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Open AccessArticle

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

1
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27705, USA
2
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
3
Department of Health Education and Behavior & Department of Psychology, University of Florida, Gainesville, FL 32611, USA
4
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(18), 3380; https://doi.org/10.3390/ijerph16183380
Received: 25 July 2019 / Revised: 3 September 2019 / Accepted: 6 September 2019 / Published: 12 September 2019
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to avoid seeing GWLs. View Full-Text
Keywords: graphic warning labels; pictorial warning labels; tobacco control; tobacco; smoking; HIV; comorbidity; behavioral economics graphic warning labels; pictorial warning labels; tobacco control; tobacco; smoking; HIV; comorbidity; behavioral economics
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Pacek, L.R.; Berry, M.S.; Rass, O.; Mercincavage, M.; McClernon, F.J.; Johnson, M.W. Graphic Warning Labels Affect Hypothetical Cigarette Purchasing Behavior among Smokers Living with HIV. Int. J. Environ. Res. Public Health 2019, 16, 3380.

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