Alcohol pictorial health warning labels: the impact of self-affirmation and health warning severity

Background and aims Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption.DesignA between-subjects randomised experiment with three groups: Group 1: image-and-text HWL; Group 2: text-only HWL; Group 3: no HWL.SettingA commercial-standard naturalistic shopping laboratory. Participants Adults (n=399) over the age of 18, who purchased beer or wine weekly to drink at home. InterventionsParticipants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: i. image-and-text HWL; ii. text-only HWL; iii. no HWL. Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks. MeasurementThe primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability.FindingsThere was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (OR=1.08, 95%CI=0.82,1.42); text-only HWL: 41% (OR=0.87, 95%CI=0.67,1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (p< 0.001) and acceptability lower (p< 0.001) in the image-and-text HWL group, compared to the text-only HWL group. ConclusionsIn a naturalistic shopping laboratory, health warning labels describing the adverse health consequences of excessive alcohol consumption did not change selection behaviour.

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Impact of Image-and-text and Text-only Health Warning Labels on Selection and Consumption of Food and Alcohol Products: Systematic Review with Meta-analysis

10.31234/osf.io/jt52m ◽

2019 ◽

Cited By ~ 3

Author(s):

Natasha Clarke ◽

Emily Pechey ◽

Daina Kosīte ◽

Laura M König ◽

Eleni Mantzari ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Experimental Studies ◽

Control Group ◽

Warning Labels ◽

Health Warning ◽

Alcoholic Drinks ◽

Randomised Controlled ◽

The Impact ◽

Selection Of

Reducing harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks would prevent much disease. Evidence from tobacco control shows that placing health warning labels (HWLs) on these products reduces their selection and consumption. A systematic review with meta-analysis was conducted using Cochrane methods to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drinks with image-and-text (sometimes termed ‘pictorial’) and text-only HWLs placed on these products. Studies were required to be randomised or quasi-randomised controlled trials. Fourteen studies were included, three on alcohol, eleven on food. For our primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared to a control group with no HWL (RR=0.74 (95% CI 0.68 to 0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger effect on selection of image-and-text HWLs (RR=0.65 (95% CI 0.54 to 0.80)) than text-only HWLs (RR=0.79 (95% CI 0.74 to 0.85)), but this difference was not statistically significant. These findings suggest significant potential for HWLs to reduce selection of food and alcohol, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and more naturalistic laboratory settings are urgently needed to estimate the potential effects of HWLs on food and alcohol.

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The impact of the 2009/2010 enhancement of cigarette health warning labels in Uruguay: longitudinal findings from the International Tobacco Control (ITC) Uruguay Survey

Tobacco Control ◽

10.1136/tobaccocontrol-2014-051742 ◽

2014 ◽

pp. tobaccocontrol-2014-051742 ◽

Cited By ~ 7

Author(s):

Shannon Gravely ◽

Geoffrey T Fong ◽

Pete Driezen ◽

Mary McNally ◽

James F Thrasher ◽

...

Keyword(s):

Tobacco Control ◽

Warning Labels ◽

Health Warning ◽

The Impact

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The impact of ‘on-pack’ pictorial health warning labels and calorie information labels on drink choice: A laboratory experiment

Appetite ◽

10.1016/j.appet.2019.104484 ◽

2020 ◽

Vol 145 ◽

pp. 104484 ◽

Cited By ~ 6

Author(s):

Eleni Mantzari ◽

Rachel Pechey ◽

Saphsa Codling ◽

Olivia Sexton ◽

Gareth J. Hollands ◽

...

Keyword(s):

Laboratory Experiment ◽

Warning Labels ◽

Health Warning ◽

The Impact

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The Impact of Health Warning Labels for Swedish Snus Advertisements on Young Adults’ Snus Perceptions and Behavioral Intentions

Nicotine & Tobacco Research ◽

10.1093/ntr/ntv140 ◽

2015 ◽

Vol 18 (5) ◽

pp. 1371-1375 ◽

Cited By ~ 14

Author(s):

Darren Mays ◽

Meghan B. Moran ◽

David T. Levy ◽

Raymond S. Niaura

Keyword(s):

Young Adults ◽

Behavioral Intentions ◽

Warning Labels ◽

Health Warning ◽

The Impact ◽

Swedish Snus

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Impact of health warning labels on snack selection: an online experimental study

10.31234/osf.io/zyca2 ◽

2019 ◽

Author(s):

Natasha Clarke ◽

Emily Pechey ◽

Eleni Mantzari ◽

Anna Katherine Mary Blackwell ◽

Katie De-loyde ◽

...

Keyword(s):

Open Science ◽

Warning Labels ◽

Health Warning ◽

Online Setting ◽

Science Framework ◽

The Impact ◽

Energy Dense Food ◽

Selection Of ◽

Data Analysis Plan

BackgroundExcessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. Methods A between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design. Participants (N=4,134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task.ResultsThe proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (image-and-text HWL: 37%; image-and-text HWL with calories: 38%; text-only HWL: 48%; text-only HWL with calories: 44%; calories only: 54%; no label: 59%). Participants were least likely to select an energy-dense snack in the image-and-text HWL group and most likely in the no label group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001).Conclusions Health warning labels – particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.Trial registration: The study protocol (https://osf.io/6n7h9, registered: April 1st 2019) and data analysis plan (https://osf.io/zvrs5) were pre-registered on the Open Science Framework. KeywordsHealth warning labels, pictorial labels, graphic warnings, snacks, food, choice architecture, energy-dense

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Evaluating the impact of introducing standardized packaging with larger health-warning labels in England: findings from adult smokers within the EUREST-PLUS ITC Europe Surveys

European Journal of Public Health ◽

10.1093/eurpub/ckaa053 ◽

2020 ◽

Vol 30 (Supplement_3) ◽

pp. iii91-iii97 ◽

Cited By ~ 1

Author(s):

Sarah Aleyan ◽

Pete Driezen ◽

Ann McNeill ◽

Máirtín McDermott ◽

Sarah Kahnert ◽

...

Keyword(s):

Control Policy ◽

Tobacco Product ◽

Warning Labels ◽

Health Warning ◽

Quasi Experimental ◽

Cross Country ◽

The Look ◽

The Uk ◽

The Impact ◽

The Eu

Abstract Background The European (EU) Tobacco Product Directive (TPD) was implemented in May 2016 to regulate the design and labelling of cigarettes and roll-your-own tobacco. At the same time, the UK introduced standardized packaging measures, whereas Germany, Greece, Hungary, Poland, Romania and Spain did not. This study examines the impact of introducing standardized packaging in England using a quasi-experimental design. Methods Data from adult smokers in Waves 1 (2016; N=9547) and 2 (2018; N=9724) from the International Tobacco Control Policy Evaluation surveys (England) and EUREST-PLUS surveys (Germany, Greece, Hungary, Poland, Romania and Spain) were used. Generalized estimating equations were used to estimate changes in pack/brand appeal, salience of health-warning labels (HWLs) and perceived relative harm of different brands in England (where larger HWLs and standardized packaging were implemented), vs. each EU country (where only larger HWLs were implemented). Results There was an increase in the percentage of respondents from Germany, Hungary and Poland reporting they did not like the look of the pack (4.7%, 9.6%, and 14.2%, respectively), but the largest increase was in England (41.0%). Moreover, there was a statistically significant increase in the salience of HWLs in Hungary, Poland and Romania (17.0%, 13.9%, and 15.3%, respectively), but the largest increase was in England (27.6%). Few differences were observed in cross-country comparisons of the perceived relative harm of different brands. Conclusions Findings suggest that standardized packaging reduces pack appeal and enhances the salience of HWLs over and above the effects of larger HWLs. Findings provide additional evidence and support for incorporating standardized packaging into the EU TPD.

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Reclaiming the value of pictorial health warning labels in Jordan

Tobacco Control ◽

10.1136/tobaccocontrol-2017-053679 ◽

2017 ◽

Vol 27 (5) ◽

pp. 589-591

Author(s):

Nour A Obeidat ◽

Mai Al-Hadid ◽

Asma A Hatoqai ◽

Rawan A Shihab ◽

Feras I Hawari

Keyword(s):

Focus Groups ◽

The Novel ◽

Warning Labels ◽

Health Warning ◽

Inductive Approach ◽

Graphic Images ◽

Vicarious Experiences ◽

The Impact ◽

Selection Of

BackgroundIn Jordan, four non-graphic pictorial health warning labels (PHWLs) concerning a limited selection of tobacco-caused harms have been used since 2011; however, research suggests that they may be ineffective.ObjectivesTo explore Jordanian smokers’ reactions to novel PHWLs featuring various health themes and/or graphic and symbolic imagery and to discuss existing PHWLs in light of the novel PHWLs.MethodsWe conducted 14 focus groups (FGs) with smokers who assessed 12 novel PHWLs and commented on four existing PHWLs. Data were analysed using an inductive approach.ResultsSix themes emerged from the FG discussions: understanding the overall meaning of PHWLs, the impact of graphic images, magnitude and controllability of harm, personal or vicarious experiences, the futility of quitting and fatalism. PHWLs depicting graphic respiratory and oral tobacco-caused harms resonated with most smokers. Smokers also sought direct, harm-specific taglines when trying to understand the overall PHWL. Some smokers viewed the PHWLs as exaggerated, and while the majority acknowledged that smoking was harmful, they felt that PHWLs would not accomplish their goal of inducing quitting.ConclusionsOur findings support the use of graphic imagery to communicate tobacco-caused harms (particularly respiratory ones) and the use of specific taglines explaining the mechanism of harm depicted.

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Impact of Waterpipe Tobacco Pack Health Warnings on Waterpipe Smoking Attitudes: A Qualitative Analysis among Regular Users in London

BioMed Research International ◽

10.1155/2015/745865 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 11

Author(s):

Mohammed Jawad ◽

Ali Bakir ◽

Mohammed Ali ◽

Aimee Grant

Keyword(s):

Thematic Analysis ◽

Waterpipe Smoking ◽

Warning Labels ◽

Health Warnings ◽

Point Of Sale ◽

Health Warning ◽

Eu Legislation ◽

Waterpipe Tobacco Smoking ◽

Inherent Nature ◽

The Impact

Background. Despite the rise in prevalence of waterpipe tobacco smoking, it has received little legislative enforcement from governing bodies, especially in the area of health warning labels.Methods. Twenty regular waterpipe tobacco smokers from London took part in five focus groups discussing the impact of waterpipe tobacco pack health warnings on their attitudes towards waterpipe smoking. We presented them with existing and mock waterpipe tobacco products, designed to be compliant with current and future UK/EU legislation. Data were analysed using thematic analysis.Results. Participants felt packs were less attractive and health warnings were more impactful as health warnings increased in size and packaging became less branded. However, participants highlighted their lack of exposure to waterpipe tobacco pack health warnings due to the inherent nature of waterpipe smoking, that is, smoking in a café with the apparatus already prepacked by staff. Health warnings at the point of consumption had more reported impact than health warnings at the point of sale.Conclusions. Waterpipe tobacco pack health warnings are likely to be effective if compliant with existing laws and exposed to end-users. Legislations should be reviewed to extend health warning labels to waterpipe accessories, particularly the apparatus, and to waterpipe-serving premises.

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