different cigarette packaging, adult daily smokers (n=338) from San Diego, California, USA completed a discrete choice appeal–aversion purchasing task and provided information on nicotine dependence and sociodemographics (2017–2019). The conjoint analysis estimated the importance and price utility for product attributes (ie, packaging, price, tobacco origin and quitline number). The price premiums that smokers would be willing to pay to avoid purchasing graphic packaging were calculated.ResultsAmong purchase determinants, the price was the most important attribute (65.5%), followed by packaging design (27.1%). Compared with blank packaging without marketing, branded industry packs had appeal valuations (US$0.54; 95% CI: US$0.44 to US$0.65), whereas graphic warning packs had aversion valuations that varied with the salience of the image (blindness=−US$2.53, 95% CI: −US$2.76 to −US$2.31; teeth damage=−US$2.90, 95% CI: −US$3.17 to −US$2.63; and gangrenous foot=−US$3.70, 95% CI: −US$4.01 to −US$3.39). The aversion was such that 46.2% of participants were willing to pay a 50+% premium over their current cigarette price to have their branded packs rather than a graphic pack. These appeal–aversion valuations were moderated by sex, income and nicotine dependence (p<0.05).ConclusionsSmokers indicated a willingness to pay substantial premiums to avoid purchasing graphic packaging. Results suggest that mandating graphic warnings on US cigarette packs would induce price aversion and may deter cigarette purchasing. Price valuations from this appeal–aversion tool could be useful for regulators to differentiate between graphic warning labels.

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The estimated effect of graphic warning labels on smoker’s intention to quit in Shanghai, China: a cross-sectional study

BMC Public Health ◽

10.1186/s12889-021-12257-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruiping Wang ◽

Yan Qiang ◽

Yan Zhu ◽

Xiangjin Gao ◽

Qiong Yang ◽

...

Keyword(s):

Smoking Cessation ◽

Logistic Regression ◽

Control Measures ◽

Intention To Quit ◽

Lower Percentage ◽

Warning Labels ◽

Cross Sectional ◽

Smoking Intensity ◽

Graphic Warning ◽

Cigarette Packs

Abstract Background Tobacco consumption is the leading cause of death worldwide. Overwhelming studies demonstrate graphic warning labels (GWLs) on cigarette packs are effective in eliciting negative response to tobacco smoking, modifying beliefs about tobacco dangers, and increasing reported intention to quit, but the estimated effect of GWLs on smoking cessation intention among smokers is still limited in China. In this study, we aim to understand the smoking intensity, smoking duration and smoking cessation intention among current smokers, and to explore how their smoking cessation intention would be influenced by the GWLs in Shanghai. Methods From January to June 2021, we totally recruited 1104 current smokers in Songjiang district and Fengxian district of Shanghai by multistage sampling design. We used Android pad assisted electronic questionnaire for data collection, and then implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore how smoking cessation intention would be influenced by the GWLs among current smokers. Results One thousand one hundred four current smokers included 914 males (82.79%), with an average age of 43.61 years. 58.06% of current smokers reported smoking cessation intention due to GWLs. Logistic regression indicated a higher percentage of smoking cessation intention due to GWLs was among female smokers [OR = 2.41, 95% CI (1.61–3.59)], smokers with smoking intensity < 20 cigarette/day [OR = 1.92, 95% CI (1.44–2.55)], smokers with tobacco burden < 20% [OR = 1.94, 95% CI (1.35–2.79)], and among smokers had plan to quit in a year [OR = 6.58, 95% CI (4.71–9.18). Smokers with higher individual monthly income had lower percentage of smoking cessation intention (OR were 0.35, 0.46 and 0.41). Meanwhile, among 642 current smokers without plan to quit in a year, approximately 40% of them reported smoking cessation intention due to GWLs. Conclusions Smoking cessation intention due to the assumed GWLs on cigarette packs is high among current smokers in Shanghai, especially in female smokers, smokers with light tobacco burden and mild nicotine dependence. Incorporating smoking intensity as well as smoking burden into the implementation of GWLs as tobacco control measures would discourage smoking in China.

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Graphic warning labels and the demand for cigarettes

Tobacco Control ◽

10.1136/tobaccocontrol-2015-052775 ◽

2016 ◽

Vol 26 (2) ◽

pp. 169-174 ◽

Cited By ~ 3

Author(s):

Martha A Starr ◽

Keith Drake

Keyword(s):

Stock Prices ◽

Abnormal Returns ◽

Warning Labels ◽

Negative Effects ◽

Share Prices ◽

Study Approach ◽

Cigarette Demand ◽

The Us ◽

The Usa ◽

Graphic Warning

BackgroundIn 2010, the US Food and Drug Administration (FDA) proposed requiring tobacco companies to add graphic warning labels (GWLs) to cigarette packs. GWLs are large prominently placed warnings that use both text and photographic images to depict health risks of smoking. The companies challenged FDA's authority on First Amendment grounds; the courts accepted that FDA could compel companies to add GWLs, but argued that FDA had not established that GWLs would significantly reduce smoking.ObjectiveThis paper adds new evidence on the question of whether GWLs would have reduced cigarette demand, by examining whether tobacco companies’ share prices fell unusually after news indicating a higher likelihood of having GWLs, and rose on the opposite news. Such findings would be expected if investors viewed GWLs as likely to reduce cigarette demand.MethodsAn event-study approach is used to determine whether the stock prices of US tobacco companies rose or fell unusually after news events in the period when GWLs were proposed, finalised, challenged and withdrawn.FindingsTobacco companies’ stock prices indeed realised significant abnormal returns after GWL news, consistent with expected negative effects on cigarette demand. Our estimates suggest investors expected GWLs to reduce the number of smokers by an extra 2.4–6.9 million in the 10 years after the rule took effect.ConclusionsThese findings support the view that the GWLs proposed by FDA would have curbed cigarette consumption in the USA in an appreciable way.

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

Journal of Drug Issues ◽

10.1177/0022042617699196 ◽

2017 ◽

Vol 47 (3) ◽

pp. 433-447 ◽

Cited By ~ 1

Author(s):

Anna Pagano ◽

Noah Gubner ◽

Barbara Tajima ◽

Deborah Yip ◽

Catherine Henderson ◽

...

Keyword(s):

Addiction Treatment ◽

Treatment Programs ◽

Emotional Impact ◽

Warning Labels ◽

Graphic Warning ◽

Group Interviews ◽

Readiness To Quit ◽

Specific Reactions ◽

Diverse Groups ◽

Cigarette Packs

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 a 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.

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Does Visual Attention to Graphic Warning Labels on Cigarette Packs Predict Key Outcomes among Youth and Low-income Smokers?

Tobacco Regulatory Science ◽

10.18001/trs.4.6.3 ◽

2018 ◽

Vol 4 (6) ◽

pp. 18-37 ◽

Cited By ~ 2

Author(s):

Sahara Byrne ◽

Motasem Kalaji ◽

Jeff Niederdeppe

Keyword(s):

Visual Attention ◽

Low Income ◽

Warning Labels ◽

Graphic Warning ◽

Cigarette Packs

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

Nicotine & Tobacco Research ◽

10.1093/ntr/ntu339 ◽

2015 ◽

Vol 17 (7) ◽

pp. 784-795 ◽

Cited By ~ 18

Author(s):

Amy McQueen ◽

Matthew W. Kreuter ◽

Sonia Boyum ◽

Vetta S. Thompson ◽

Charlene A. Caburnay ◽

...

Keyword(s):

Warning Labels ◽

Graphic Warning ◽

Cigarette Packs

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FDA withdraws from fight over graphic warning labels on cigarette packs

Cancer ◽

10.1002/cncr.28206 ◽

2013 ◽

Vol 119 (13) ◽

pp. 2361-2361

Author(s):

Carrie Printz

Keyword(s):

Warning Labels ◽

Graphic Warning ◽

Cigarette Packs

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Effect of Graphic Warning Labels on Cigarette Packs on US Smokers’ Cognitions and Smoking Behavior After 3 Months

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.21387 ◽

2021 ◽

Vol 4 (8) ◽

pp. e2121387

Author(s):

David R. Strong ◽

John P. Pierce ◽

Kim Pulvers ◽

Matthew D. Stone ◽

Adriana Villaseñor ◽

...

Keyword(s):

Smoking Behavior ◽

Warning Labels ◽

Graphic Warning ◽

Cigarette Packs

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Graphic Warning Labels Affect Hypothetical Cigarette Purchasing Behavior among Smokers Living with HIV

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16183380 ◽

2019 ◽

Vol 16 (18) ◽

pp. 3380

Author(s):

Lauren Pacek ◽

Meredith Berry ◽

Olga Rass ◽

Melissa Mercincavage ◽

F. McClernon ◽

...

Keyword(s):

Hiv Positive ◽

Purchasing Behavior ◽

Warning Label ◽

Purchasing Decisions ◽

Warning Labels ◽

Cigarette Pack ◽

Valuation Task ◽

Graphic Warning ◽

Living With Hiv ◽

Cigarette Packs

Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to a void seeing GWLs.

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