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Magnan RE, Song AV, Cameron LD. Worry as a mechanism of the relationship between perceived new knowledge and discouragement to smoke elicited from graphic cigarette warnings. J Behav Med 2022; 45:818-824. [DOI: 10.1007/s10865-022-00344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
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Campbell BK, Le T, Yip D, Griffin KB, Gubner NR, Guydish JR. Sex Differences in Graphic Warning Label Ratings by Addictions Clients. TOB REGUL SCI 2019; 5:3-14. [PMID: 31236435 PMCID: PMC6590904 DOI: 10.18001/trs.5.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Research on sex differences in responses to cigarette graphic warning labels (GWLs) has been limited despite tobacco-related, health disparities for women. We examined whether women had stronger responses to certain labels than to others, whether this pattern differed from men's, and whether there were overall sex ratings differences. METHODS Smokers (N = 881) in 24, addictions treatment programs rated 3 of 9 Food and Drug Administration-developed labels on credibility, message reactance, quit motivation, and negative emotions. Participants rated one label depicting a woman and/or baby, and 2 depicting tobacco-related disease or male images. RESULTS Women's (n = 432) ratings of labels depicting women/babies versus other labels did not differ from men's (n = 449) ratings. Women had higher ratings than men across all labels combined on credibility (p < .001), quit motivation (p = .007), and negative emotions (p < .001). Individual labels were analyzed for sex differences. Women's ratings were higher on credibility for 3 of 9 labels, and on negative emotions for 7 of 9 labels. CONCLUSIONS Female smokers in addictions treatment had generally stronger responses to GWLs than men, supporting GWL implementation in the United States to help close the sex gap in smoking cessation.
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Affiliation(s)
- Barbara K. Campbell
- OHSU/PSU School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Thao Le
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Deborah Yip
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Kayla B. Griffin
- Morgan State University, 1700 E. Cold Springs Lane, Baltimore, MD 21251, USA
| | - Noah R. Gubner
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
| | - Joseph R. Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA 94118, USA
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Cho YJ, Thrasher JF, Yong HH, Szklo AS, O'Connor RJ, Bansal-Travers M, Hammond D, Fong GT, Hardin J, Borland R. Path analysis of warning label effects on negative emotions and quit attempts: A longitudinal study of smokers in Australia, Canada, Mexico, and the US. Soc Sci Med 2017; 197:226-234. [PMID: 29096946 DOI: 10.1016/j.socscimed.2017.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cigarette pack health warning labels can elicit negative emotions among smokers, yet little is known about how these negative emotions influence behavior change. OBJECTIVE Guided by psychological theories emphasizing the role of emotions on risk concern and behavior change, we investigated whether smokers who reported stronger negative emotional responses when viewing warnings reported stronger responses to warnings in daily life and were more likely to try to quit at follow-up. METHODS We analyzed data from 5439 adult smokers from Australia, Canada, Mexico, and the US, who were surveyed every four months from September 2012 to September 2014. Participants were shown warnings already implemented on packs in their country and reported negative emotional responses (i.e., fear, disgust, worry), which were averaged (range = 1 to 9). Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Models were adjusted for socio-demographic and smoking-related characteristics, survey wave, and the number of prior surveys answered. RESULTS Smokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. There was no significant interaction of negative emotions with self-efficacy or nicotine dependence. CONCLUSION Negative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts.
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Affiliation(s)
- Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA; Department of Tobacco Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Hua-Hie Yong
- The Cancer Council Victoria, Carlton, Victoria, Australia
| | - André Salem Szklo
- Division of Epidemiology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Ron Borland
- The Cancer Council Victoria, Carlton, Victoria, Australia
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Riley KE, Ulrich MR, Hamann HA, Ostroff JS. Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care. AMA J Ethics 2017; 19:475-485. [PMID: 28553905 PMCID: PMC5679230 DOI: 10.1001/journalofethics.2017.19.5.msoc1-1705] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns. We also contend that health care professionals have an ethical responsibility to try to mitigate stigmatizing messages of public health campaigns with empathic patient-clinician communication during clinical encounters.
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Affiliation(s)
- Kristen E Riley
- Postdoctoral research fellow at Memorial Sloan Kettering Cancer Center in New York City
| | - Michael R Ulrich
- Assistant professor in the Center for Health Law, Ethics & Human Rights and the Department of Health, Law, and Policy Management at Boston University School of Public Health
| | - Heidi A Hamann
- Associate professor in the Departments of Psychology and Family and Community Medicine at the University of Arizona in Tucson
| | - Jamie S Ostroff
- Chief of the behavioral sciences service in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center and a professor of psychology in the Department of Healthcare Policy and Research at Weill Cornell Medical College, both in New York City
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McQueen A, Waters EA, Kaphingst KA, Caburnay CA, Thompson VS, Boyum S, Kreuter MW. Examining Interpretations of Graphic Cigarette Warning Labels Among U.S. Youth and Adults. JOURNAL OF HEALTH COMMUNICATION 2016; 21:855-67. [PMID: 27410753 PMCID: PMC8193916 DOI: 10.1080/10810730.2016.1177142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Few studies have examined how diverse populations interpret warning labels. This study examined interpretations of 9 graphic cigarette warning labels (image plus text) proposed by the U.S. Food and Drug Administration among a convenience sample of youth (ages 13-17) and adults (18+) across the United States. Participants (N = 1,571) completed a cross-sectional survey. Participants were asked to select 1 of 3 plausible interpretations (1 preferred vs. 2 alternative) created by the research team about the particular consequence of smoking addressed in each warning label. Participants also rated each label for novelty, counterarguing, perceived effectiveness, and harm. Smokers reported their thoughts of quitting, self-efficacy, and motivation to quit. Although at least 70% of the sample chose the preferred interpretation for 7 of 9 labels, only 13% of participants chose all 9 preferred interpretations. The odds of selecting the preferred interpretation were lower among African Americans, among those with less education, and for labels perceived as being more novel. Smokers reported greater counterarguing and less perceived effectiveness and harms than nonsmokers, but results were not consistent across all labels and interpretations. The alternative interpretations of cigarette warning labels were associated with lower perceived effectiveness and lower perceived harms of smoking, both of which are important for motivating quit attempts.
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Affiliation(s)
- Amy McQueen
- Division of General Medical Sciences, Washington University, School of Medicine, St. Louis MO
- Health Communication Research Laboratory, Washington University, School of Social Work, St. Louis MO
| | - Erika A. Waters
- Division of Public Health Sciences, Washington University, School of Medicine, St. Louis MO
| | - Kimberly A. Kaphingst
- Department of Communication, University of Utah, Salt Lake City UT
- Huntsman Cancer Institute, Salt Lake City UT
| | - Charlene A. Caburnay
- Health Communication Research Laboratory, Washington University, School of Social Work, St. Louis MO
| | - Vetta S. Thompson
- Health Communication Research Laboratory, Washington University, School of Social Work, St. Louis MO
| | - Sonia Boyum
- Health Communication Research Laboratory, Washington University, School of Social Work, St. Louis MO
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Washington University, School of Social Work, St. Louis MO
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Bogliacino F, Codagnone C, Veltri GA, Chakravarti A, Ortoleva P, Gaskell G, Ivchenko A, Lupiáñez-Villanueva F, Mureddu F, Rudisill C. Pathos & Ethos: Emotions and Willingness to Pay for Tobacco Products. PLoS One 2015; 10:e0139542. [PMID: 26485272 PMCID: PMC4618929 DOI: 10.1371/journal.pone.0139542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/07/2015] [Indexed: 11/18/2022] Open
Abstract
In this article we use data from a multi-country Randomized Control Trial study on the effect of anti-tobacco pictorial warnings on an individual’s emotions and behavior. By exploiting the exogenous variations of images as an instrument, we are able to identify the effect of emotional responses. We use a range of outcome variables, from cognitive (risk perception and depth of processing) to behavioural (willingness to buy and willingness to pay). Our findings suggest that the odds of buying a tobacco product can be reduced by 80% if the negative affect elicited by the images increases by one standard deviation. More importantly from a public policy perspective, not all emotions behave alike, as eliciting shame, anger, or distress proves more effective in reducing smoking than fear and disgust.
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Affiliation(s)
| | | | | | - Amitav Chakravarti
- London School of Economics and Political Science, London, United Kingdom
- University of California Riverside, Riverside, California, United States of America
| | - Pietro Ortoleva
- Columbia University, New York City, United States of America
| | - George Gaskell
- London School of Economics and Political Science, London, United Kingdom
| | | | | | - Francesco Mureddu
- Universitat Oberta de Catalunya, Barcelona, Spain
- CRENoS—Centre for North South Economic Research, Cagliari, Italy
| | - Caroline Rudisill
- London School of Economics and Political Science, London, United Kingdom
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Magnan RE, Cameron LD. Do Young Adults Perceive That Cigarette Graphic Warnings Provide New Knowledge About the Harms of Smoking? Ann Behav Med 2015; 49:594-604. [DOI: 10.1007/s12160-015-9691-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Brewer NT, Hall MG, Lee JGL, Peebles K, Noar SM, Ribisl KM. Testing warning messages on smokers' cigarette packages: a standardised protocol. Tob Control 2015; 25:153-9. [PMID: 25564282 DOI: 10.1136/tobaccocontrol-2014-051661] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 12/12/2014] [Indexed: 01/24/2023]
Abstract
PURPOSE Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers' own packs. METHODS We tested a cigarette pack labelling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers' cigarette packs. RESULTS Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p<0.05). CONCLUSIONS Our findings suggest a feasible pack labelling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers' cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomised controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labelling policy. CLINICAL TRIAL NUMBER NCT02247908.
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Affiliation(s)
- Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph G L Lee
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kathryn Peebles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Seth M Noar
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA School of Journalism and Mass Communication, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Bekki K, Inaba Y, Kunugita N. [WHO Framework Convention on Tobacco Control (FCTC) Article 11: packaging and labelling of tobacco products]. Nihon Eiseigaku Zasshi 2015; 70:24-32. [PMID: 25744790 DOI: 10.1265/jjh.70.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires member countries to implement measures aimed at reducing the demand for tobacco products. FCTC article 11 describes the important forms of health communication and packaging regulations. And this article recommends on large pictorial health warnings and encourages more effective forms of disclosure on constituents and emissions. Furthermore, article 11 recognizes the importance of the package as a promotional vehicle for tobacco companies and requires the removal of potentially misleading packaging information, including the terms "light" and "mild." The Conference of the Parties (COP) adopted guidelines for implementation of article 11 on "Packaging and labelling of Tobacco Products". Some countries, such as Canada, the U.S.A., Australia, EU countries etc. positively promoted tobacco control by implementing countermeasures such as the graphic health warning labels and plain packages. These countermeasures showed the significant effects of decreasing smoking rate and preventing smoking initiation in young people. Furthermore, these warning labels were effective for the literally challenged. However, the Japanese government has not implemented these countermeasures, and only limited texts are shown on Japanese tobacco packaging. Therefore, Japan should emulate approaches taken by other countries, and promote the tobacco control policy in accordance with FCTC.
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Affiliation(s)
- Kanae Bekki
- Department of Environmental Health, National Institute of Public Health
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