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Al-Ahmadi AF, Almatrafi MA, Ali AK, Alsaedi OH, Al-Zalabani AH. Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey. Tob Induc Dis 2024; 22:TID-22-44. [PMID: 38384733 PMCID: PMC10879763 DOI: 10.18332/tid/182912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Health warnings on cigarette sticks are emerging as a tool to control tobacco consumption; hence, understanding how they are perceived is valuable in determining their effectiveness. Our study aimed to evaluate the perception of health-related messages and warnings on individual cigarette sticks. It also aimed to evaluate the perceptions of the effectiveness of cigarette packaging warnings and the acceptance level for the inclusion of health warnings on cigarette sticks. METHODS This cross-sectional survey was conducted on 285 individuals in Al-Madinah, Saudi Arabia. The survey was distributed online using a non-probability convenience sampling technique. The chi-squared test and logistic regression analysis were used to determine the association of sociodemographic characteristics and smoking-related variables with participants' perceptions of health warnings on cigarette sticks and packaging. The responses were also assessed qualitatively using conceptual content analysis. RESULTS In all, 18.6% of participants perceived that the package warnings were either 'quite effective' or 'very effective' in prompting smokers to quit. For health warnings on cigarette sticks, 28.1% of participants perceived that the theme of statistics on mortality was either 'quite effective' or 'very effective' in prompting smokers to quit, compared to 35.0 % for the theme of social and financial consequences. Respondents who had secondary education and lower were almost two times more likely to support the inclusion of health warnings than those who had a university education and higher (OR=1.9; 95% CI: 1.02-3.7, p=0.042). Most of the comments were positive for the inclusion of health warnings on cigarette sticks. CONCLUSIONS Most participants perceived that package warnings were ineffective, but warnings on cigarette sticks were effective methods of dissuasion of cigarette use. Smokers were almost twice as likely to perceive as effective supportive messages to quit than non-smokers. The majority of participants 'agreed' or 'strongly agreed' to the inclusion of health warnings on cigarette sticks.
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Affiliation(s)
- Ahmed F. Al-Ahmadi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
- Quit Smoking Clinic, Public Health Department, King Salman Medical City, Al-Madinah, Saudi Arabia
- Preventive Medicine Program for Postgraduate Studies, Ministry of Health, Al-Madinah, Saudi Arabia
| | - Mohammed A. Almatrafi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
| | - Ahmed K. Ali
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
| | - Osama H. Alsaedi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al Madinah, Saudi Arabia
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Caner A, Turan B, Gürdal MY, Güven S. Perceptions of plain packaging and health warnings among university students in Turkey: a survey-based experiment. BMC Public Health 2023; 23:779. [PMID: 37118758 PMCID: PMC10141903 DOI: 10.1186/s12889-023-15637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 04/09/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Cigarette pack design plays a crucial role in attracting customers, especially when other marketing methods are limited by policy. University students who engage in casual smoking take the risk of developing an addiction. The objective of this study was to assess the effects of plain packaging (PP) and graphic health warnings (GHWs) on cigarette packages on three outcome variables (negative affect, avoidant responses, and intentions to quit) among ever-smoker university students in Ankara, Turkey, where youth smoking prevalence is high. METHODS An online survey-based experiment was used to collect data. The respondents were randomly assigned to one of the five conditions that contained images of cigarette packs with specific design elements. Regression analyses (n = 623) were used to compare across conditions and to estimate the effects of combined warnings (versus text-only warnings), stronger GHWs (versus old GHWs), and PP (versus branded packages) on the outcome variables, accounting for potential confounders. RESULTS Stronger GHWs generated more negative affect (0.31 points out of 5, p = 0.010) and avoidant responses (0.42 points out of 5, p = 0.002) than old warnings (when brand logos were visible). Plain packages generated more negative affect (0.48 points out of 5, p < 0.001) and avoidant responses (0.46 points out of 5, p = 0.001) than branded packages (with old warnings). Disentangling the effects of PP and new GHWs revealed that neither had individual differential effect on intentions to quit within 6 months. CONCLUSIONS Although no differential effect of PP or harsher GHWs was found on intentions to quit when respondents were exposed to images on screen, both design elements were found to be effective in generating negative affect and avoidant responses. More work is needed to design effective tobacco control measures among youth during critical years of tertiary education.
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Affiliation(s)
- Asena Caner
- Department of Economics, TOBB University of Economics and Technology, Ankara, 06560, Turkey.
| | - Belgi Turan
- Department of Economics, TOBB University of Economics and Technology, Ankara, 06560, Turkey
| | - Mehmet Y Gürdal
- Department of Economics, Bogazici University, Istanbul, 34342, Turkey
| | - Sibel Güven
- The Economic Policy Research Foundation of Turkey (TEPAV), Ankara, 06560, Turkey
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Cannoy CN, Bauer SJ, Prakash K, Excell S, Ghosh S, Lundahl LH, Ledgerwood DM. Response to health warnings on cigarette packs as a predictor of future smoking among current tobacco smokers. Addict Behav 2023; 144:107717. [PMID: 37060882 DOI: 10.1016/j.addbeh.2023.107717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
The United States (US) Food and Drug Administration (FDA) requires health warning labels on all cigarette packages as part of a campaign to reduce tobacco smoking. Prior research has revealed the mixed effectiveness of these health warning labels. The present study used nationally representative, longitudinal data from the Population Study of Tobacco and Health (PATH) Study to assess whether reported reactions to health warning labels on cigarette packs predict smoking frequency and smoking cessation two years later. We hypothesized that individuals who reported strong reactions to health warnings at Wave 1 of the PATH Study would engage in less frequent smoking behavior and would be more likely to have completely quit cigarette smoking two years later (Wave 3), compared with individuals who did not report strong reactions. Multinomial and binary logistic regressions were used to estimate the associations between attitudes toward health warning labels and later smoking frequency and smoking cessation. Our hypotheses were partially supported; results indicated that several attitudes toward health warnings predict later smoking behaviors. These findings indicate general effectiveness of health warning labels and support the FDA's initiative to require more attention-grabbing health warning labels on cigarette packs.
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Affiliation(s)
- Ciara N Cannoy
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Samantha J Bauer
- College of Liberal Arts and Sciences, Wayne State University, Detroit, MI, United States
| | - Krithika Prakash
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - ShayLin Excell
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Samiran Ghosh
- Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, United States
| | - Leslie H Lundahl
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, United States.
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Cho A, Chan G, Gartner C. Motivations to Change Smoking Behaviors Between 2007 and 2019 in Australia: A Repeated Cross-sectional Study. Nicotine Tob Res 2023; 25:674-681. [PMID: 35973439 DOI: 10.1093/ntr/ntac176] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION In 2010, Australian tobacco excise (administered federally) increased by 25%, and by 12.5% annually from 2013 to 2020, with additional increases on roll-your-own (RYO) tobacco between 2017 and 2020. We estimated past year changes in smoking behavior among Australian adults who smoked (daily and non-daily) in the past year, and the association between consumer characteristics and stated motivations to change/attempt to change smoking behavior between 2007 and 2019. METHODS Logistic regression analysis of combined data from national representative triennial cross-sectional surveys in Australia (N = 22 977). RESULTS The main motivation cited for changing smoking behavior switched from health-related from 2007 to 2010 to cost-related from 2013 to 2019. Among those who quit between one and 12 months ago, living in a lower socioeconomic area (odds ratio (OR) = 1.61, 95% CI = 1.18% to -2.18%), was associated with reporting the cost of smoking motivated them to quit. Among those who reduced their smoking, smoking daily and >20 cigarettes/day vs. non-daily smoking (OR = 2.11, 95% CI = 1.60% to 2.78%), having high/very high psychological distress (OR = 1.33, 95% CI = 1.12% to 1.59%), and alcohol consumption (ORdaily drinking = 1.38, 95% CI = 1.05% to 1.81%) was associated with cost as a motivation. Exclusive (OR = 0.65, 95% CI = 0.53% to 0.80%) and non-exclusive (OR = 0.77, 95% CI = 0.65% to 0.91%) RYO use was associated with being less likely to report the cost of tobacco as motivation for cutting down. CONCLUSIONS The cost of smoking became the most cited motivator to change smoking behavior (eg, quitting and cutting down), particularly for those who lived in low socioeconomic areas, smoked more cigarettes per day, drank alcohol, and had high/very high psychological distress. IMPLICATIONS A change in the main federal tobacco control intervention implemented in Australia from mass-media campaigns to tobacco tax increases has likely led to cost, rather than health, being the main motivation cited for changing smoking behavior in Australia since 2013. Further monitoring is needed to ensure the harmonization in tax rates for RYO and factory-made cigarettes has effectively reduced the price difference between these products because the lower cost of RYO may have reduced the effectiveness of tax increases as a motivator to change smoking behavior.
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Affiliation(s)
- Ara Cho
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
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Gilbert E, Ewald A. "You get past the packaging": young women smokers' resistance to standardized cigarette packaging. Women Health 2023; 63:186-193. [PMID: 36650637 DOI: 10.1080/03630242.2022.2164397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We examined how young women construct and experience plain tobacco packaging. Forty-one Australian young women who are current smokers took part in this qualitative interview research. Data was analyzed using constructivist grounded theory, with the core category about the strategic ways young women resist plain tobacco packaging. The majority of women reported that plain packaging was unappealing and that the larger health warnings were shocking and offensive. However, almost all reported being desensitized to the graphic health warnings. The graphic warnings were seen as "fake" or lacking in credibility, and irrelevant to the women's life stage. Importantly, the majority of women engaged in practices to strategically resist and avoid health warnings on the packs as a way to continue smoking. Our findings point to the need to develop health warnings on tobacco products that are gender specific and focus on proximal social consequences to increase salience for young women smokers.
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Affiliation(s)
- E Gilbert
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - A Ewald
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
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Donini LM, Berry EM, Folkvord F, Jansen L, Leroy F, Şimşek Ö, Fava F, Gobbetti M, Lenzi A. Front-of-pack labels: "Directive" versus "informative" approaches. Nutrition 2023; 105:111861. [PMID: 36401998 DOI: 10.1016/j.nut.2022.111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022]
Abstract
Front-of-pack labels (FOPLs) aim at communicating to consumers the health value of food items in support of public health policies. Two main types can be discerned: directive and semidirective FOPLs using color schemes (e.g., Nutri-Score) and informative FOPLs (e.g., Nutrinform Battery). Directive approaches tend to show a "wear-out effect" and, additionally, they tend to have various underlying conceptual problems. Usually, their nutritional scores are calculated using changing, arbitrary algorithms and involve a reductionist set of parameters of debatable validity. Thus, they overstate the effects of selected nutritional factors, such as saturated fat and energy, while overlooking the food matrix and the more holistic aspects of nourishment. Moreover, they do not reflect the portion that is consumed, ignore the preparation steps at home, and fail to serve as a useful basis for composing a healthy diet. Also, so long as the nutritional formulations match the algorithmic standards, they tend to allow ultra-processed products. Thus, this might confuse and mislead consumers. Overconfidence in green-colored labels could even result in unbalanced dietary choices, whereas avoidance of red products may eliminate certain foods from the diet that are rich in essential nutrients (e.g., cheese), leading to opposite results than aimed for. The latter is particularly relevant to vulnerable populations, such as the young, pregnant women, and older adults, or for individuals with specific needs. Taken together, directive FOPLs such as Nutri-Score contradict the declared intent of the European Commission to empower consumers to undertake healthy and balanced diets based on easily accessible and robust information. Although informative systems usually also keep the focus on a few selected nutritional parameters, they have are less paternalizing and obviate the need to classify foods as healthy or unhealthy. They also focus attention on the individual portions that are consumed (even if the definition of portion size remains contentious). Given the importance of dietary patterns, rather than individual foods or nutrients, directiveFOPLs of the Nutri-Score type represent a regretful case of nutritionism. Finally, attempts to associate the adoption of a FOPL with an improvement in the health status are few and mainly applied in virtual settings; none of which are longitudinal, nor have they been able to identify a causal link.
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Affiliation(s)
| | - Elliot M Berry
- Braun School of Public Health, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Frans Folkvord
- Tilburg University, Tilburg, Netherlands; PredictBy, Barcelona, Spain
| | - Léon Jansen
- Schuttelaar & Partners, Wageningen, Netherlands
| | | | - Ömer Şimşek
- Yildiz Technical University, İstanbul, Turkey
| | - Fabio Fava
- Alma Mater Studiorum, University of Bologna, Bologna, Italy; Italian Committee for Biosafety, Biotechnology and Life Sciences (CNBBSV), Rome, Italy
| | - Marco Gobbetti
- Italian Committee for Biosafety, Biotechnology and Life Sciences (CNBBSV), Rome, Italy; University of Bolzano, Bolzano, Italy
| | - Andrea Lenzi
- Sapienza University, Rome, Italy; Italian Committee for Biosafety, Biotechnology and Life Sciences (CNBBSV), Rome, Italy
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Penzavecchia C, Todisco P, Muzzioli L, Poli A, Marangoni F, Poggiogalle E, Giusti AM, Lenzi A, Pinto A, Donini LM. The influence of front-of-pack nutritional labels on eating and purchasing behaviors: a narrative review of the literature. Eat Weight Disord 2022; 27:3037-3051. [PMID: 36369593 PMCID: PMC9803757 DOI: 10.1007/s40519-022-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Front-of-Pack Nutritional Labels are considered a useful tool to help consumers orient themselves in their food choices and direct their behavior toward a healthier diet. FOPNL development and use are part of a framework that includes cognitive, biological, hedonic and cultural aspects, able to affect consumers' eating and purchasing behavior. AIM Given the complexity of the matter, the aim of this narrative review is to analyze the combination of different factors that drive food choices and eating behaviors and to highlight some aspects that are not fully studied. METHODS The authors conducted the research using a top-down approach at first, followed by a bottom-up approach; starting with general considerations about the purchasing process, gradually narrowing the discussion to a specific sub-population, and finally extending the discussion back to more general reasonings about the direction to adopt in future, or at least to evaluate, for effective communication. RESULTS Biases and attitudes toward food products were found to regularly interfere with buying behavior patterns, making it impossible to standardize an average consumer. This reflects in current research, increasing the complexity of the topic. All determinants influencing food choices are often assessed individually rather than in a synergistic and multidimensional context, while the purchasing scenario is characterized by multiple stimuli to which the consumer is subjected. FOPNLs' impact on perceived healthiness has been studied in different conditions, but some population subgroups have not been sufficiently represented. In particular, the effect of FOPNLs on consumers suffering from eating disorders is understudied and needs further attention. Furthermore, some approaches can be compared to "negative nutrition" or "loss-framed communication", putting nutrients out of context, emphasizing losses more than gains and risking promoting negative feelings in consumers. CONCLUSION Due to the heterogeneity of studies, evidence on what works best in driving people to adopt lasting lifestyle changes is still mixed. Science communicators and policymakers should consider the possibility that a multi-component approach incorporating nutrition information and education may be a key strategy to promote consumers' self-consciousness and to support them in their cognitive efforts toward a healthy and sustainable diet. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Claudia Penzavecchia
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Vicenza, Italy
| | - Luca Muzzioli
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milan, Italy
| | | | - Eleonora Poggiogalle
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Anna Maria Giusti
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Andrea Lenzi
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Alessandro Pinto
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy
| | - Lorenzo Maria Donini
- Medical Pathophysiology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research Unit, Experimental Medicine Department, Sapienza University, Ple. Aldo Moro, 5, 00185, Rome, Italy.
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Australian Perceptions of Warnings on Cigarette Sticks. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Joo HJ, Joo JH, Kim SH, Park EC, Jang SI. Association Between Graphic Health Warning Labels on Cigarette Packs and Smoking Cessation Attempts in Korean Adolescent Smokers: A Cross-Sectional Study. Front Public Health 2022; 10:789707. [PMID: 35223730 PMCID: PMC8873167 DOI: 10.3389/fpubh.2022.789707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/20/2022] [Indexed: 01/14/2023] Open
Abstract
Graphic health warning labels on cigarette packs inform smokers about the health risks associated with tobacco smoking. Adolescents are generally the main targets to influence by graphic health warning labels. This study investigated the association between graphic health warning labels on cigarette packs and attempts to quit smoking in South Korean adolescents. This cross-sectional study used data from the 2017 to 2019 Korea Youth Risk Behavior Web-based Survey, using multiple logistic regression for the analysis. The study population comprised 11,142 adolescents aged 12–18 years. The outcome variable was attempts to quit smoking among adolescent smokers who had seen graphic health warning labels. Attempts to quit smoking were higher among adolescent smokers who had seen graphic health warning labels compared to those who had not {boys, odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.48–2.00]; girls, OR = 1.74 (95% CI, 1.33–2.28)}. The correlation was greater for adolescents who thought about the harm of smoking [boys, OR = 1.86 (95% CI, 1.60–2.16); girls, OR = 1.85 (95% CI, 1.41–2.43)] and the willingness to quit [boys, OR = 2.03 (95% CI, 1.74–2.36); girls, OR = 2.04 (95% CI, 1.55–2.68)] after seeing graphic health warning labels. Our findings indicate that graphic health warning labels on cigarette packs have the potential to lower smoking intentions of adolescents. We suggest that the use of graphic health warning labels is an effective policy-related intervention to reduce smoking in South Korean adolescents.
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Affiliation(s)
- Hye Jin Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Jae Hong Joo
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Seung Hoon Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Sung-In Jang
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Her W, Oh YS. Examining the Mediating Effect of Believability on the Relationship between Social Influences and Smoking Behavior for Smoking Cessation among Korean Youths. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Moodie C, Best C, Lund I, Scheffels J, Critchlow N, Stead M, McNeill A, Hitchman S, Mackintosh AM. The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging. Nicotine Tob Res 2021; 23:1551-1558. [PMID: 33599723 PMCID: PMC8372634 DOI: 10.1093/ntr/ntab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Standardized packaging was phased in between May 2016 and May 2017 in the United Kingdom and July 2017 and July 2018 in Norway. In both countries, the health warnings on packs prior to standardized packaging being implemented were from the former Tobacco Products Directive library of warnings (text warnings covering 43% of the pack front and pictorial warnings covering 53% of the pack reverse). The warnings on packs, postimplementation, were from the current Tobacco Products Directive library of warnings (novel pictorial warnings covering 65% of the pack front and reverse) for the United Kingdom but unchanged in Norway. AIMS AND METHODS Longitudinal online surveys were conducted prior to standardized packaging (United Kingdom: April-May 2016; Norway: May-June 2017) and postimplementation (United Kingdom: September-November 2017 and May-July 2019; Norway: August-September 2018). We explored smokers' response to the on-pack warnings (salience, cognitive reactions, and behavioral reactions). RESULTS In the United Kingdom, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the health risks, avoidant behaviors, forgoing cigarettes, and being more likely to quit due to the warnings significantly increased from waves 1 to 2, and then decreased from waves 2 to 3, but remained higher than at wave 1. In Norway, noticing warnings, reading or looking closely at them, thinking about them, thinking about the health risks, and being more likely to quit due to the warnings significantly decreased from waves 1 to 2; avoidant behaviors and forgoing cigarettes remained unchanged. CONCLUSIONS The inclusion of large novel pictorial warnings on standardized packs increases warning salience and effectiveness. IMPLICATIONS Two longitudinal online surveys in the United Kingdom and Norway explored the impact of standardized packaging on warning salience and effectiveness. That warning salience and effectiveness only increased in the UK postimplementation, where standardized packaging was implemented alongside new larger pictorial warnings on the pack front and reverse, and not in Norway, where standardized packaging was introduced but older smaller text warnings (pack front) and pictorial warnings (pack reverse) were retained, highlights the importance of removing full branding and introducing stronger warnings simultaneously.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ingeborg Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute for Public Health, Oslo, Norway
| | - Janne Scheffels
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute for Public Health, Oslo, Norway
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Martine Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sara Hitchman
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anne Marie Mackintosh
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Gilbert E, Ewald A. Fresher with flavour: young women smokers' constructions and experiences of menthol capsule cigarettes and regular cigarettes. BMC WOMENS HEALTH 2021; 21:155. [PMID: 33863322 PMCID: PMC8051088 DOI: 10.1186/s12905-021-01297-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/23/2021] [Indexed: 11/23/2022]
Abstract
Background Flavour capsule cigarettes are one of the fastest growing segments of the tobacco market, and there is evidence that Australian young people are increasingly using menthol flavoured capsule cigarettes. This qualitative research examines how young women construct and experience menthol flavour capsule cigarettes as part of their smoking practices, and explores the perceived differences between menthol capsule cigarettes and regular cigarettes. Semi-structured face-to-face in-depth interviews were conducted with 41 Australian young women smokers, using a constructivist grounded theory approach. Results Findings reveal that the perceived fresh and improved taste of menthol and the ability to customise the smoking process positively contributed to young women’s experiences of smoking menthol capsule cigarettes. In particular, menthol capsule flavour cigarettes were constructed by the young women as “fresh”, “light” and “minty”, and “popping” the menthol capsule allowed the young women to personalise their smoking experience. Conclusion These results indicate that specific public health campaigns and legislation should be developed to counter the powerfully alluring effects and the innovative appeal of menthol capsule cigarettes. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01297-2.
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Affiliation(s)
- E Gilbert
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - A Ewald
- School of Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Pierce JP, Strong DR, Stone MD, Villaseñor A, Dimofte CV, Leas EC, Oratowski J, Brighton E, Hurst S, Pulvers K, Kealey S, Chen R, Messer K. Real-world exposure to graphic warning labels on cigarette packages in US smokers: The CASA randomized trial protocol. Contemp Clin Trials 2020; 98:106152. [PMID: 32966877 PMCID: PMC7502239 DOI: 10.1016/j.cct.2020.106152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The US lags behind >120 countries in implementing graphic warning labels (GWLs) on cigarette packs. US courts prevented implementation of FDA's 2012 rule requiring GWLs citing the need for more evidence on effectiveness. After more research, in 2020, the FDA proposed a revised rule mandating GWLs. This trial will test how the introduction of GWLs influence cognitions and behavior in US smokers. METHOD To investigate the "real-world" impact of GWLs in US smokers, we are conducting a randomized trial involving a 3-month intervention and 8-month follow-up. The study recruited California smokers between September 2016 through December 2019 and randomly assigned them into 3 groups (1) Blank Pack devoid of any cigarette branding; (2) GWL Pack featuring 1 of 3 rotating images added to blank pack; or (3) their usual Standard US Pack. Throughout the 3-month intervention, participants purchased study-packaged cigarettes and reported daily cognitions and behavior through ecological momentary assessments. We will validate self-reported tobacco use with saliva cotinine concentrations following the 3-month intervention and 8-month follow-up. RESULTS The trial enrolled 359 participants (average age 39 years; average cigarette consumption half a pack/day). The 3 study groups were balanced on age, gender, race-ethnicity, education and income (17% low income) as well as on smoking related variables. CONCLUSIONS This 3-month real-world randomized trial will test the effect of repackaging cigarettes from standard US packs to GWL plain packs on smokers' perceptions of the risks of smoking, their perception of the appeal of their cigarettes, and on their smoking behavior.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States,Corresponding author at: Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Matthew D. Stone
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Adriana Villaseñor
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Claudiu V. Dimofte
- Department of Marketing, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, United States
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jesica Oratowski
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Elizabeth Brighton
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Samantha Hurst
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Kimberley Pulvers
- Department of Psychology, Social and Behavioral Sciences Building, California State University, San Marcos 200 E Barham Dr, San Marcos, CA, 92096, United States
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Ruifeng Chen
- Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Karen Messer
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
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Shi J, Colder Carras M, Potenza MN, Turner NE. A Perspective on Age Restrictions and Other Harm Reduction Approaches Targeting Youth Online Gambling, Considering Convergences of Gambling and Videogaming. Front Psychiatry 2020; 11:601712. [PMID: 33584369 PMCID: PMC7873963 DOI: 10.3389/fpsyt.2020.601712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/28/2020] [Indexed: 12/02/2022] Open
Abstract
Internet gambling has become a popular activity among some youth. Vulnerable youth may be particularly at risk due to limited harm reduction and enforcement measures. This article explores age restrictions and other harm reduction measures relating to youth and young adult online gambling. A systematic rapid review was conducted by searching eight databases. Additional articles on online gambling (e.g., from references) were later included. To place this perspective into context, articles on adult gambling, land-based gambling, and substance use and other problematic behaviors were also considered. Several studies show promising findings for legally restricting youth from gambling in that such restrictions may reduce the amount of youth gambling and gambling-related harms. However, simply labeling an activity as "age-restricted" may not deter youth from gambling; in some instances, it may generate increased appeal for gambling. Therefore, advertising and warning labels should be examined in conjunction with age restrictions. Recommendations for age enforcement strategies, advertising, education, and warning labels are made to help multiple stakeholders including policymakers and public health officials internationally. Age restrictions in online gambling should consider multiple populations including youth and young adults. Prevention and harm reduction in gambling should examine how age-restriction strategies may affect problem gambling and how they may be best enforced across gambling platforms. More research is needed to protect youth with respect to online gambling.
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Affiliation(s)
- Jing Shi
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Michelle Colder Carras
- JHU Global mHealth Initiative, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marc N Potenza
- Department of Psychiatry and Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Connecticut Council on Problem Gambling, Wethersfield, CT, United States.,Connecticut Mental Health Center, New Haven, CT, United States.,Department of Neuroscience, Yale University, New Haven, CT, United States
| | - Nigel E Turner
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, ON, Canada
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White VM, Guerin N, Williams T, Wakefield MA. Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017. Tob Control 2019; 28:e77-e84. [DOI: 10.1136/tobaccocontrol-2019-054988] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022]
Abstract
ObjectiveTo assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents’ relevant tobacco-related perceptions.MethodsCross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.ResultsSmoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.ConclusionsPP’s initial impact in reducing adolescent’s positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.
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King JL, Reboussin BA, Ross JC, Sutfin EL. Waterpipe tobacco package warning exposure's impact on risk perceptions and use among young adults in the USA: a longitudinal analysis of the population assessment of tobacco and health study. Tob Control 2019; 28:e16-e23. [PMID: 30158209 PMCID: PMC6395506 DOI: 10.1136/tobaccocontrol-2018-054562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/23/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although Food and Drug Administration (FDA)-mandated waterpipe tobacco warnings were not required until August 2018, some waterpipe tobacco packaging (WTP) sold in the USA, contained warnings prior to this date. We examined the prevalence of WTP warning exposure and whether exposure influenced risk perceptions or use among young adult (aged 18-24 years) current waterpipe users. METHODS We used data from waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adults and youth. We conducted logistic regression analyses to identify factors associated with wave 1 warning exposure, and whether wave 1 WTP warning exposure predicted wave 2 relative risk perceptions and waterpipe use. RESULTS More than one-third of our sample (35.9%, 95% CI 33.5 to 38.4) reported past-month WTP warning exposure. Exposure was higher among males (adjusted OR (AOR)=1.34, 95% CI 1.04 to 1.72), those who usually do not share the waterpipe (AOR=3.10, 95% CI 1.45 to 6.60), those who purchased waterpipe tobacco (AOR=1.73, 95% CI 1.28 to 2.34), and those with a regular brand (AOR=1.84, 95% CI 1.26 to 2.68). Those exposed to WTP warnings at wave 1 were more likely than those not exposed to perceive waterpipe tobacco to be as or more harmful than cigarettes at wave 2 (AOR=1.35, 95% CI 1.02 to 1.78). There was no association between wave 1 WTP exposure and wave 2 waterpipe use. CONCLUSIONS More than one-third of US young adult current waterpipe users reported WTP warning exposure prior to FDA-mandated warning implementation. Findings suggest the mandated warning may result in high exposure among users; it will be critical to assess exposure's impact on risk perceptions and behaviour after FDA-mandated warnings are implemented.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study. Tob Induc Dis 2019; 17:23. [PMID: 31582934 PMCID: PMC6751965 DOI: 10.18332/tid/104753] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries. METHODS An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. RESULTS Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings. CONCLUSIONS The findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Wimardhani YS, Warnakulasuriya S, Subita GP, Soegyanto AI, Pradono SA, Patoni N. Public awareness of oral cancer among adults in Jakarta, Indonesia. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2019; 10:e12379. [PMID: 30499194 DOI: 10.1111/jicd.12379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/06/2018] [Indexed: 01/02/2023]
Abstract
AIM The aim of the present study was to investigate the awareness of oral cancer among adults in Jakarta, Indonesia, and explore the factors influencing it. METHODS A previously-tested questionnaire on 1000 adults in Jakarta was used in the present study. The data included sociodemographic factors and answers to assess the awareness of oral cancer, early signs and symptoms, risks factors, lifestyles, and history of dental visits. RESULTS Only 53.2% of participants were aware of oral cancer. The level of awareness significantly differed by level of education, occupation, and experience of dental visits. Only 30% of patients had been asked about their tobacco and alcohol habits, and had been informed about the hazards of these by their dentists. All of the smokers knew that tobacco increased the risk for oral cancer. However, only a few participants considered alcohol, betel quid chewing, UV light exposure, poor diet, and genetics to play role in the development of oral cancer. Health warnings were the main source of information about oral cancer; the role of health professionals is still quite low and needs to be emphasized. CONCLUSION Oral cancer awareness is still low among adults in Jakarta; this finding was consistent with other studies conducted in Asia. Educational material suited to particular communities is warranted.
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Affiliation(s)
- Yuniardini S Wimardhani
- Department of Oral Medicine, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia
| | - Saman Warnakulasuriya
- Department of Oral Medicine, King's College London, London, UK
- World Health Organization Collaborating Centre for Oral Cancer, London, UK
| | - Gus P Subita
- Department of Oral Medicine, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia
| | - Anandina I Soegyanto
- Department of Oral Medicine, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia
| | - Siti A Pradono
- Department of Oral Medicine, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia
| | - Nurfianti Patoni
- Oral Medicine Residency Program, Faculty of Dentistry, University of Indonesia, Jakarta, Indonesia
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Woelbert E, d'Hombres B. Pictorial health warnings and wear-out effects: evidence from a web experiment in 10 European countries. Tob Control 2019; 28:e71-e76. [PMID: 30610081 PMCID: PMC6824613 DOI: 10.1136/tobaccocontrol-2018-054402] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 10/12/2018] [Accepted: 10/31/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This paper examines whether there are possible wear-out effects associated with repeated exposure to pictorial health warnings on tobacco products. Wear-out effects can be general, that is, people get used to the presence of pictorial warnings in general, or specific to the content of the warnings (ie, the images used). Distinguishing between these two types of wear-out is important for understanding how to maintain the effectiveness of health warnings over time. METHODS This study used data from two surveys carried out in 10 European countries. Participants (n=12 600) were exposed in a random order to a series of health warnings and assessed the salience of the warnings as well as their effects on smoking intentions. Using these data and country variations in health warning legislation, we tested whether warning pictures are subject to general and/or specific wear-out effects. RESULTS Responses were stronger to combined text+picture warnings than to text-only warnings. This effect was lower for smokers living in countries where combined warnings were already in place at the time of the data collection, compared with smokers residing in countries where text-only warnings were in use. This result, observed for combined warnings with new pictures, is in line with the presence of general wear-out effects. Combined warnings with an unknown pictorial content were more effective than those including pictorial warnings already in use, suggesting that specific wear-out effects are also at play. CONCLUSIONS These findings strengthen the evidence that pictorial health warnings are an effective tool for tobacco control policies and suggest that, even in the presence of a general wear-out effect among smokers, periodically introducing new pictures helps to maintain warning effectiveness over time.
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Affiliation(s)
- Eva Woelbert
- European Commission, Joint Research Centre (JRC), Ispra, Italy
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Ngoc Bich N, Thu Ngan T, Bao Giang K, Thi Hai P, Thi Thu Huyen D, Ngoc Khue L, Tuan Lam N, Van Minh H, Thi Quynh Nga P, The Quan N, Loan VH. Salience and Impact of Health Warning Label on Cigarette Packs in Vietnam: Findings From the Global Adult Tobacco Survey 2015. Behav Med 2019; 45:30-39. [PMID: 29652628 DOI: 10.1080/08964289.2018.1434117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Viet Nam is among the countries having highest rate of male smokers in the world. The country has joined the Global Tobacco Surveillance System since 2010. Under this system, two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2010 and 2015. Those two surveys provide excellent comparable data on tobacco usage and its related aspects in Vietnam. This study using the data from GATS 2015 to examine the salience and impact of cigarette pack health warnings on quitting intention in Vietnam. The Vietnam GATS 2015 was a nationally representative survey in which 9,513 households were selected using two-stage random systematic sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was "ever made a quit attempt in the past 12 months" followed by "believes that tobacco smoking causes serious illness". Compared to GATS 2010, GATS 2015 observed the increase in salience of cigarette health warnings. However, the current pictorial health warnings are losing their impact on motivating intention to quit. The results highlight that it is time to start the rotation cycle to refresh the current health warning set. Actions to select a new and more impressive set of pictorial health warnings should be developed as soon as possible.
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Affiliation(s)
| | - Tran Thu Ngan
- a Hanoi University of Public Health , Hanoi , Vietnam
| | | | - Phan Thi Hai
- c Vietnam Steering Committee on Smoking and Health , Hanoi , Vietnam
| | | | - Luong Ngoc Khue
- c Vietnam Steering Committee on Smoking and Health , Hanoi , Vietnam
| | - Nguyen Tuan Lam
- d World Health Organization Office in Viet Nam , Hanoi , Vietnam
| | | | | | | | - Vu Hoang Loan
- a Hanoi University of Public Health , Hanoi , Vietnam
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Mostafa A, Mohammed HT, Hussein WM, Elhabiby M, Safwat W, Labib S, Aboul Fotouh A, Hoek J. Plain packaging of waterpipe tobacco? A qualitative analysis exploring waterpipe smokers' and non-smokers' responses to enhanced versus existing pictorial health warnings in Egypt. BMJ Open 2018; 8:e023496. [PMID: 30355793 PMCID: PMC6224725 DOI: 10.1136/bmjopen-2018-023496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/20/2018] [Accepted: 08/08/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Despite the global increase in waterpipe tobacco smoking (WTS) including in Egypt, few studies have assessed the effectiveness of waterpipe tobacco (WT) health warnings. Egypt has used pictorial health warnings (PHWs) on waterpipe tobacco packs (WTPs) and has rotated these every two years since 2008. We explored in this qualitative study how participants perceived existing PHWs on WTPs, assessed how they interpreted novel plain packaging of WT featuring enhanced PHWs, and probed perceptions of how existing and novel sets would affect uptake or cessation of WTS. DESIGN We conducted ten qualitative focus groups and ten in-depth interviews. We explored participants' views of the four existing PHWs (occupied 50% of the front and back of WTPs, displayed cancers, and featured colourful fruits and flavors) and four novel PHWs (occupied 80% of the front and back of WTPs, displayed different topical content, with plain packaging). Transcripts were analyzed using thematic analysis. SETTING Rural Menoufia, urban and semi-urban Cairo, Egypt. PARTICIPANTS 90 waterpipe smokers and non-smokers, men and women, aged 18 years or older. OUTCOMES Perceived potential effect on WTS uptake or cessation, probing factors related to PHW content and WTP design. RESULTS Participants in focus groups and in-depth interviews thought existing WT PHWs elicited affective responses, but found them unclear or unrealistic and thought the colourful packaging detracted from the warnings. In contrast, they thought novel and larger WT PHWs presented in plain packaging might prevent WTS initiation or trigger quit attempts. Participants regarded warnings featuring proximal health risks as most likely to be acceptable. CONCLUSIONS Our exploratory study suggests larger WT PHWs featuring proximal risks and presented on plain WTPs could potentially deter experimentation with WT products among non-users and promote cessation among existing users.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Tallah Mohammed
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Wafaa Mohamed Hussein
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Elhabiby
- Department of Psychiatry Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wael Safwat
- Egyptian Tobacco Control Coalition, Cairo, Egypt
- Egypt Health Foundation, Cairo, Egypt
| | - Sahar Labib
- Tobacco Control Unit, Ministry of Health, Cairo, Egypt
| | - Aisha Aboul Fotouh
- Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, Otago, New Zealand
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian School Student Perceptions of Effective Anti-tobacco Health Warnings. Front Public Health 2018; 6:297. [PMID: 30386764 PMCID: PMC6199459 DOI: 10.3389/fpubh.2018.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population. Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model. Results: Participants (N = 150; Age = 15-18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67-4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72-6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks. Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.
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Kang E. Assessing Health Impacts of Pictorial Health Warning Labels on Cigarette Packs in Korea Using DYNAMO-HIA. J Prev Med Public Health 2017; 50:251-261. [PMID: 28768403 PMCID: PMC5541276 DOI: 10.3961/jpmph.17.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to predict the 10-year impacts of the introduction of pictorial warning labels (PWLs) on cigarette packaging in 2016 in Korea for adults using DYNAMO-HIA. METHODS In total, four scenarios were constructed to better understand the potential health impacts of PWLs: two for PWLs and the other two for a hypothetical cigarette tax increase. In both policies, an optimistic and a conservative scenario were constructed. The reference scenario assumed the 2015 smoking rate would remain the same. Demographic data and epidemiological data were obtained from various sources. Differences in the predicted smoking prevalence and prevalence, incidence, and mortality from diseases were compared between the reference scenario and the four policy scenarios. RESULTS It was predicted that the optimistic PWLs scenario (PWO) would lower the smoking rate by 4.79% in males and 0.66% in females compared to the reference scenario in 2017. However, the impact on the reduction of the smoking rate was expected to diminish over time. PWO will prevent 85 238 cases of diabetes, 67 948 of chronic obstructive pulmonary disease, 31 526 of ischemic heart disease, 21 036 of lung cancer, and 3972 prevalent cases of oral cancer in total over the 10-year span due to the reductions in smoking prevalence. The impacts of PWO are expected to be between the impact of the optimistic and the conservative cigarette tax increase scenarios. The results were sensitive to the transition probability of smoking status. CONCLUSIONS The introduction of PWLs in 2016 in Korea is expected reduce smoking prevalence and disease cases for the next 10 years, but regular replacements of PWLs are needed for persistent impacts.
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Affiliation(s)
- Eunjeong Kang
- Department of Health Administration and Management, Soonchunhyang University, Asan, Korea
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Brinker TJ, Holzapfel J, Baudson TG, Sies K, Jakob L, Baumert HM, Heckl M, Cirac A, Suhre JL, Mathes V, Fries FN, Spielmann H, Rigotti N, Seeger W, Herth F, Groneberg DA, Raupach T, Gall H, Bauer C, Marek P, Batra A, Harrison CH, Taha L, Owczarek A, Hofmann FJ, Thomas R, Mons U, Kreuter M. Photoaging smartphone app promoting poster campaign to reduce smoking prevalence in secondary schools: the Smokerface Randomized Trial: design and baseline characteristics. BMJ Open 2016; 6:e014288. [PMID: 27821601 PMCID: PMC5128772 DOI: 10.1136/bmjopen-2016-014288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Smoking is the largest cause of preventable death globally. Most smokers smoke their first cigarette in early adolescence. We took advantage of the widespread availability of mobile phones and adolescents' interest in appearance to develop a free photoaging app which is promoted via a poster campaign in secondary schools. This study aims to evaluate its effectiveness regarding smoking prevalence and students' attitudes towards smoking. METHODS AND ANALYSIS A randomised controlled trial is conducted with 9851 students of both genders with an average age of 12 years in grades 6 and 7 of 126 secondary schools in Germany. At present, cigarette smoking prevalence in our sample is 4.7%, with 4.6% of the students currently using e-cigarettes (1.6% use both). The prospective experimental study design includes measurements at baseline and at 6, 12 and 24 months postintervention via a questionnaire plus a random cotinine saliva sample at 24 months postintervention. The study groups consist of randomised schools receiving the Smokerface poster campaign and control schools with comparable baseline data (no intervention). The primary end point is the difference of change in smoking prevalence in the intervention group versus the difference in the control group at 24 months follow-up. Longitudinal changes in smoking-related attitudes, the number of new smokers and quitters and the change in the number of never-smokers will be compared between the two groups as secondary outcomes. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of the University of Gießen and the ministries of cultural affairs, both in Germany. Results will be disseminated at conferences, in peer-reviewed journals, on our websites and throughout the multinational Education Against Tobacco network. TRIAL REGISTRATION NUMBER NCT02544360, Pre-results.
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Affiliation(s)
- Titus J Brinker
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Julia Holzapfel
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | | | | | - Lena Jakob
- University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | - Ana Cirac
- Technical University of Munich, Munich, Germany
| | | | - Verena Mathes
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Fabian N Fries
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Hannah Spielmann
- Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Nancy Rigotti
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Werner Seeger
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Felix Herth
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Medical Centre, Göttingen, Germany
| | - Henning Gall
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Claudia Bauer
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Pat Marek
- Division of Public Health Sciences, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Tübingen, Germany
| | - Chase H Harrison
- Department of Government, Faculty of Arts and Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Lava Taha
- University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Owczarek
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Felix J Hofmann
- Universities of Gießen and Marburg Lung Center (UGMLC); Member of the German Center for Lung Research (DZL), Justus-Liebig-University of Gießen, Gießen, Germany
| | - Roger Thomas
- University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Kreuter
- Pulmonary and Respiratory Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
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Ratneswaran C, Chisnall B, Li M, Tan S, Douiri A, Anantham D, Steier J. Desensitisation to cigarette package graphic health warnings: a cohort comparison between London and Singapore. BMJ Open 2016; 6:e012693. [PMID: 27798017 PMCID: PMC5093627 DOI: 10.1136/bmjopen-2016-012693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We compared 2 sociocultural cohorts with different duration of exposure to graphic health warning labels (GHWL), to investigate a possible desensitisation to their use. We further studied how a differing awareness and emotional impact of smoking-associated risks could be used to prevent this. SETTING Structured interviews of patients from the general respiratory department were undertaken between 2012 and 2013 in 2 tertiary hospitals in Singapore and London. PARTICIPANTS 266 participants were studied, 163 Londoners (35% smokers, 54% male, age 52±18 years) and 103 Singaporeans (53% smokers, p=0.003; 78% male, p<0.001; age 58±15 years, p=0.012). MAIN OUTCOMES AND MEASURES 50 items assessed demographics, smoking history, knowledge and the deterring impact of smoking-associated risks. After showing 10 GHWL, the impact on emotional response, cognitive processing and intended smoking behaviour was recorded. RESULTS Singaporeans scored lower than the Londoners across all label processing constructs, and this was consistent for the smoking and non-smoking groups. Londoners experienced more 'disgust' and felt GHWL were more effective at preventing initiation of, or quitting, smoking. Singaporeans had a lower awareness of lung cancer (82% vs 96%, p<0.001), despite ranking it as the most deterring consequence of smoking. Overall, 'blindness' was the least known potential risk (28%), despite being ranked as more deterring than 'stroke' and 'oral cancer' in all participants. CONCLUSIONS The length of exposure to GHWL impacts on the effectiveness. However, acknowledging the different levels of awareness and emotional impact of smoking-associated risks within different sociocultural cohorts could be used to maintain their impact.
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Affiliation(s)
- Culadeeban Ratneswaran
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Ben Chisnall
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Mingyue Li
- Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sarah Tan
- Department of Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Abdel Douiri
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Devanand Anantham
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Joerg Steier
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Guy's & St Thomas’ NHS Foundation Trust, London, UK
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Eye Tracking Outcomes in Tobacco Control Regulation and Communication: A Systematic Review. TOB REGUL SCI 2016; 2:377-403. [PMID: 27668270 DOI: 10.18001/trs.2.4.9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this paper we synthesize the evidence from eye tracking research in tobacco control to inform tobacco regulatory strategies and tobacco communication campaigns. METHODS We systematically searched 11 databases for studies that reported eye tracking outcomes in regards to tobacco regulation and communication. Two coders independently reviewed studies for inclusion and abstracted study characteristics and findings. RESULTS Eighteen studies met full criteria for inclusion. Eye tracking studies on health warnings consistently showed these warnings often were ignored, though eye tracking demonstrated that novel warnings, graphic warnings, and plain packaging can increase attention toward warnings. Eye tracking also revealed that greater visual attention to warnings on advertisements and packages consistently was associated with cognitive processing as measured by warning recall. CONCLUSIONS Eye tracking is a valid indicator of attention, cognitive processing, and memory. The use of this technology in tobacco control research complements existing methods in tobacco regulatory and communication science; it also can be used to examine the effects of health warnings and other tobacco product communications on consumer behavior in experimental settings prior to the implementation of novel health communication policies. However, the utility of eye tracking will be enhanced by the standardization of methodology and reporting metrics.
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Szklo AS, Volchan E, Thrasher JF, Perez C, Szklo M, de Almeida LM. Do more graphic and aversive cigarette health warning labels affect Brazilian smokers' likelihood of quitting? Addict Behav 2016; 60:209-12. [PMID: 27161535 DOI: 10.1016/j.addbeh.2016.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/23/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Abstract
Between 2008 and 2013, Brazil experienced a large decline in smoking prevalence, with an innovative round of aversive pictorial health warnings implemented on cigarette packs and at points of sale in 2009. The objective of this study was to examine changes over time in the distribution of quitting attempts and self-reported thoughts about quitting due to health warnings among current smokers. We conducted a pre-post study to evaluate data from two nationally-representative surveys conducted in 2008 and 2013. Responses to questions on smokers' quitting attempts in the last year (yes vs. no) and whether health warnings led them to think about quitting in the last month (yes vs. no) were combined into four categories, for which the distribution of the Brazilian smoking population by year was estimated. A multinomial model was used to obtain proportions for each category, adjusted by socio-demographic variables and nicotine dependence. The proportion of smokers who reported making a quitting attempt in the last year and stated that health warnings led them think about quitting smoking statistically increased over time (from 30.0% to 33.1%; p-value=0.010). The percentage of those who answered "no" to these two questions also increased over time (from 23.5% to 32.9%; p-value≤0.001). These findings suggest that innovative warnings introduced in Brazil likely served as a "reminder" for continuing to think about cessation among those who attempted to quit in the last year. These warnings may have also triggered more avoidance of thinking about their contents than the previous warnings, which some studies have found to promote subsequent quitting activity.
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White V, Williams T, Faulkner A, Wakefield M. Do larger graphic health warnings on standardised cigarette packs increase adolescents' cognitive processing of consumer health information and beliefs about smoking-related harms? Tob Control 2015; 24:ii50-ii57. [PMID: 28407612 PMCID: PMC4401340 DOI: 10.1136/tobaccocontrol-2014-052085] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/26/2014] [Indexed: 11/04/2022]
Abstract
Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on Australian adolescents’ cognitive processing of warnings and awareness of different health consequences of smoking. Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of standardised packaging, n=6338) and 2013 (7–12 months afterwards, n=5915). Students indicated frequency of attending to, reading, thinking or talking about warnings. Students viewed a list of diseases or health effects and were asked to indicate whether each was caused by smoking. Two—‘kidney and bladder cancer’ and ‘damages gums and teeth’—were new while the remainder had been promoted through previous health warnings and/or television campaigns. The 60% of students seeing a cigarette pack in previous 6 months in 2011 and 65% in 2013 form the sample for analysis. Changes in responses over time are examined. Results Awareness that smoking causes bladder cancer increased between 2011 and 2013 (p=0.002). There was high agreement with statements reflecting health effects featured in previous warnings or advertisements with little change over time. Exceptions to this were increases in the proportion agreeing that smoking was a leading cause of death (p<0.001) and causes blindness (p<0.001). The frequency of students reading, attending to, thinking or talking about the health warnings on cigarette packs did not change. Conclusions Acknowledgement of negative health effects of smoking among Australian adolescents remains high. Apart from increased awareness of bladder cancer, new requirements for packaging and health warnings did not increase adolescents’ cognitive processing of warning information.
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Affiliation(s)
- Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Tahlia Williams
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Agatha Faulkner
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
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White V, Williams T, Wakefield M. Has the introduction of plain packaging with larger graphic health warnings changed adolescents' perceptions of cigarette packs and brands? Tob Control 2015; 24:ii42-ii49. [PMID: 28407611 PMCID: PMC4401345 DOI: 10.1136/tobaccocontrol-2014-052084] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/13/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on adolescents' perceptions of pack image and perceived brand differences. METHODS Cross-sectional school-based surveys conducted in 2011 (prior to introduction of new cigarette packaging) and in 2013 (7-12 months afterwards). Students aged 12-17 years (2011 n=6338; 2013 n=5915) indicated whether they had seen a cigarette pack in previous 6 months. Students rated the character of four popular cigarette brands, indicated level of agreement regarding differences between brands in ease of smoking, quitting, addictiveness, harmfulness and look of pack; and indicated positive and negative perceptions of pack image. Changes in responses of students seeing cigarette packs in the previous 6 months (2011: 60%; 2013: 65%) were examined. RESULTS Positive character ratings for each brand reduced significantly between 2011 and 2013. Changes were found for four of five statements reflecting brand differences. Significantly fewer students in 2013 than 2011 agreed that 'some brands have better looking packs than others' (2011: 43%; 2013: 25%, p<0.001), with larger decreases found among smokers (interaction p<0.001). Packs were rated less positively and more negatively in 2013 than in 2011 (p<0.001). The decrease in positive image ratings was greater among smokers. CONCLUSIONS The introduction of standardised packaging has reduced the appeal of cigarette packs. Further research could determine if continued exposure to standardised packs creates more uncertainty or disagreement regarding brand differences in ease of smoking and quitting, perceived addictiveness and harms.
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Affiliation(s)
- Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Tahlia Williams
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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