Public support for pictorial warnings on cigarette packs: an experimental study of US smokers

Abstract Background Our randomized trial found that pictorial cigarette pack warnings elicited more quit attempts than text-only warnings. Purpose In the current study, we sought to identify psychological mechanisms that explain why pictorial cigarette pack warnings change behavior. Methods In 2014 and 2015, we recruited 2,149 adult smokers in NC and CA, USA. We randomly assigned smokers to receive on their cigarette packs for 4 weeks either a text-only warning (one of the USA’s current warnings on the side of cigarette packs) or a pictorial warning (one of the USA’s proposed text warnings with pictures on the top half of the front and back of cigarette packs). Results Pictorial warnings increased attention to, reactions to, and social interactions about cigarette pack warnings (all p < .05). However, pictorial warnings changed almost no belief or attitude measures. Mediators of the impact of pictorial warnings included increased attention, negative affect, social interactions, thinking about the warning and harms of smoking, and intentions to quit (all p < .05). Analyses also found that pictorial warnings led to greater avoidance of the warnings, which was associated with more quit attempts (p < .05). Conclusions Pictorial warnings increased quit attempts by eliciting aversive reactions and by keeping the message vividly in smokers’ minds. Contrary to predictions from several theories of health behavior, the warnings exerted little of their influence through changes in beliefs and attitudes and none of their influence through changes in risk perception. We propose the Tobacco Warnings Model based on these findings. Clinical Trial information ClinicalTrials.gov identifier: NCT02247908; https://clinicaltrials.gov/ct2/show/NCT02247908.

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The impact of including cessation resource information on health warnings on standardised tobacco packaging on awareness and use: A longitudinal online survey in the United Kingdom

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa251 ◽

2020 ◽

Author(s):

Crawford Moodie ◽

Catherine Best ◽

Nathan Critchlow ◽

Martine Stead ◽

Ann McNeill ◽

...

Keyword(s):

Online Survey ◽

Cigarette Smokers ◽

Resource Information ◽

The United Kingdom ◽

Pictorial Warnings ◽

Stop Smoking ◽

The Uk ◽

The Impact ◽

Source Of Information ◽

Cigarette Packs

Abstract Introduction Since May 2017, all cigarettes and roll-your-own (RYO) tobacco in the UK must be sold in standardised packs with pictorial warnings displaying, for the first time, a stop-smoking website. Methods Data comes from three waves of a longitudinal online survey with smokers and ex-smokers conducted pre- and post-standardised packaging, with Wave 1 (W1) in April-May 2016, Wave 2 (W2) in October-November 2017, and Wave 3 (W3) in May-June 2019. Only smokers are included in the analysis: W1 (N=6233), W2 (N=3629) and W3 (N=2412). We explored any change in citing warnings on packs as a source of information about a stop-smoking website, and whether citing warnings as a source was associated with use of a stop-smoking website. As the warnings, and therefore the stop-smoking website, are larger on RYO packs than on cigarette packs due to the larger pack size, we explored differences in awareness of a stop-smoking website among exclusive cigarette smokers (W1=3142, W2=1884, W3=1247) and exclusive RYO smokers (W1=2046, W2=1119, W3=814). Results Among smokers recalling seeing information about a stop-smoking website, citing warnings as a source increased between waves (W1=14.0%, W2=24.2%, W3=25.1%) and was associated with having visited a stop-smoking website (OR=11.81, 95% CI 8.47-16.46). Citing warnings as a source of a stop-smoking website increased among exclusive RYO smokers at each wave (W1=15.5%, W2=26.3%, W3=32.1%), while for exclusive cigarette smokers it only increased at W2 (W1=10.5%, W2=22.4%, W3=19.9%). Conclusions Warnings are an important source of cessation resource information. Making this information more prominent may help sustain awareness. Implications The findings support the inclusion of a stop-smoking website on warnings as awareness among smokers increased and citing warnings as a source of information about a stop-smoking website was associated with having visited a stop-smoking website. We also explored whether the stop-smoking website on warnings on RYO packs, which is larger than on cigarette packs as a function of the larger size of RYO packs, would have any impact on awareness of this information. That exclusive RYO smokers were more likely than exclusive cigarette smokers to notice a stop-smoking website on warnings suggests that this information should be more prominent.

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