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Jin T, Seo J, Ye S, Lee S, Park EY, Oh JK, Han C, Kim B. Suicide mortality following the implementation of tobacco packaging and pricing policies in Korea: an interrupted time-series analysis. BMC Med 2024; 22:180. [PMID: 38679738 PMCID: PMC11057188 DOI: 10.1186/s12916-024-03372-5] [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: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND To prevent tobacco use in Korea, the national quitline number was added to tobacco packages in December 2012, tobacco prices were raised by 80% in January 2015, and graphic health warning labels were placed on tobacco packages in December 2016. This study evaluated the association of these tobacco packaging and pricing policies with suicide mortality in Korea. METHODS Monthly mortality from suicide was obtained from Cause-of-Death Statistics in Korea from December 2007 to December 2019. Interrupted time-series analysis was performed using segmented Poisson regression models. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated adjusted for suicide prevention strategies. RESULTS Suicide mortality was 20 per 1,000,000 in December 2007 and showed a downward trend over the study period. After the implementation of tobacco packaging and pricing policies, suicide mortality immediately declined by - 0.09 percent points (95% CI = - 0.19 to 0.01; P > 0.05) for the national quitline number, - 0.22 percent points (95% CI = - 0.35 to - 0.09; P < 0.01) for tobacco prices, and - 0.30 percent points (95% CI = - 0.49 to - 0.11; P < 0.01) for graphic health warning labels. The corresponding RRs for these post-implementation changes compared with the pre-implementation level were 0.91 (95% CI = 0.83 to 1.00), 0.80 (95% CI = 0.70 to 0.91), and 0.74 (95% CI = 0.61 to 0.90), respectively. Significant associations between tobacco control policies and suicide mortality were observed even when stratified by sex and region. CONCLUSIONS The findings of this study provide new evidence for an association between tobacco control policies and deaths by suicide. An array of effective tobacco control policies should be considered for prevention programs targeting suicide.
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Affiliation(s)
- Taiyue Jin
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
| | - Juhee Seo
- Vital Statistics Division, Statistics Korea, Daejeon, South Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, South Korea
| | - Seulbi Lee
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Eun Young Park
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Kyoung Oh
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea.
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
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de Visme S, Korevaar DA, Gras-Le Guen C, Flamant A, Bevacqua M, Stanzelova A, Trinh NTH, Ciobanu DA, Carvalho AA, Kyriakoglou I, Fuentes M, Refes Y, Briand-Huchet E, Sellier AL, Harrewijn I, Cohen JF, Chalumeau M. Inconsistency Between Pictures on Baby Diaper Packaging in Europe and Safe Infant Sleep Recommendations. J Pediatr 2024; 264:113763. [PMID: 37778411 DOI: 10.1016/j.jpeds.2023.113763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To describe the level of inconsistency between pictures on baby diaper packaging and safe infant sleep recommendations (SISRs) in Europe. STUDY DESIGN We attempted to identify all packaging of baby diapers sold in 11 European countries for infants weighing less than 5 kg through internet searches from July 2022 through February 2023. For each type of package, we extracted whether there was a picture depicting a baby, whether the baby was sleeping, and whether the picture of the sleeping baby was inconsistent with ≥1 of 3 SISRs: (i) nonsupine sleeping position, (ii) soft objects or loose bedding, or (iii) sharing a sleep surface with another person. Data were aggregated at the country level, and a random-effects meta-analysis of proportions was used to obtain summary estimates. The outcome was the summary estimate of the proportion of pictures that were inconsistent with SISRs. RESULTS We identified 631 baby diaper packaging types of which 49% (95% CI: 42-57; n = 311) displayed a picture of a sleeping baby. Among those 311 packages, 79% (95% CI 73-84) were inconsistent with ≥1 SISR, including a nonsupine sleeping position, 45% (95% CI 39-51), soft objects or loose bedding such as pillows or blankets, 51% (95% CI 46-57), and sharing a sleep surface with another person, 10% (95% CI 4-18). CONCLUSIONS Pictures on baby diaper packaging in Europe are often inconsistent with SISRs. The prevention of sudden unexpected death in infancy requires action from manufacturers and legislators to stop parents' exposure to misleading images that may lead to dangerous practices.
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Affiliation(s)
- Sophie de Visme
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France
| | - Daniel A Korevaar
- Department of Pulmonary Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Christèle Gras-Le Guen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; CHU de Nantes, INSERM, Department of General Pediatrics and Pediatric Emergencies, CIC1413, Nantes Université, Nantes, France; CHU de Nantes, Department of General Pediatrics and Pediatric Emergencies, Nantes Université, Nantes, France
| | - Alix Flamant
- Department of General Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martina Bevacqua
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Anna Stanzelova
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Independent Researcher, Galway, Ireland
| | - Nhung T H Trinh
- Department of Pharmacy, PharmacoEpidemiology and Drug Safety Research Group, University of Oslo, Oslo, Norway
| | - Dalia-Alexandra Ciobanu
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Children's Hospital "Doctor Victor Gomoiu", Bucharest, Romania
| | - Ana Araújo Carvalho
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Centro Hospitalar e Universitário de Lisboa Central, Hospital Dona Estefânia, Paediatric Department, Lisboa, Portugal
| | - Ifigeneia Kyriakoglou
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Fuentes
- Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France; Department of Pediatric Emergencies, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Yacine Refes
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France
| | - Elisabeth Briand-Huchet
- Naître et Vivre, National Association for the Support of Bereaved Parents and the Fight Against Sudden Unexpected Death in Infancy, Paris, France
| | | | - Inge Harrewijn
- Department of Neonatal Pediatrics and Intensive Care, Montpellier University Hospital, University of Montpellier, Montpellier, France.
| | - Jérémie F Cohen
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martin Chalumeau
- Epidemiology and Statistics Research Center, Obstetrical Perinatal and Pediatric Epidemiology Research Team, INSERM, Université Paris Cité, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
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Seitz CM, Ward KD, Kabir Z. Quitline Information Included on Cigarette Packaging: An Assessment of Country Adherence to WHO FCTC Guidelines, 2007 to 2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12193. [PMID: 34831948 PMCID: PMC8625675 DOI: 10.3390/ijerph182212193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Abstract
The purpose of this study is to evaluate country adherence to the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC) guidelines in terms of including quitline information on cigarette packaging. Data were gathered from the WHO's Global Health Observatory database. The study included countries that were signatories to the FCTC, had a toll-free quitline, and required health warnings on cigarette packaging. Countries were then classified by income level according to the World Bank. From 2007 to 2018, the number of countries that established a quitline increased from 34 to 60. During the same timeframe among those countries, the number of countries that included information about the quitline on cigarette packaging increased from 5 to 37, with a larger proportion (79%) of high-income countries promoting their quitlines on cigarette packaging compared to middle-income (45%) countries. Although there was an increase in adherence to the WHO FCTC guidelines, there is still a need for several countries to include quitline information on cigarette packaging.
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Affiliation(s)
- Christopher M. Seitz
- Department of Health & Exercise Science, Appalachian State University, Boone, NC 28608, USA
| | - Kenneth D. Ward
- Division of Social and Behavioral Sciences, The University of Memphis School of Public Health, Memphis, TN 38152, USA;
| | - Zubair Kabir
- School of Public Health, University College Cork, T12 XF62 Cork, Ireland;
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Pepper JK, Zarndt AN, Eggers ME, Nonnemaker JM, Portnoy DB. Impact of Pictorial Cigarette Warnings Compared With Surgeon General's Warnings on Understanding of the Negative Health Consequences of Smoking. Nicotine Tob Res 2020; 22:1795-1804. [PMID: 32202624 PMCID: PMC10557086 DOI: 10.1093/ntr/ntaa032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 02/03/2020] [Indexed: 10/08/2023]
Abstract
INTRODUCTION The Family Smoking Prevention and Tobacco Control Act requires cigarette packages and advertisements to bear health warnings with "color graphics depicting the negative health consequences of smoking." AIMS AND METHODS This study assessed whether new US Food and Drug Administration developed pictorial cigarette warnings (PCW) increased understanding of smoking-related risks relative to the current Surgeon General's (SG) warnings. In March-May 2019, adolescent and adult smokers and nonsmokers participated in an online experiment with three sessions completed over approximately 2 weeks. Participants viewed 1 of 16 PCW (treatment conditions) or an SG warning (control) on mock cigarette packages and advertisements. Measures assessed whether warnings provided new information, induced thinking about risks, changed smoking-related health beliefs, and were accurately recalled, among other outcomes. RESULTS The majority of PCW (≥13 conditions) resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks; they were viewed as more informative, understandable, and attention-drawing compared with the control condition. Most participants believed the warning were factual, although 8 PCW were perceived as less factual than the control. There were changes toward more agreement with health beliefs for 11 PCW between Sessions 1 and 2 and 7 PCW between Sessions 1 and 3. Participants in all treatment conditions were more likely than control condition participants to correctly recall the warning. Across outcomes, PCW related to addiction, death, and quitting did not perform as well as other PCW. CONCLUSIONS Many of the PCW tested increased understanding of the risks associated with cigarette smoking relative to current SG warnings. IMPLICATIONS The Tobacco Control Act requires cigarette packages and advertisements to bear PCW depicting the negative health consequences of smoking. This study tested whether any of 16 newly proposed PCW increased understanding of smoking-related risks relative to existing SG warnings. Results suggest that most PCW tested, particularly those related to less widely known health effects, resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks compared with SG warnings. These results, along with other factors, informed the US Food and Drug Administration's selection of proposed PCW.
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Affiliation(s)
- Jessica K. Pepper
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
| | - Anh Nguyen Zarndt
- US Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD
| | - Matthew E. Eggers
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
| | - James M. Nonnemaker
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, NC
| | - David B. Portnoy
- US Food and Drug Administration, Center for Tobacco Products, Silver Spring, MD
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Mannocci A, Guerra F, Colamesta V, Backhaus I, Firenze A, Provenzano S, Fiore M, Ferrara M, Langiano E, De Vito E, Lorini C, Bonaccorsi G, Villari P, La Torre G. The Adolescent Label Impact Index in a Multicentric Observational Study. Have the Tobacco Advertisements an Impact on the Adolescents? JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1774026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alice Mannocci
- “Sapienza” University of Rome, Roma, Italy
- Universitas Mercatorum, Rome, Italy
| | | | | | | | | | | | | | - Maria Ferrara
- University of Cassino and Southern Lazio, Cassino, Italy
| | - Elisa Langiano
- University of Cassino and Southern Lazio, Cassino, Italy
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van Mourik DJA, Nagelhout GE, Willemsen MC, van den Putte B, de Vries H. Differences in smokers' awareness of the health risks of smoking before and after introducing pictorial tobacco health warnings: findings from the 2012-2017 international tobacco control (ITC) Netherlands surveys. BMC Public Health 2020; 20:512. [PMID: 32381050 PMCID: PMC7206780 DOI: 10.1186/s12889-020-08667-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups. Methods We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses. Results Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p < 0.001) and knowledge about the health risks of smoking (β = 0.184, p < 0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012–2015 (p values of interactions: p = 0.002 and p < 0.001 respectively). Compared to high educated smokers, low educated smokers (β = − 1.137, p < 0.001) and moderate educated smokers (β = − 0.894, p < 0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017. Conclusions Introducing PHWs coincided with an increase in smokers’ knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers’ awareness of the health risks of smoking even more, especially among low educated smokers.
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Affiliation(s)
- Dirk-Jan A van Mourik
- Department of Health Promotion, Maastricht University (CAPHRI), PO Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), PO Box 616, 6200 MD, Maastricht, the Netherlands.,Department of Family Medicine, Maastricht University (CAPHRI), Maastricht, the Netherlands.,IVO Research Institute, The Hague, the Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), PO Box 616, 6200 MD, Maastricht, the Netherlands.,Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, the Netherlands
| | - Bas van den Putte
- Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, the Netherlands.,Department of Communication, University of Amsterdam, Amsterdam, the Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University (CAPHRI), PO Box 616, 6200 MD, Maastricht, the Netherlands
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Kuehnle D. How effective are pictorial warnings on tobacco products? New evidence on smoking behaviour using Australian panel data. JOURNAL OF HEALTH ECONOMICS 2019; 67:102215. [PMID: 31319336 DOI: 10.1016/j.jhealeco.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 06/10/2023]
Abstract
Studies examining the introduction of pictorial warnings on cigarette packages provide inconclusive evidence due to small samples and methodological issues. We use individual-level panel data from Australia to examine the association between pictorial warnings and smoking behaviour - prevalence, quitting, initiating and relapsing. The pictorial warnings were accompanied by a reference to a smoking cessation helpline and supportive television commercials. Applying an event study framework, we show that the reform reduced smoking rates by around 4% within the first year of the policy. The effect decreases with age, is similar for men and women, and is slightly larger for low-educated compared to high-educated individuals. The reform permanently lowered smoking rates primarily due to increased quitting in the year of the reform. Thus, pictorial warnings combined with a reference to a smoking cessation helpline and supportive media campaigns are an important tobacco control measure to reduce the social costs of smoking.
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Affiliation(s)
- Daniel Kuehnle
- University of Erlangen-Nuremberg, Lange Gasse 20, 90403 Nuremberg, Germany; Institute for the Study of Labor (IZA), Germany.
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Green AC, Driezen P, Noar SM, Hammond D, Fong GT. Impact of adding and removing warning label messages from cigarette packages on adult smokers' awareness about the health harms of smoking: findings from the ITC Canada Survey. Tob Control 2019; 28:e56-e63. [PMID: 31253717 PMCID: PMC7495415 DOI: 10.1136/tobaccocontrol-2018-054885] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Adding messages to cigarette health warning labels (HWLs) about the harms of smoking increases awareness of these health facts, but little is known about the impact of removing messages. This is the first study to directly investigate the impact of adding and removing messages from cigarette HWLs on smokers' awareness of harms. METHODS Data were drawn from nine waves of the International Tobacco Control (ITC) Canada Survey, a national representative cohort of adult smokers (n=5863) conducted nearly annually between 2002 and 2013-2014. Two analytical approaches were conducted: generalised estimating equation (GEE) regression models estimated adjusted percentages of correct smoking-related health statements at each wave and segmented regression analyses modelled temporal trends in awareness before and after the revisions by measuring the difference in slopes. RESULTS Adding messages to HWLs significantly increased awareness that smoking causes blindness (OR=3.36 (95% CI 2.71 to 4.18); p<0.001; estimated increase of 1.01 million smokers in Canada) and bladder cancer (OR=2.14 (95% CI 1.71 to 2.66), p<0.001; estimated increase of 1.09 million smokers). Adding the warning that nicotine causes addiction did not significantly impact smokers' awareness. Removing messages was shown to decrease awareness that cigarette smoke contains carbon monoxide (OR=0.53 (95% CI 0.41 to 0.70), p<0.001; estimated decrease of 342 000 smokers) and smoking causes impotence (p=0.007 for the difference in slopes; estimated decrease of 354 000 smokers). CONCLUSIONS Adding messages to HWLs increases smokers' awareness of health facts, but removing messages decreases awareness. These findings demonstrate the importance of carefully considering the implications of adding and especially removing messages from HWLs and the importance of regularly revising warnings.
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Affiliation(s)
- Annika C Green
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Seth M Noar
- School of Journalism and Mass Communication, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Miller CL, Dono J, Wakefield MA, Pettigrew S, Coveney J, Roder D, Durkin SJ, Wittert G, Martin J, Ettridge KA. Are Australians ready for warning labels, marketing bans and sugary drink taxes? Two cross-sectional surveys measuring support for policy responses to sugar-sweetened beverages. BMJ Open 2019; 9:e027962. [PMID: 31248926 PMCID: PMC6597645 DOI: 10.1136/bmjopen-2018-027962] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To assess public support for 10 potential policy initiatives to reduce sugar-sweetened beverage (SSB) consumption. DESIGN A 2014 historical data set, which employed a face-to-face survey in one Australian state (study 1), provided the basis for comparison with our 2017 nationally representative, cross-sectional, computer-assisted telephone interviewing population survey (study 2). PARTICIPANTS Study 1: South Australians, 15+ years (n=2732); study 2: Australians, 18+ years (n=3430). PRIMARY OUTCOME MEASURES levels of support for SSB-specific policy initiatives. For the 2017 national study (study 2), demographic characteristics, body mass index, knowledge of potential harms caused by consuming SSBs and SSB consumption were included in multivariable regression analyses. RESULTS In 2017, all 10 potential policy initiatives received majority support (60%-88% either 'somewhat' or 'strongly' in favour). Initiatives with educative elements or focused on children received high support (>70%), with highest support observed for text warning labels on drink containers (88%) and government campaigns warning of adverse health effects (87%). Higher support was observed for SSB tax paired with using funds for obesity prevention (77%) than a stand-alone tax (60%). Support for policy initiatives was generally greater among those who believed SSB daily consumption could cause health problems in adults (4%-18% absolute difference) and/or in children (8%-26% absolute difference) and lower among SSB high consumers (7+ drinks per week; 9%-29% absolute difference). State-specific data comparison indicated increased support from 2014 to 2017 for taxation (42%vs55%; χ2=15.7, p<0.001) and graphic health warnings (52%vs68%; χ2=23.4. p<0.001). CONCLUSIONS There is strong public support for government action, particularly regulatory and educational interventions, to reduce SSB consumption, which appears to have increased since 2014. The findings suggest that framing policies as protecting children, presenting taxation of SSBs in conjunction with other obesity prevention initiatives and education focused on the harms associated with SSB consumption will increase support.
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Affiliation(s)
- Caroline L Miller
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Joanne Dono
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - John Coveney
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Wittert
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
- Centre for Nutrition and GI Diseases, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jane Martin
- Obesity Policy Coalition and Alcohol and Obesity Policy, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerry A Ettridge
- Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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10
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Francis DB, Mason N, Ross JC, Noar SM. Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies. Tob Induc Dis 2019; 17:41. [PMID: 31516484 PMCID: PMC6662785 DOI: 10.18332/tid/108614] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults. METHODS We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes. RESULTS Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs. CONCLUSIONS The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.
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Affiliation(s)
- Diane B Francis
- Department of Communication, University of Kentucky, Lexington, United States
| | - Nia Mason
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, United States
| | - Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, United States
| | - Seth M Noar
- School of Media & Journalism, University of North Carolina at Chapel Hill, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, United States
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11
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Ratih SP, Susanna D. Perceived effectiveness of pictorial health warnings on changes in smoking behaviour in Asia: a literature review. BMC Public Health 2018; 18:1165. [PMID: 30305061 PMCID: PMC6180548 DOI: 10.1186/s12889-018-6072-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several Asian countries have implemented pictorial health warnings on cigarette packs as suggested by the World Health Organization with various policies based on countries' systems. The study is aimed to analyse multiple research studies on the perceived effectiveness of Pictorial Health Warnings as a deterrent to smoking intention and as a stimulant of smoking behaviour in smokers and non-smokers in Asian countries. METHOD Peer-reviewed articles were identified through multiple science databases indexed by Scopus, MEDLINE or PubMed. The review was limited to articles that reported original research findings, were conducted in Asian countries and were available for review by January 2010. A PRISMA Flow diagram was used to identify the articles through the process of data screening and extractions. RESULT A total of 14 original articles which met the criteria were included in the review, consisting of 12 quantitative studies and 2 studies with both quantitative and qualitative methods from 17 jurisdictions. The reviewed studies found that pictorial health warnings were associated with a greater perception of salience (reading and noticing the warning), emotional effects, and cognitive increase. Additionally, in the reviewed studies, pictorial health warnings were perceived as more effective in deterring smoking initiation and encouraging smoking cessation than text-only warnings. Several studies also evaluated the effectiveness of a new pictorial warning compared with the old one. However, the relevance of refreshing the pictures of pictorial health warnings and the length of the effective period of the implementation of pictorial health warnings were less frequently studied. CONCLUSION Pictorial health warnings perceived as more effective in deterring smoking initiation among non-smokers and as well as in stimulating smoking cessation among smokers. Future studies on pictorial health warnings should study the relevance of changing or refreshing pictorial health warning on cigarette packages in a period of time.
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Affiliation(s)
- Suci Puspita Ratih
- Faculty of Public Health, Universitas Indonesia, Depok, 16424, West Java, Indonesia.,Department of Public Health, Faculty of Sports Sciences, Universitas Negeri Malang, Malang, 65145, East Java, Indonesia
| | - Dewi Susanna
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, West Java, 16424, Indonesia.
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12
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Hayashi H, Tan A, Kawachi I, Viswanath K. Does Segmentation Really Work? Effectiveness of Matched Graphic Health Warnings on Cigarette Packaging by Race, Gender and Chronic Disease Conditions on Cognitive Outcomes among Vulnerable Populations. JOURNAL OF HEALTH COMMUNICATION 2018; 23:523-533. [PMID: 29912655 PMCID: PMC6351315 DOI: 10.1080/10810730.2018.1474299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined the differential impact of exposure to smoking-related graphic health warnings (GHWs) on risk perceptions and intentions to quit among different audience segments characterized by gender, race/ethnic group, and presence of chronic disease condition. Specifically, we sought to test whether GHWs that portray specific groups (in terms of gender, race, and chronic disease conditions) are associated with differences in risk perception and intention to quit among smokers who match the portrayed group. We used data from Project CLEAR, which oversampled lower SES groups as well as race/ethnic minority groups living in the Greater Boston area (n = 565). We fitted multiple linear regression models to examine the impact of exposure to different GHWs on risk perceptions and quit intentions. After controlling for age, gender, education and household income, we found that women who viewed GHWs portraying females reported increased risk perception as compared to women who viewed GHWs portraying men. However, no other interactions were found between the groups depicted in GHWs and audience characteristics. The findings suggest that audience segmentation of GHWs may have limited impact on risk perceptions and intention to quit smoking among adult smokers.
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Affiliation(s)
- Hana Hayashi
- McCann Global Health, McCann Erickson, U.S.A., New York, United States of America
| | - Andy Tan
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Community-Based Research, Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts, United States of America
- Center for Translational Health Communication Science, HSPH/DFCI
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Community-Based Research, Dana-Farber Cancer Institute (DFCI), Boston, Massachusetts, United States of America
- Center for Translational Health Communication Science, HSPH/DFCI
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13
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Sathar F, Dalvie MA, Rother HA, London L. Demographic determinants of chemical safety information recall in workers and consumers in South Africa: A cross sectional study. JOURNAL OF SAFETY RESEARCH 2017; 63:61-71. [PMID: 29203025 DOI: 10.1016/j.jsr.2017.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/09/2017] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chemical hazard communication is intended to alert users of the potential hazards of chemicals. Hazard information needs to be understood and recalled. Recall of hazard communication is critical when the written form of the information is not available at the time it is required. METHODS A cross-sectional study investigating associations between recall of chemical safety information on labels amongst 402 participants including 315 workers and 87 consumers in two provinces of South Africa. RESULTS Respondents were predominantly male (67.7%), the median age was 37 years (IQR: 30-46years) and less than half of the participants completed high school (47.5%). Multivariate analysis identified the following positive associations with the recall of all the label elements listing the strongest association: call appropriate services and industrial vs consumer sector (OR=2.4; 95% CI: 1.2; 4.6 ); call appropriate services and transport vs consumer sector (OR=4.4; 95% CI: 1.2; 16.0); flammable symbol and male vs female gender (OR=2.3; 95% CI: 1.0; 5.3); flammable symbol and home language English vs African languages (OR=6.6; 95% CI: 2.1; 21.2); any hazard statement and home language Afrikaans vs African languages (OR=14.0; 95% CI: 3.6; 54.2), any first aid statement and further education vs none (OR=3.3; 95% CI: 1.3; 8.0), correct chemical name and industry blue collar workers vs non-industry blue collar workers (OR=2.6; 95% CI: 1.1; 6.1), correct chemical name and non-industry white collar occupations vs non-industry blue collar workers (OR=2.7; 95% CI: 1.0; 7.1). CONCLUSION The study found a number of potential positive associations which influence recall of label elements of which some (e.g., sector, gender, occupation) suggest further research. Relevant policies in South Africa should ensure that the safety information on chemical labels is clearly visible to read and understandable which aids recall and the reduction in harmful chemical exposures.
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Affiliation(s)
- Farzana Sathar
- Centre for Environmental and Occupational Health Research (CEOHR), School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research (CEOHR), School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Hanna-Andrea Rother
- Centre for Environmental and Occupational Health Research (CEOHR) and Division of Environmental Health, School of Public Health and Family Medicine, University of Cape Town, South Africa.
| | - Leslie London
- Centre for Environmental and Occupational Health Research (CEOHR) and Division of Environmental Health, School of Public Health and Family Medicine, University of Cape Town, South Africa.
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14
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Francis DB, Noar SM, Kowitt SD, Jarman KL, Goldstein AO. Believability of new diseases reported in the 2014 Surgeon General's Report on smoking: Experimental results from a national survey of US adults. Prev Med 2017; 99:94-98. [PMID: 28189803 PMCID: PMC5687516 DOI: 10.1016/j.ypmed.2017.01.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/03/2017] [Accepted: 01/31/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Tobacco use is the leading cause of preventable disease and death globally. The 2014 Surgeon General's Report included new diseases linked to smoking, including liver and colon cancer, diabetes and tuberculosis. As more diseases are linked to smoking, which diseases should we communicate to the public and what message source has the most impact? METHODS Data were collected through a nationally representative phone survey of US adults (N=5014), conducted from September 2014 through May 2015. We experimentally randomized participants to a 2 (new smoking disease messages - liver and colon cancers compared to diabetes and tuberculosis) by 4 (message sources - CDC, FDA, Surgeon General, and none) experiment. The outcome was message believability. RESULTS About half the sample was female (51.5%) and 17.8% were a current smoker. Overall, 56% of participants said the messages were very believable. Cancer messages (liver and colon cancer) were significantly more believable than messages about chronic disease (tuberculosis and diabetes), 61% vs. 52%. Smokers were less likely to report both sets of new disease messages as very believable compared to non-smokers. Significantly more smokers intending to quit (44.5%) found the messages to be very believable compared to smokers not intending to quit (22.6%). Believability did not differ by message source. CONCLUSION Important differences exist in believability of disease messages about new tobacco-related information. Messages emphasizing the causal link between smoking and new diseases should be considered for use in mass media campaigns.
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Affiliation(s)
- Diane B Francis
- Manship School of Mass Communication, Louisiana State University, Baton Rouge, LA 80803, USA.
| | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sarah D Kowitt
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L Jarman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adam O Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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15
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Noar SM, Francis DB, Bridges C, Sontag JM, Brewer NT, Ribisl KM. Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review. JOURNALISM & MASS COMMUNICATION QUARTERLY 2017; 94:416-442. [PMID: 29975497 PMCID: PMC5483339 DOI: 10.1177/1077699016674188] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.
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Affiliation(s)
- Seth M. Noar
- The University of North Carolina at Chapel Hill, USA
- Seth M. Noar, School of Media and Journalism, The University of North Carolina at Chapel Hill, 382 Carroll Hall, CB 3365, Chapel Hill, NC 27599-3365, USA.
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Kollath-Cattano C, Osman A, Thrasher JF. Evaluating the perceived effectiveness of pregnancy-related cigarette package health warning labels among different gender/age groups. Addict Behav 2017; 66:33-40. [PMID: 27871043 PMCID: PMC5177510 DOI: 10.1016/j.addbeh.2016.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The impact of pregnancy-related health warning labels (HWLs) appearing on cigarette packages on women of reproductive age and other socio-demographic groups is not well understood. The current study analyzes how different age/gender groups respond to pregnancy-related HWLs as compared to non-pregnancy HWLs. METHODS Data were analyzed from four waves of an online longitudinal study with adult smokers aged 18-64 in Australia, Canada, Mexico, and the US. Participants were classified into four age\gender groups: women 40 and under; men 40 and under; women over 40; men over 40. Participants rated one pregnancy-related and several non-pregnancy related labels on worry, believability, and motivation to quit. Country-specific adjusted linear GEE were estimated regressing ratings for each of the three key outcomes for 1) pregnancy-related HWLs and 2) a rating difference score that subtracted the average ratings of the non-pregnancy warning from the rating of the pregnancy warning. All models adjusted for socio-demographics and smoking related variables. RESULTS In Mexico and Australia, where graphic pregnancy-related HWL imagery is used (i.e., premature infant), women of reproductive age reported stronger believability, worry, and quit motivation than all other groups. Results were similar in the US, where text only HWLs are used. In contrast in Canada, where the pregnancy-related HWL imagery features a pregnant woman, ratings were unassociated with gender/age groups. Stronger effects among women of reproductive age were limited to pregnancy HWLs in each country, except Canada. CONCLUSIONS HWLs that depict graphic effects to illustrate smoking-related pregnancy risks appear to be perceived as particularly effective among women of reproductive age.
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Affiliation(s)
- Christy Kollath-Cattano
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA.
| | - Amira Osman
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA
| | - James F Thrasher
- Department of Health Prevention, Education, and Behavior, University of South Carolina, 915 Greene St., Columbia, SC 29208, USA
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Dost F, Do L, Farah CS. Knowledge of oral cancer risk factors amongst high-risk Australians: findings from the LESIONS programme. Aust Dent J 2016; 61:432-439. [DOI: 10.1111/adj.12408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 12/25/2022]
Affiliation(s)
- F Dost
- The University of Queensland Centre for Clinical Research; Herston Queensland Australia
| | - L Do
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide South Australia Australia
| | - CS Farah
- The University of Queensland Centre for Clinical Research; Herston Queensland Australia
- School of Dentistry; The University of Western Australia; Nedlands Western Australia Australia
- Australian Centre for Oral Oncology Research and Education; Nedlands Western Australia Australia
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18
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Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Soc Sci Med 2016; 164:118-129. [PMID: 27423739 PMCID: PMC5026824 DOI: 10.1016/j.socscimed.2016.06.011] [Citation(s) in RCA: 222] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings. METHODS We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior. RESULTS We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies. CONCLUSIONS Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.
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Affiliation(s)
- Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA.
| | - Diane B Francis
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA
| | - Christy Bridges
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Jennah M Sontag
- School of Media and Journalism, University of North Carolina at Chapel Hill, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
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The influence of graphic warning labels on efficacy beliefs and risk perceptions: a qualitative study with low-income, urban smokers. Tob Induc Dis 2016; 14:25. [PMID: 27471440 PMCID: PMC4964038 DOI: 10.1186/s12971-016-0088-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 07/01/2016] [Indexed: 11/22/2022] Open
Abstract
Background Health communication theories indicate that messages depicting efficacy and threat might promote behavior change by enhancing individuals’ efficacy beliefs and risk perceptions, but this has received little attention in graphic warning label research. We explored low socioeconomic status (SES) smokers’ perceptions of theory-based graphic warning labels to inform the development of labels to promote smoking cessation. Methods Twelve graphic warning labels were developed with self-efficacy and response efficacy messages paired with messages portraying high, low, or no threat from smoking. Self-efficacy messages were designed to promote confidence in ability to quit, while response efficacy messages were designed to promote confidence in the ability of the Quitline to aid cessation. From January – February 2014, we conducted in-depth interviews with 25 low SES adult men and women smokers in Baltimore, Maryland, U.S. Participants discussed the labels’ role in their self-efficacy beliefs, response efficacy beliefs about the Quitline, and risk perceptions (including perceived severity of and susceptibility to disease). Data were analyzed through framework analysis, a type of thematic analysis. Results Efficacy messages in which participants vicariously experienced the characters’ quit successes were reported as most influential to self-efficacy beliefs. Labels portraying a high threat were reported as most influential to participants’ perceived severity of and susceptibility to smoking risks. Self-efficacy messages alone and paired with high threat were seen as most influential on self-efficacy beliefs. Labels portraying the threat from smoking were most motivational for calling the Quitline, followed by labels showing healthy role models who had successfully quit using the Quitline. Conclusions Role model-based efficacy messages might enhance the effectiveness of labels by making smokers’ self-efficacy beliefs about quitting most salient and enhancing the perceived efficacy of the Quitline. Threatening messages play an important role in enhancing risk perceptions, but findings suggest that efficacy messages are also important in the impact of labels on beliefs and motivation. Our findings could aid in the development of labels to address smoking disparities among low SES populations in the U.S.
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Review of the Literature on Determinants of Chemical Hazard Information Recall among Workers and Consumers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060546. [PMID: 27258291 PMCID: PMC4924003 DOI: 10.3390/ijerph13060546] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
In many low and middle income countries (LMIC), workers’ and consumers’ only access to risk and hazard information in relation to the chemicals they use or work with is on the chemical label and safety data sheet. Recall of chemical hazard information is vital in order for label warnings and precautionary information to promote effective safety behaviors. A literature review, therefore, was conducted on determinants of chemical hazard information recall among workers and consumers globally. Since comprehension and recall are closely linked, the determinants of both were reviewed. Literature was reviewed from both online and print peer reviewed journals for all study designs and countries. This review indicated that the level of education, previous training and the inclusion of pictograms on the hazard communication material are all factors that contribute to the recall of hazard information. The influence of gender and age on recall is incongruent and remains to be explored. More research is required on the demographic predictors of the recall of hazard information, the effect of design and non-design factors on recall, the effect of training on the recall among low literate populations and the examining of different regions or contexts.
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Nicholson AK, Borland R, Couzos S, Stevens M, Thomas DP. Smoking-related knowledge and health risk beliefs in a national sample of Aboriginal and Torres Strait Islander people. Med J Aust 2015; 202:S45-50. [PMID: 26017256 DOI: 10.5694/mja14.00877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe general knowledge and perceived risk of the health consequences of smoking among Aboriginal and Torres Strait Islander people; and to assess whether knowledge varies among smokers and whether higher knowledge and perceived risk are associated with quitting. DESIGN, SETTING AND PARTICIPANTS The Talking About The Smokes project used quota sampling to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline survey data were collected from 2522 Aboriginal and Torres Strait Islander adults from April 2012 to October 2013. MAIN OUTCOME MEASURES Knowledge of direct effects of smoking and harms of second-hand smoke (SHS), risk minimisation, health worry, and wanting and attempting to quit. RESULTS Most Aboriginal and Torres Strait Islander participants who were daily smokers demonstrated knowledge that smoking causes lung cancer (94%), heart disease (89%) and low birthweight (82%), but fewer were aware that it makes diabetes worse (68%). Similarly, almost all daily smokers knew of the harms of SHS: that it is dangerous to non-smokers (90%) and children (95%) and that it causes asthma in children (91%). Levels of knowledge among daily smokers were lower than among non-daily smokers, ex-smokers and never-smokers. Among smokers, greater knowledge of SHS harms was associated with health worry, wanting to quit and having attempted to quit in the past year, but knowledge of direct harms of smoking was not. CONCLUSION Lack of basic knowledge about the health consequences of smoking is not an important barrier to trying to quit for Aboriginal and Torres Strait Islander smokers. Framing new messages about the negative health effects of smoking in ways that encompass the health of others is likely to contribute to goal setting and prioritising quitting among Aboriginal and Torres Strait Islander people.
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Affiliation(s)
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
| | | | | | - David P Thomas
- Menzies School of Health Research, Darwin, NT, Australia
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Nicholson AK, Borland R, Sarin J, Wallace S, Sterren AE, Stevens M, Thomas DP. Recall of anti‐tobacco advertising and information, warning labels and news stories in a national sample of Aboriginal and Torres Strait Islander smokers. Med J Aust 2015; 202:S67-72. [DOI: 10.5694/mja14.01628] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/20/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Jasmine Sarin
- Aboriginal Health & Medical Research Council, Sydney, NSW
| | - Sharon Wallace
- Aboriginal Medical Services Alliance Northern Territory, Darwin, NT
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Guillaumier A, Bonevski B, Paul C. Tobacco health warning messages on plain cigarette packs and in television campaigns: a qualitative study with Australian socioeconomically disadvantaged smokers. HEALTH EDUCATION RESEARCH 2015; 30:57-66. [PMID: 24966335 DOI: 10.1093/her/cyu037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health risk and cessation benefit messages. Six focus groups were conducted over September 2012-April 2013 with adult clients of welfare organizations in regional New South Wales, Australia who were current smokers (n = 51). Participants discussed HWLs, plain packaging and anti-smoking television advertisements. Discussions were audio-taped, transcribed verbatim and analysed using thematic analysis. Highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco. Careful consideration of message content and medium is required to communicate the anti-smoking message to disadvantaged smokers who consider themselves desensitized to warnings. Health communication strategies should continue to address false beliefs about smoking and educate on cessation services that are currently underutilized.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine and Public Health, University of Newcastle, Newcastle 2308, Australia and Hunter Medical Research Institute, Newcastle 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Newcastle 2308, Australia and Hunter Medical Research Institute, Newcastle 2308, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle 2308, Australia and Hunter Medical Research Institute, Newcastle 2308, Australia School of Medicine and Public Health, University of Newcastle, Newcastle 2308, Australia and Hunter Medical Research Institute, Newcastle 2308, Australia
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White V, Bariola E, Faulkner A, Coomber K, Wakefield M. Graphic Health Warnings on Cigarette Packs: How Long Before the Effects on Adolescents Wear Out? Nicotine Tob Res 2014; 17:776-83. [PMID: 25239958 DOI: 10.1093/ntr/ntu184] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 08/10/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION To examine the long-term impact of graphic health-warning labels (GHWL) on adolescents' cognitive processing of warning labels and cigarette pack perceptions. METHODS Cross-sectional school-based surveys of students aged 13-17 years residing in urban centers, conducted prior to GHWL introduction (2005) and 6 months (2006), 2 years (2008), and 5 years (2011) post-GHWL introduction. Students who had seen a cigarette pack in the previous 6 months or in 2006, who had seen GHWL were included in analyses (2005 n = 2,560; 2006 n = 1,306; 2008 n = 2,303; 2011 n = 2,716). Smoking stage, reported exposure to cigarette packs, cognitive processing of GHWL, and positive and negative perceptions of pack image were assessed. RESULTS While cognitive processing of GHWL in 2006 and 2008 was greater than 2005 (p < .01), by 2011 scores had returned to 2005 levels. This pattern of change was consistent across smoking status groups. Pack image perceptions became more negative over time among all students, irrespective of smoking experience. While positive pack image ratings were lower in all subsequent years than 2005, the 2008 rating was higher than 2006 (p < .01). A significant interaction between survey time and smoking status (p < .01) showed that significant increases in positive pack ratings after 2006 only occurred among current and experimental smokers. CONCLUSIONS When novel, GHWL on cigarette packs increase cognitive processing among adolescents. However, this effect diminishes after 5 years, suggesting more regular message refreshment is needed. Australia's adoption of plain packaging is intended to undermine positive pack appeal and increase warning salience.
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Affiliation(s)
- Victoria White
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Emily Bariola
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Agatha Faulkner
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Kerri Coomber
- 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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