Search Results (15)

Limited research has examined attention to these cigar-specific health warnings and their perceived effectiveness among young people. The objective of our study was to evaluate the attention to and perceptions of a set of cigar-specific health warnings among young adult tobacco users and non-users. Methods: Young adults ages 18–24 in Columbus, Ohio, were recruited into an eye-tracking experiment examining cigarillo packaging between May 2022 and February 2023. Participants (n = 124) were shown 12 unique, branded cigarillo packages featuring a rotation of four of the Food and Drug Administration’s mandated health warnings: (1) Cigar smoking can cause lung cancer and heart disease (“disease”); (2) tobacco smoke increases the risk of lung cancer and heart disease, even in nonsmokers (“nonsmokers”); (3) cigar smoking can cause cancers of the mouth and throat, even if you do not inhale (“inhale”); and (4) cigars are not a safe alternative to cigarettes (“alternative”). Software captured visual attention to each product package, including the health warning. Participants also ranked the most effective message to motivate people to quit; one week later, the participants (n = 118) self-reported unaided recall of the experiment. Results: Study participants were an average of 21.2 years old, 54.2% were female, 73.7% were White, 65.3% had some college education, and 26.3% reported tobacco use in the previous month. The health warning, “Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale” was ranked the most effective cigar warning (41.5%) and drew the greatest proportion of visual attention (26.1%). More than half (52.5%) recalled details regarding the health warning messages one week following the experiment, with few recalling (17.7%) specific warning message themes. Conclusions: Understanding the best performing health warnings is a crucial strategy to share accurate information on the risks of tobacco use. Our findings suggest that the warning on cancer risk even without inhaling drew the greatest visual attention and highest rating of perceived effectiveness among this sample of young adult cigarillo users and non-users. Full article

Understanding students’ attitudes toward smoking and tobacco products is essential for effective smoking prevention interventions. This questionnaire-based cross-sectional survey aims to determine the prevalence of use and knowledge about cigarettes, heated tobacco products, and electronic cigarettes and their harmful effects among university students. The survey was conducted using a self-administered online questionnaire among 1184 students. Questions were related to the respondents’ demographic characteristics, tobacco use patterns, and opinions about exposure to health warnings and tobacco product advertising messages. Data were analyzed using descriptive statistics and generalized linear regression analysis. The results showed that 30.2% of the students use tobacco products (74.5% smoked conventional cigarettes; 7.9% used electronic cigarettes; and 17.6% used heated tobacco products). The median (interquartile range) score of the students’ knowledge (maximum = 27) was 16 (12–22). The results showed that students from technical, social, humanities, natural, and biotechnology scientific programs had lower levels of knowledge about tobacco products and their harmful effects than biomedical students (p ≤ 0.001). In addition, past and current use of tobacco products was significantly associated with higher overall knowledge of tobacco products and their harmful effects (adjusted odds ratio (OR) 1.90, % confidence interval (CI) 1.09–3.31, p = 0.023; OR 1.41, CI 1.08–1.84, p = 0.011). The research findings confirm the lack of knowledge and misconceptions about the harmful effects associated with tobacco product use. They also emphasize the need for better prevention and awareness of the harmful effects of smoking on human health. Full article

The WHO recommended pictorial health warnings (PHWs) on cigarette packs in 2003 to educate and warn the public of smoking effects. Malaysia too has implemented this policy since 2009. This study explored the public’s understanding of the gazetted PHWs depicted on cigarette packs available in Malaysia. A qualitative study using four focus group discussions (FGDs) was conducted among smokers and non-smokers aged 18–40 in Malacca, Peninsular Malaysia. Thematic analyses were performed using the Atlas Ti version 8.0 software. Six themes have emerged reflecting the public’s understanding of the existing PHWs in Malaysia, namely, (i) awareness and exposures, (ii) recall and attention, (iii) perceived goals, (iv) perceived target groups, (v) attitude in understanding, and (vi) knowledge and meaning of PHWs. All participants were aware of the PHWs depicted on legal cigarettes but not seen on most illicit cigarettes. PHWs were perceived to give awareness and warning about the smoking effects targeting smokers and non-smokers. Participants understood the lung and oral health-related images easily than other body parts such as gangrene foot, miscarriages, etc. Besides enforcement on illicit cigarettes without PHWs, policymakers or relevant authorities should emphasize creating relevant and clear pictorial messages in educating the public to avoid confusion affecting the public’s understanding of the PHWs. Full article

Current text-only cigarette warning labels (long-term, loss-framed messages) may not motivate positive changes in smoking behavior. The current project was a cross-sectional study examining the effects of tailored cigarette warnings on perceived message effectiveness (PME) in adult smokers (n = 512) conducted using Amazon Mechanical Turk (M-Turk) in January–February 2020. Participants were an average age of 40.7 (SD = 11.6), with the majority of the sample being female (62.2%) and White (88.9%). Participants reported smoking an average of 14.6 cigarettes/day (SD = 9.2) with an average FTND score of 4.6 (SD = 2.2). Participants were asked to complete a tobacco use history questionnaire, and mixed gambles and delay discounting tasks before random assignment to one of five message groups. The groups were based on a 2 (gain versus loss framing) ×2 (short-term versus long-term framing) between-subject design; a fifth group served as the control group. All experimental messages reported higher PME scores than the control (p values < 0.001, Cohen’s d = 1.88–2.48). Participants with shallower delayed reward discounting and lower loss aversion rates reported higher total PME scores, p values < 0.05. Our findings also suggest that loss aversion rates vary widely among smokers and that individuals are more responsive to messages congruent with their behavioral economic profile. Specifically, smokers who viewed messages congruent with their loss aversion and delay discounting rates reported higher PME scores than those who viewed incongruent messages (p = 0.04, Cohen’s d = 0.24). These preliminary findings suggest that anti-smoking campaigns may best impact smokers by tailoring messages based on individual loss aversion and delay discounting rates versus a one-size-fits-all approach. Full article

Background: Cigarette consumption remains high and increasing in Indonesia. The government implemented a pictorial health warnings requirement of 40% cover of the pack (front and back) using fear appeal messages. Objective: Our study aims to assess the effectiveness of cigarette pictorial health warnings by message and size. Methods: We conducted a mixed factorial experiment online study using three messaging approaches (fear vs. guilt vs. financial loss) and two picture sizes (40% vs. 75%) among 209 smoking participants. Sociodemographic variables included gender, education, income, employment status, and marital status. Data analysis used a mixed model ANOVA to see the main effect and interaction effect on dependent variables. For subgroup analysis, we used t-test and one-way ANOVA. All analyzes were in SPSS 22. Results: We found significant differences in the three message types, in which fear and guilt have higher effectiveness than financial loss. By subgroup, the guilt message was more compelling among female smokers and married smokers. The financial loss message was effective among lower-income smokers. We found no difference in pictorial health warning effectiveness by image size, potentially because participants could zoom in/out the cigarette pack image on the screen. Conclusions: Our finding supports more diverse message types in pictorial health warnings in Indonesia and other countries. Full article

In the U.S., e-cigarette companies can apply for permission to use reduced or modified risk messages (MRMs) in their marketing materials. Because e-cigarette marketing materials should have a nicotine addictiveness warning, MRMs and a nicotine warning could appear together—resulting in a conflicting message. When reading a conflicting message, individuals assimilate evidence supporting their pre-existing beliefs and eventually develop stronger beliefs, diverging more from those with different pre-existing beliefs (i.e., polarization). This study examined if exposure to e-cigarette MRMs with a nicotine warning polarizes smokers’ initially opposing beliefs about the efficacy of switching completely to e-cigarettes in reducing smoking-related risks, and if this polarization depends on individuals’ need for closure. An online experiment randomized 761 U.S. adult smokers to either three MRMs with a nicotine warning or three control messages. People reported their perceived efficacy of switching completely to e-cigarettes at pre- and posttest and need for closure at pretest. Linear regression showed no polarization effects. Nonetheless, need for closure and pretest efficacy beliefs influenced message response: MRMs with a nicotine warning only enhanced efficacy beliefs of smokers with low pretest efficacy beliefs and low need for closure. Evaluation of e-cigarette mixed communication should consider individuals’ motivational and cognitive differences. Full article

In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further. Full article

Cigarette smoking represents a major public health problem in Lao People’s Democratic Republic (Lao PDR). This study aims to examine factors associated with cigarette smoking cessation attempts and intention to quit. Data were from the Lao National Adult Tobacco Survey that consisted of 7562 participants ≥15 years old. Multivariable logistic regression models were used to evaluate the associations, adjusted for sex, age groups, education level, income per day, and smoking frequency. Results show that past quit attempts were associated with visiting a healthcare provider in the past year (adjusted odds ratio [AOR]: 1.74, 95% confidence intervals [CI]: 1.28–2.35), home smoking bans (AOR: 5.52, 95% CI: 2.13–14.33), noticing media-based messages informing the dangers of smoking or encouraging quitting (AOR: 3.25, 95% CI: 2.28–4.63), noticing health warnings on cigarette packages in the past 30 days (AOR: 3.33, 95% CI: 2.21–5.03), and believing that smoking is seriously harmful to their health (AOR: 3.45, 95% CI: 1.24–9.57). The Lao PDR government should continue implementing tobacco control policies that demonstrated associations with cessation attempts or intention to quit, such as smoke-free environments and required health warnings on cigarette packages. Tobacco cessation treatment programs are pressingly needed in Lao PDR. Full article

This study sought to assess the effectiveness of religious cigarette health warning labels (HWLs) in Indonesia, a country with a high public health burden from tobacco use. The study tested different religious and nonreligious messages related to suicide, secondhand smoke (SHS) and gangrene. Participants were smokers and non-smokers from Surabaya, Indonesia (n = 817). Participants rated each HWL for its effectiveness on a scale of 1 to 10 (1 = “not at all”, 10 = “extremely”) with respect to 10 items. Nonreligious HWLs were marginally superior for SHS and suicide while religious HWLs were marginally superior for gangrene. Given the close rating scores between religious and nonreligious HWLs, they were functionally equal in effectiveness. With proper assessment of potential unintended consequences, the implementation of religious HWLs could be considered for a proportion of HWLs. Full article

Although e-cigarettes in the United States are required to carry one nicotine addiction warning, little is known about the impact of other potential e-cigarette warning themes, nor about pairing warnings with messages that communicate e-cigarettes’ reduced-harm potential relative to cigarettes. We randomly assigned 876 young adults (ages 18–29) to view e-cigarette ads in a 3 × 2 plus control online experiment that varied by warning theme (i.e., nicotine addiction; nicotine’s impact on adolescent brain development; presence of harmful chemicals) and warning type—i.e., the presence (“relative harm warning”) or absence (“standard warning”) of a relative harm (RH) statement in the warning label (“e-cigarettes may cause harm to health but are less harmful than cigarettes”). Warning believability, informativeness, understandability and support were high across conditions and there were no significant differences by warning theme on e-cigarette harm perceptions or use intentions nor on nicotine (mis)perceptions. Perceived warning effectiveness for discouraging youth initiation was higher for the “brain” and “chemicals” warnings compared to the addiction warning. Warnings with the included RH statement were perceived as less believable and credible and were less frequently correctly recalled. Research should continue to investigate the impact of different e-cigarette warning themes and formats with priority audiences. Full article

Health warnings for e-cigarettes are a promising and novel tobacco control intervention for reducing e-cigarette use. We developed a new protocol for evaluating e-cigarette warnings by placing them on users’ own devices to reflect real-world exposure. Study 1 participants were a national convenience sample of 606 U.S. adult e-cigarette users surveyed online in March 2017. Most Study 1 participants were willing to have their e-cigarette devices (87%) and refills (83%) labeled. Study 2 participants were a convenience sample of 22 adult e-cigarette users recruited in California, United States in April 2017. We applied the U.S. Food and Drug Administration’s proposed e-cigarette warning to users’ own devices and refills. Most Study 2 participants (81%) reported using e-cigarette devices with our warning labels at least 90% of the time during the study. Nearly all (95%) said they would participate in the study again, and 100% would recommend the study to a friend. Conversations about e-cigarette harms, conversations about quitting e-cigarettes, and intentions to quit using e-cigarettes increased during the study (all p < 0.05). These studies show that our naturalistic labeling protocol was feasible, acceptable to participants, and had high retention over three weeks. Using the protocol can yield important evidence on the impact of e-cigarette warnings to inform tobacco warning policies. Full article

(1) Background: Several brands of electronic nicotine delivery systems (ENDS) carry voluntary health warning messages. This study examined how potential exposure to ENDS magazine ads with these voluntary health warnings were associated with the perceived harmfulness of ENDS. (2) Methods: Risk perception measures and self-reported exposure to ENDS ads were obtained from the 2014 Georgia State University (GSU) Tobacco Products and Risk Perceptions Survey of a nationally representative sample of U.S. adults. We examined the association between potential exposure to magazine ads with warnings and the perceived harms of ENDS relative to cigarettes, using binary logistic regressions and controlling for general ENDS ad exposure and socio-demographic characteristics. (3) Results: Potential exposure to ENDS magazine ads with warnings was associated with a lower probability of considering ENDS to be more or equally harmful compared to cigarettes, particularly among non-smokers (OR = 0.16; 95% CI: 0.04–0.77). In addition, ad exposure, ENDS use history, race/ethnicity, gender, education, and income were also associated with harm perceptions. (4) Conclusions: This study did not find evidence that magazine ads with warnings increased misperceptions that ENDS are equally or more harmful than cigarettes. With more ENDS advertisements carrying warnings, more research is needed to determine how the warnings in advertisements convey relative harm information to consumers and the public. Full article

Background: Text warnings are mandated on cigars sold in the United States (U.S.), however little published research has examined effectiveness of cigar warnings. This is the first study examining the believability of cigar warnings among adults in the U.S. Methods: Adults in the U.S. (n = 5014) were randomized in a phone survey to receive one of three cigar-specific mandated warning messages (“Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale”, “Cigar smoking can cause lung cancer and heart disease”, and “Cigars are not a safe alternative to cigarettes”) with one of four warning sources (no source, Surgeon General, CDC (Centers for Disease Control and Prevention), FDA (Food and Drug Administration)). Results: Most adults found the cigar warnings very believable (66.9%). Weighted logistic regression results indicate that the message “Cigar smoking can cause lung cancer and heart disease” was associated with higher odds of being very believable (AOR: 2.05, 95% CI: 1.55, 2.70) and the message “Cigars are not a safe alternative to cigarettes” was associated with lower odds of being very believable (AOR: 0.71, 95% CI: 0.55, 0.92) compared to the message “Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale”. Warning source had no impact on believability. Conclusions: We tested three of the currently mandated cigar warnings in the U.S. and found significant differences in believability between them. Further research on cigar warnings may improve communication to the public on cigar health risks, ultimately preventing uptake of cigars and promoting cessation among cigar users. Full article

Tobacco warning labels are important sources of risk information but research historically has been cigarette-centric. This qualitative study aimed to inform future direction and research on warnings for e-cigarettes. Between June and August 2016, we conducted interviews with 10 researchers with expertise in tobacco warning label research. Interviewees were registrants of a 2016 National Cancer Institute grantee meeting on tobacco warnings. Several participants agreed that the Food and Drug Administration’s new nicotine addiction warning for e-cigarettes could be informative but that it might not resonate with young people. Many agreed that more than one warning would be important as e-cigarette science evolves and that research on additional warning themes (e.g., nicotine exposure, harmful constituents) and execution styles (including use of pictorials) was important. Participants were somewhat mixed about the use of reduced-risk messages within e-cigarette warnings, but agreed that research on how to communicate about cigarette/e-cigarette relative risks was needed. Overall, more research is needed on tobacco warnings for non-cigarette products, including on the message content, placement, execution and potential impact on audiences’ product knowledge, risk perceptions and use intentions. This is particularly needed for products such as e-cigarettes which may have harm-reduction potential relative to cigarettes and require unique considerations. Full article

The Message Impact Framework suggests that social interactions may offer smokers the opportunity to process pictorial warnings on cigarette packs more deeply. We aimed to describe adult smokers’ social interactions about pictorial cigarette pack warnings in two longitudinal pilot studies. In Pilot Study 1, 30 smokers used cigarette packs with one of nine pictorial warnings for two weeks. In Pilot Study 2, 46 smokers used cigarette packs with one of five pictorial warnings for four weeks. Nearly all smokers (97%/96% in Pilot Study 1/2) talked about the warnings with other people, with the most common people being friends (67%/87%) and spouses/significant others (34%/42%). Pilot Study 2 found that 26% of smokers talked about the warnings with strangers. Discussions about the health effects of smoking and quitting smoking were more frequent during the first week of exposure to pictorial warnings than in the week prior to beginning the study (both p < 0.05). Pictorial warnings sparked social interactions about the warnings, the health effects of smoking, and quitting smoking, indicating that pictorial warnings may act as a social intervention reaching beyond the individual. Future research should examine social interactions as a potential mediator of the impact of pictorial warnings on smoking behavior. Full article