Pictorial Cigarette Warning Labels: Effects of Severity and Likelihood of Risk Messages

INTRODUCTION: Pictorial cigarette warning labels often contain text-messages about severity of health risks and less often about the likelihood of health risks. We aimed to examine the influence of severity of risk versus likelihood of risk text-messages on information seeking behavior. METHODS: Study 1: An experimental study with a 2 (severity) x 2 (likelihood) between-subjects design (n=260); Study 2: An experimental study with a 2 (severity) x 2 (likelihood) x 2 (picture) between-subjects design (n=537). Main outcome measures were information seeking intention and information seeking behavior (accepting a brochure about smoking cessation in Study 1; clicking on a link to a smoking cessation webpage in Study 2). RESULTS: In Study 1, exposure to likelihood text-messages was associated with more information seeking behavior but not with attitudes and intention to quit. In Study 2, exposure to likelihood text-messages was not associated with information seeking behavior, but was associated with higher warning label ratings and with more positive attitudes towards quitting when it was a pictorial cigarette warning label; exposure to severity text-messages was associated with higher warning label ratings and higher risk perceptions. Presence of a picture with smokers' diseased lungs in Study 2 was associated with higher warning label ratings and with higher risk perceptions, but did not influence attitudes and intention to quit. CONCLUSIONS: We found preliminary indications that pictorial cigarette labels with likelihood of risk text-messages may be effective in influencing behavior. However, results from our two studies were not consistent. Therefore, future studies should examine this further

Mediational pathways of the impact of cigarette warning labels on quit attempts

OBJECTIVES: To test and develop, using structural equation modelling, a robust model of the mediational pathways through which health warning labels exert their influence on smokers’ subsequent quitting behaviour. METHODS: Data come from the International Tobacco Control Four-Country Survey, a longitudinal cohort study conducted in Australia, Canada, the UK, and the US. Waves 5–6 data (n=4988) were used to calibrate the hypothesized model of warning label impact on subsequent quit attempts via a set of policy-specific and general psychosocial mediators. The finalised model was validated using Waves 6–7 data (n=5065). RESULTS: As hypothesized, warning label salience was positively associated with thoughts about risks of smoking stimulated by the warnings (β=.58, p<.001), which in turn were positively related to increased worry about negative outcomes of smoking (β=.52, p<.001); increased worry in turn predicted stronger intention to quit (β=.39, p<.001) which was a strong predictor of subsequent quit attempts (β=.39, p<.001). This calibrated model was successfully replicated using Waves 6–7 data. CONCLUSIONS: Health warning labels seem to influence future quitting attempts primarily through their ability to stimulate thoughts about the risks of smoking, which in turn help to raise smoking-related health concerns, which lead to stronger intentions to quit, a known key predictor of future quit attempts for smokers. By making warning labels more salient and engaging, they should have a greater chance to change behaviour