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Ranney LM, Clark SA, Jarman KL, Lazard AJ, Kowitt SD, Cornacchione Ross J, Baler G, Thrasher JF, Goldstein AO. How do current tobacco warnings compare to the WHO FCTC guidelines: a content analysis of combustible tobacco warnings worldwide. BMJ Open 2023; 13:e062033. [PMID: 36940946 PMCID: PMC10030571 DOI: 10.1136/bmjopen-2022-062033] [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] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVE Many countries have adopted warning labels for combustible tobacco products, yet little research exists describing tobacco warning characteristics globally and to what extent they meet the WHO Framework Convention for Tobacco Control (FCTC) Guidelines. This study evaluates characteristics of combustible tobacco warnings. DESIGN We conducted a content analysis to describe the overall landscape of warnings using descriptive statistics and compared to the WHO FCTC Guidelines. SETTING We searched existing warning databases for combustible tobacco warnings from English-speaking countries. We compiled warnings meeting inclusion criteria and coded for message and image characteristics using a pre-defined codebook. PRIMARY AND SECONDARY OUTCOMES MEASURES Characteristics of combustible tobacco warning text statements and warning images were the primary study outcomes. There were no secondary study outcomes. RESULTS We identified a total of 316 warnings from 26 countries or jurisdictions worldwide. Of these warnings, 94% included warning text and an image. Warning text statements most often described health effects to the respiratory (26%), circulatory (19%) and reproductive systems (19%). Cancer was the most frequently mentioned health topic (28%). Fewer than half of warnings included a Quitline resource (41%). Few warnings included messages about secondhand smoke (11%), addiction (6%) or cost (1%). Of warnings with images, most were in colour and showed people (88%), mostly adults (40%). More than 1 in 5 warnings with images included a smoking cue (ie, cigarette). CONCLUSIONS While most tobacco warnings followed WHO FCTC guidance on effective tobacco warnings, such as communicating health risks and inclusion of images, many did not include local Quitline or cessation resources. A sizeable minority include smoking cues that could inhibit effectiveness. Full alignment with WHO FCTC guidelines will improve warnings and better achieve the WHO FCTC objectives.
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Affiliation(s)
- Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sonia A Clark
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen L Jarman
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah D Kowitt
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University, School of Public Health, Boston, MA, USA
| | - Guido Baler
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Perez CDA, Camacho LAB, Mendes FL, Oliveira da Silva AL, Figueiredo VC, Latuf GMDO, Fernandes AMMS, Albertassi PGD, Castello Branco PA, Branco PF, Piras SS, Suarez MC. 'If I hadn't seen this picture, I'd be smoking'-perceptions about innovations in health warnings for cigarette packages in Brazil: a focus group study. Tob Control 2023; 32:13-18. [PMID: 34290136 DOI: 10.1136/tobaccocontrol-2020-056360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/03/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the perceptions of young people and adults, smokers and non-smokers about the current set of innovations introduced in 2018 into the Brazilian tobacco products' health warnings. METHODS Twenty focus groups were conducted in five state capitals in Brazil. The participants (n=163) were segmented by smoking status, age (15-17 years, 18-55 years) and social grade (C, D-E classes) to examine cigarette packaging and explore the participants' perceptions of health warnings. RESULTS Health warnings capture attention, eliciting apprehension, fear, disgust and concern about the negative consequences of cigarette consumption. The 2018 Brazil health warnings are spontaneously recalled by participants, even without the presence of cigarette packages. However, the analysis also reveals the challenges of overcoming communication barriers and distorted interpretations, especially among smokers. The inclusion of direct and provocative stimuli, such as the use of the word 'you', attracts attention and creates more proximity to the recipient of the message. The results also highlight the interest and fear elicited by warnings on toxic constituents and the importance of using contrasting colours in warnings, which differentiate them from the colours of cigarette packs. CONCLUSION Introducing innovative components in health warnings can catch consumers' attention but considering that the interviewees encountered difficulties interpreting textual warnings about toxic constituents in cigarettes, the study reinforces the importance of adopting direct language and pictures, instead of text, which can visually transmit the warning messages and the use of specific wording that generates proximity between the emitter and receiver.
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Affiliation(s)
- Cristina de Abreu Perez
- National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | - Valeska Carvalho Figueiredo
- Center for Studies on Tobacco and Health. National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Sawyer K, Burke C, Ng RLY, Freeman TP, Adams S, Taylor G. Effectiveness of Mental Health Warnings on Tobacco Packaging in People With and Without Common Mental Health Conditions: An Online Randomised Experiment. Front Psychiatry 2022; 13:869158. [PMID: 35911223 PMCID: PMC9331922 DOI: 10.3389/fpsyt.2022.869158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health warning labels on tobacco packaging are a cost-effective means of health risk communication. However, while an extensive range of physical health risks are well-portrayed via current tobacco health warnings in the UK, there are none that currently portray the negative impact of smoking on mental health. Aims (i) develop novel mental health warning labels for tobacco packaging and (ii) test perceptions of these warnings in smokers and non-smokers, with and without mental health problems. Methods Six mental health warning labels were developed with a consultancy focus group. These warning labels were tested in an online randomised experiment, where respondents (N = 687) rated six Mental Health Warning Labels (MHWLs) and six Physical Health Warning Labels (PHWLs) on measures of perceived effectiveness, believability, arousal, valence, acceptability, reactance and novelty of information. Results MHWLs were perceived as low to moderately effective (mean = 4.02, SD = 2.40), but less effective than PHWLs (mean = 5.78, SD = 2.55, p < 0.001, η p 2 = 0.63). MHWLs were perceived as less believable, arousing, unpleasant, and acceptable than PHWLs. MHWLs evoked more reactance and were rated as more novel. Perceptions of MHWLs did not differ in people with and without mental health problems except for reactance and acceptability, but consistent with the PHWL literature, perceptions of MHWLs differed between non-smokers and smokers. Conclusion MHWLs could be an effective means to communicate novel information about the effects of smoking on mental health. MHWLs are perceived as less effective, believable, arousing, unpleasant, and acceptable than PHWLs, but MHWLs evoke more reactance and are rated as more novel.
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Affiliation(s)
- Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Chloe Burke
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Ronnie Long Yee Ng
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Tom P. Freeman
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Sally Adams
- Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
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Lemos TC, Coutinho GMS, Silva LAA, Stariolo JB, Campagnoli RR, Oliveira L, Pereira MG, Mota BEF, Souza GGL, Canella DS, Khandpur N, David IA. Ultra-Processed Foods Elicit Higher Approach Motivation Than Unprocessed and Minimally Processed Foods. Front Public Health 2022; 10:891546. [PMID: 35801235 PMCID: PMC9253546 DOI: 10.3389/fpubh.2022.891546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ultra-processed foods (UPF) are becoming extensively available in the food environments. UPF are industrial formulations that are designed to maximize palatability and consumption through a combination of calorie-dense ingredients and chemical additives. UPFs are also aggressively marketed, which may make them more attractive than unprocessed/minimally processed foods (UMPF). Since consumers' purchase decisions are guided by food-evoked emotions, we aimed to provide evidence that UPF visual cues trigger higher emotional responses and approach motivation than UMPF visual cues, with potential impacts on individuals' intention to consume the UPF over the UMPF. Methods Participants (n = 174; 144 women; mean age = 20.7 years; standard deviation = 4.35) performed two tasks. In the first task, 16 pictures of foods (8 UPF and 8 UMPF), and 74 pictures from other affective categories, were presented. After viewing each picture, the participants rated it along two basic dimensions of emotion through the Self-Assessment Manikin scale: pleasantness and arousal. In the second task, the participants viewed the same food pictures, and they rated their intention to consume the foods depicted in the pictures. Each picture was plotted in terms of its mean pleasantness and arousal ratings in a Cartesian plane, which resulted in an affective space. Results Pictures of UPF and UMPF were positioned in the upper arm of the boomerang-shaped affective space that represents approach motivation. Pictures containing UPF triggered higher approach motivation and intention to consume than pictures containing UMPF. We also found a stronger association between emotional responses and intention to consume UPF relative to UMPF. Conclusion These results shed new light on the role of ultra-processed foods evoked emotions that contribute to less healthy and sustainable food environments.
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Affiliation(s)
- Thayane C. Lemos
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Guilherme M. S. Coutinho
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Laiz A. A. Silva
- Department of Neurobiology, Institute of Biology, Universidade Federal Fluminense, Niterói, Brazil
| | - Jasmin B. Stariolo
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Rafaela R. Campagnoli
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
- Department of Neurobiology, Institute of Biology, Universidade Federal Fluminense, Niterói, Brazil
| | - Leticia Oliveira
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Mirtes G. Pereira
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
| | - Bruna E. F. Mota
- Laboratory of Psychophysiology, Department of Biological Sciences, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
- School of Nutrition, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Gabriela G. L. Souza
- Laboratory of Psychophysiology, Department of Biological Sciences, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
- School of Nutrition, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Daniela S. Canella
- Department of Applied Nutrition, Nutrition Institute, Universidade Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Nutrition, Center for Epidemiological Research in Nutrition and Health, Universidade de São Paulo, São Paulo, Brazil
| | - Neha Khandpur
- Department of Nutrition, Center for Epidemiological Research in Nutrition and Health, Universidade de São Paulo, São Paulo, Brazil
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Isabel A. David
- Department of Physiology and Pharmacology, Biomedical Institute, Universidade Federal Fluminense, Niterói, Brazil
- *Correspondence: Isabel A. David
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Gantiva C, Sotaquirá M, Chaparro V, Colorado L, Gómez A. Emotional impact of graphic health warnings on tobacco packaging: Analysis of their content. EUROPES JOURNAL OF PSYCHOLOGY 2022; 18:40-52. [PMID: 35330858 PMCID: PMC8895704 DOI: 10.5964/ejop.2885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
The use of graphic health warnings (GHWs) on tobacco packaging is one of the most widely used public health strategies worldwide, but there is little evidence of the emotional impact of its content and craving they generate. The objective of the present study was to evaluate the emotional and craving responses to GHW content. The study included 300 men and women of different ages (adolescents, young adults, and adults), both smokers and non-smokers. We evaluated the participants’ emotional and craving responses to 16 GHWs with different content (i.e., cancer, cardiovascular disease, abortion, and childhood illness). We analyzed the effects of sex, smoking status, and age. GHWs exhibited the capacity to elicit aversive emotional states, with low levels of arousal and high levels of dominance and did not produce craving. GHWs that showed images of cancer and abortion had the greatest emotional impact. Non-smoking adolescent females experienced the greatest emotional impact of GHWs. The results suggest that GHWs effectively reduce the attractiveness of cigarette packages and discourage consumption, and increasing the size of GHWs may favor avoidance of the package. GHWs that depicted explicit threats had a greater emotional impact, especially in women.
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Affiliation(s)
- Carlos Gantiva
- Department of Psychology, Universidad de los Andes, Bogotá, Colombia
- Department of Psychology, Universidad de los Andes, Cr 1 # 18a-12, Bogotá, Colombia. Tel: +57(1) 3394949.
| | - Miguel Sotaquirá
- Department of Psychology, Universidad de San Buenaventura, Bogotá, Colombia
| | - Vanessa Chaparro
- Department of Psychology, Universidad de San Buenaventura, Bogotá, Colombia
| | - Laura Colorado
- Department of Psychology, Universidad de San Buenaventura, Bogotá, Colombia
| | - Alejandra Gómez
- Department of Psychology, Universidad de San Buenaventura, Bogotá, Colombia
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Thrasher JF, Brewer NT, Niederdeppe J, Peters E, Strasser AA, Grana R, Kaufman AR. Advancing Tobacco Product Warning Labels Research Methods and Theory: A Summary of a Grantee Meeting Held by the US National Cancer Institute. Nicotine Tob Res 2019; 21:855-862. [PMID: 29444268 PMCID: PMC6775856 DOI: 10.1093/ntr/nty017] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/31/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The World Health Organization's Framework Convention on Tobacco Control recommends prominent pictorial health warnings on tobacco products. To advance research methods, theory and understanding of how tobacco product warning labels (TPWLs) work, the US National Cancer Institute convened a grantee meeting. Our article describes the key insights that emerged from the meeting, situated within the context of the scientific literature. RESULTS & RECOMMENDATIONS First, presentations confirmed that large, pictorial TPWLs motivate people to try to quit and encourage smoking cessation. Second, pictorial TPWLs increase attention, knowledge, negative affect, and thinking about the warning. Third, TPWL studies have primarily used brief-exposure laboratory studies and observational studies of sustained exposure through national policy implementation, with a few randomized trials involving several weeks of exposure-with generally consistent results found across study designs. Fourth, novel assessment methods include brain imaging, eye tracking and "best-worst" discrete choice experiments. To make TPWL even more effective, research is needed to confirm the mechanisms of their influence, their impact across vulnerable populations, and their effect on social media posts about tobacco products. Research is also needed on the effect of trial design choices, the predictive validity of new measurement approaches, and warning labels for non-cigarette tobacco products. IMPLICATIONS To improve scientific understanding of TPWL effects, this grantee meeting summary describes emerging research methods, theory and study results. Directions for future research include examination of the mechanisms of how warning labels work across diverse tobacco products and across different populations and contexts.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Ellen Peters
- Department of Psychology, The Ohio State University, Columbus, OH
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel Grana
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Annette R Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Gantiva C, Palacio S, Ortega A, Castillo K, Ortiz K. [Effectiveness of cigarette-pack warning labels in capturing the attention of smokers and nonsmokersEficácia das tarjas de advertência em maços de cigarro para atrair a atenção de fumantes e não fumantes]. Rev Panam Salud Publica 2019; 42:e101. [PMID: 31093129 PMCID: PMC6386099 DOI: 10.26633/rpsp.2018.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/29/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the ability of cigarette-pack warning labels, of the minimum size required by the World Health Organization, to capture the attention of smokers and nonsmokers. Methods In this study, 30 smokers and 30 nonsmokers completed a dot-probe task in which they simultaneously observed images of cigarette packs split in two: the top contained the cigarette brand and the bottom contained the warning label. During the task, brain activity was recorded through two event-related potentials of the negative-polarity type--the potential that occurs in the posterior-contralateral zone approximately 200 ms after a stimulus (N2pc) and the sustained posterior contralateral negativity (SPCN) response--which are indicators of early and sustained attention. Results In both groups, a greater amplitude of N2pc and SPCN potentials was found for the part of the pack containing the cigarette brand. However, during the dot-probe task, reaction times were shorter for the warning label. Conclusions These results suggest that, initially, attention is focused on the cigarette brand, and only then on the warning label. The inability of warning labels to capture early-phase attention decreases their effectiveness, especially in smokers. We suggest that warning labels be enlarged to facilitate increased attention response.
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Affiliation(s)
- Carlos Gantiva
- Laboratorio de Neurociencias y Neuropsicología, Departamento de Psicología, Universidad de San Buenaventura, Bogotá, Colombia
| | - Stefanny Palacio
- Laboratorio de Neurociencias y Neuropsicología, Departamento de Psicología, Universidad de San Buenaventura, Bogotá, Colombia
| | - Alejandra Ortega
- Laboratorio de Neurociencias y Neuropsicología, Departamento de Psicología, Universidad de San Buenaventura, Bogotá, Colombia
| | - Karen Castillo
- Laboratorio de Neurociencias y Neuropsicología, Departamento de Psicología, Universidad de San Buenaventura, Bogotá, Colombia
| | - Katherine Ortiz
- Laboratorio de Neurociencias y Neuropsicología, Departamento de Psicología, Universidad de San Buenaventura, Bogotá, Colombia
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Gantiva C, Sotaquirá M, Marroquín M, Carné C, Parada L, Muñoz MA. Size matters in the case of graphic health warnings: Evidence from physiological measures. Addict Behav 2019; 92:64-68. [PMID: 30597332 DOI: 10.1016/j.addbeh.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/30/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES >50 countries use graphic health warnings (GHWs) with the minimum size that is recommended by the World Health Organization (WHO). The aim of the present study was to evaluate the effect of the size of GHWs on physiological responses that serve as indices of arousal and aversive motivation in nonsmokers, weekly smokers, and daily smokers. METHODS The skin conductance response, corrugator muscle activity, and startle reflex were recorded in 35 nonsmokers, 35 weekly smokers, and 35 daily smokers while they observed pictures of cigarette packs without GHWs, cigarette packs with GHWs that covered 30% of the pack, and cigarette packs with GHWs that covered 60% of the pack. RESULTS Cigarette packs with 30% GHWs did not generate significantly higher responses on any of the physiological measures compared with cigarette packs without GHWs. Conversely, cigarette packs with GHWs that covered 60% of the pack generated a greater skin conductance response, greater corrugator muscle activity, and an increase in the startle reflex compared with cigarette packs without GHWs. No significant differences were found between groups in any of the physiological measures. CONCLUSIONS The minimum size of GHW that is recommended by the WHO is insufficient to generate an emotional response that favors avoidance of the cigarette pack. GHW that cover 60% of the cigarette pack significantly reduced the attractiveness of the tobacco packaging and generated greater arousal responses.
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Virgolini M, Fallocca V, Leonardelli E, Volchan E. Evaluación emocional y actitudinal de advertencias sanitarias de tabaco en adultos y jóvenes de Argentina. SALUD PUBLICA DE MEXICO 2018; 60:432-441. [DOI: 10.21149/9027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/15/2018] [Indexed: 11/06/2022] Open
Abstract
Objetivo. Evaluar el impacto emocional y las respuestas cognitivas y actitudinales de las advertencias sanitarias, para evitar el consumo del tabaco. Material y métodos. Se evaluaron 27 advertencias sanitarias de control del tabaco, procedentes de Argentina y de otros países, en 151 adolescentes y 168 adultos. Se aplicó un instrumento estandarizado para medir valencia y activación emocional y un cuestionario estructurado para la medición cognitivo-actitudinal. Se analizaron las correlaciones según edad y sexo, nivel de instrucción, condición de fumador, etapa de cambio en fumadores y susceptibilidad en adolescentes no fumadores. Resultados. Se observó alta correlación entre las valoraciones cognitivo-actitudinales y las emocionales. Las advertencias basadas en imágenes cruentas y de sufrimiento generaron más respuestas actitudinales asociadas con el abandono y la prevención del consumo del tabaco. Conclusiones. Se recomienda el uso de advertencias con altos niveles de activación emocional tanto para adultos como para adolescentes.
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David IA, Krutman L, Fernández-Santaella MC, Andrade JR, Andrade EB, Oliveira L, Pereira MG, Gomes FS, Gleiser S, Oliveira JM, Araújo RL, Volchan E, Braga F. Appetitive drives for ultra-processed food products and the ability of text warnings to counteract consumption predispositions. Public Health Nutr 2018; 21:543-557. [PMID: 29173214 PMCID: PMC10284718 DOI: 10.1017/s1368980017003263] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/12/2017] [Accepted: 10/06/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study aimed to (i) assess the appetitive drives evoked by the visual cues of ultra-processed food and drink products and (ii) investigate whether text warnings reduce appetitive drives and consumers' reported intentions to eat or drink ultra-processed products. DESIGN In Study I, a well-established psychometric tool was applied to estimate the appetitive drives associated with ultra-processed products using sixty-four image representations. Sixteen product types with four exemplars of a given product were included. Pictures from the International Affective Picture System (IAPS) served as controls. The two exemplars of each product type rated as more appetitive were selected for investigation in the second study. Study II assessed the impact of textual warnings on the appetitive drive towards these thirty-two exemplars. Each participant was exposed to two picture exemplars of the same product type preceded by a text warning or a control text. After viewing each displayed picture, the participants reported their emotional reactions and their intention to consume the product. SETTING Controlled classroom experiments SUBJECTS: Undergraduate students (Study I: n 215, 135 women; Study II: n 98, 52 women). RESULTS In Study I, the pictures of ultra-processed products prompted an appetitive motivation associated with the products' nutritional content. In Study II, text warnings were effective in reducing the intention to consume and the appetitive drive evoked by ultra-processed products. CONCLUSIONS This research provides initial evidence favouring the use of text warnings as a public policy tool to curb the powerful influence of highly appetitive ultra-processed food cues.
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Affiliation(s)
- Isabel A David
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello 101, Niterói, RJ 24210-130, Brazil
| | - Laura Krutman
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello 101, Niterói, RJ 24210-130, Brazil
- Facultad de Psicología, Universidad de Granada, Granada, Spain
| | | | - Jéssica R Andrade
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eduardo B Andrade
- Fundação Getulio Vargas, Escola Brasileira de Administração Pública e de Empresas, Rio de Janeiro, RJ, Brazil
| | - Leticia Oliveira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello 101, Niterói, RJ 24210-130, Brazil
| | - Mirtes G Pereira
- Departamento de Fisiologia e Farmacologia, Instituto Biomédico, Universidade Federal Fluminense, Rua Hernani Pires de Mello 101, Niterói, RJ 24210-130, Brazil
| | - Fabio S Gomes
- Pan American Health Organization/World Health Organization, Washington, DC, USA
| | - Sonia Gleiser
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - José M Oliveira
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renata L Araújo
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Eliane Volchan
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Filipe Braga
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Campus-UFRJ-Macaé Professor Aloísio Teixeira, Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
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Abstract
Objectives We examined the receptivity of non-college young adult hookah users to health warning labels. Methods We conducted in-person qualitative interviews with 23 hookah users, aged 18-29 in Austin, Texas, who were not currently enrolled in college/university. Data were transcribed, coded, and thematically analyzed using NVivo Pro, version 11. Results Gaps in knowledge were evident regarding the level of chemical exposure, cancer risks, and negative health consequences of hookah use. Respondents preferred warning labels that factually listed health consequences rather than labels that used "sensationalistic" wording (eg, "kills") or technical terms. Participants thought placement of hookah warning labels would be most effective on product packaging or on the door of establishments selling hookah. Respondents thought most of the warning labels would be effective in deterring hookah use; however, the majority stated they would likely continue to use hookah over the next year. Conclusions Non-college-attending young adult hookah users preferred hookah health warning labels that are simple, factual, informative, and non-sensationalistic. These results may inform regulations regarding the packaging of tobacco products, specifically in the design and placement of warning labels, which may result in better user message receptivity.
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Mostafa A, Mohammed HT. Graphic health warnings and their best position on waterpipes: A cross-sectional survey of expert and public opinion. Tob Prev Cessat 2017; 3:116. [PMID: 32432191 PMCID: PMC7232823 DOI: 10.18332/tpc/70873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Our aim was to assess the visibility and efficiency of graphic health warnings (GHWs) on waterpipe tobacco packs (WTPs) and to explore other more effective places to display them for better impact. We also evaluated the visibility of GHWs when placed on the waterpipe device. METHODS We conducted 3 cross-sectional study phases using face-to-face survey questionnaires in 2014-2015. Phase I surveyed 31 tobacco control experts, while Phase II surveyed 700 participants and Phase III surveyed 348 from the public in Cairo, Egypt. RESULTS Approximately half of the experts and participants in Phases II and III thought that GHWs on WTPs are not adequately visible, and 68.9% and 79.6% in Phases II and III, respectively, suggested posting warnings also in other places. About one-third of experts and 69.1% of Phase II participants suggested posting GHWs inside cafés or in public places, while 46.9% of Phase III participants favored placing them on waterpipes. After viewing our suggested positions on a waterpipe, all experts, 80.6% of participants in Phase II, and 81.6% in Phase III acknowledged that GHWs would be more visible there. The mouthpiece was the location selected most often across all phases (31.1% in Phase I, 35.6% in Phase II and 36.3% in Phase III). Lung and throat cancers were similarly effective in raising participants’ concern about waterpipe smoking health risks (24.7%). CONCLUSIONS This is the first population-based study to explore the best location to place GHWs on waterpipes. Policymakers should consider enacting a regulatory framework for placing GHWs on waterpipe devices.
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Affiliation(s)
- Aya Mostafa
- Ain Shams University, Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Cairo, Egypt
| | - Heba Tallah Mohammed
- Ain Shams University, Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Cairo, Egypt.,School of Pharmacy, University of Waterloo, Ontario, Canada
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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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Popova L, So J, Sangalang A, Neilands TB, Ling PM. Do Emotions Spark Interest in Alternative Tobacco Products? HEALTH EDUCATION & BEHAVIOR 2017; 44:598-612. [PMID: 28071144 DOI: 10.1177/1090198116683169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Exposure to advertisements for tobacco products and tobacco warning labels evokes emotions. This study evaluated the association of discrete positive and negative emotions with interest in alternative tobacco products. METHOD In 2013, 1,226 U.S. adult nonsmokers and current smokers viewed advertisements for moist snuff, snus, and electronic cigarettes (e-cigarettes) with various warning labels and then indicated their emotional responses in terms of anger, anxiety, sadness, guilt, disgust, discouragement, hope, and contentment. Outcomes were openness to using moist snuff, snus, and e-cigarettes in the future and interest in a free sample of each product. Data were analyzed in 2016. RESULTS Hope was positively associated with openness and interest across all alternative tobacco products as was contentment for moist snuff and snus. Anger was negatively associated with openness to moist snuff and e-cigarettes, disgust negatively to moist snuff and snus, and anxiety negatively to e-cigarettes. Being a current smoker, ever trying a corresponding product, being male, and younger age were associated with greater openness to and interest in moist snuff and snus. For e-cigarettes, being a current smoker, ever trying e-cigarettes, and being female were associated with greater openness, and being a current smoker was associated with greater odds of selecting a free sample. CONCLUSIONS Positive emotions, particularly hope, were consistently positively associated with interest in alternative tobacco products. Hope is widely used by tobacco and e-cigarette companies to advertise their products. Antitobacco messages should aim to lower hope associated with tobacco products but increase hope for cessation or life without tobacco.
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Affiliation(s)
- Lucy Popova
- 1 Georgia State University, Atlanta, GA, USA
| | - Jiyeon So
- 2 University of Georgia, Athens, GA, USA
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15
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Araújo P, Carvalho MGN, van Weelden M, Lourenço B, Queiroz LB, Silva CA. Uso indevido de drogas e função sexual em adolescentes com doenças crônicas. REVISTA PAULISTA DE PEDIATRIA 2016; 34:323-9. [DOI: 10.1016/j.rpped.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 10/21/2022]
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Araújo P, Carvalho MGN, van Weelden M, Lourenço B, Queiroz LB, Silva CA. Substance misuse and sexual function in adolescents with chronic diseases. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 27354415 PMCID: PMC5178118 DOI: 10.1016/j.rppede.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective: To evaluate alcohol/tobacco and/or illicit drug misuse in Chronic Diseases (CDs). Methods: A cross-sectional study with 220 CDs adolescents and 110 healthy controls including: demographic/anthropometric data; puberty markers; modified questionnaire evaluating sexual function, alcohol/smoking/illicit drug misuse and bullying; and the physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk. Results: The frequencies of alcohol/tobacco and/or illicit drug use were similar in both groups (30% vs. 34%, p=0.529), likewise the frequencies of bullying (42% vs. 41%, p=0.905). Further analysis solely in CDs patients that used alcohol/tobacco/illicit drug versus those that did not use showed that the median current age [15 (11–18) vs. 14 (10–18) years, p <0.0001] and education years [9 (5–14) vs. 8 (3–12) years, p <0.0001] were significant higher in substance use group. The frequencies of Tanner 5 (p <0.0001), menarche (p <0.0001) and spermarche (p=0.001) were also significantly higher in patients with CDs that used alcohol/tobacco/illicit, likewise sexual activity (23% vs. 3%, p <0.0001). A trend of a low frequency of drug therapy was observed in patients that used substances (70% vs. 82%, p=0.051). A positive correlation was observed between CRAFFT score and current age in CD patients (p=0.005, r=+0.189) and controls (p=0.018, r=+0.226). Conclusions: A later age was evidenced in CDs patients that reported licit/ilicit drug misuse. In CDs adolescent, substance use was more likely to have sexual intercourse. Our study reinforces that these patients should be systematically screened by pediatricians for drug related health behavioral patterns.
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Affiliation(s)
| | | | | | - Benito Lourenço
- Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Lígia Bruni Queiroz
- Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Clovis Artur Silva
- Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil.
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Paes J, de Oliveira L, Pereira MG, David I, Souza GGL, Sobral AP, Machado-Pinheiro W, Mocaiber I. The Perception of Aversiveness of Surgical Procedure Pictures Is Modulated by Personal/Occupational Relevance. PLoS One 2016; 11:e0160582. [PMID: 27518897 PMCID: PMC4982615 DOI: 10.1371/journal.pone.0160582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
It is well established that emotions are organized around two motivational systems: the defensive and the appetitive. Individual differences are relevant factors in emotional reactions, making them more flexible and less stereotyped. There is evidence that health professionals have lower emotional reactivity when viewing scenes of situations involving pain. The objective of this study was to investigate whether the rating of pictures of surgical procedure depends on their personal/occupational relevance. Fifty-two female Nursing (health discipline) and forty-eight Social Work (social science discipline) students participated in the experiment, which consisted of the presentation of 105 images of different categories (e.g., neutral, food), including 25 images of surgical procedure. Volunteers judged each picture according to its valence (pleasantness) and arousal using the Self-Assessment Manikin scale (dimensional approach). Additionally, the participants chose the word that best described what they felt while viewing each image (discrete emotion perspective). The average valence score for surgical procedure pictures for the Nursing group (M = 4.57; SD = 1.02) was higher than the score for the Social Work group (M = 3.31; SD = 1.05), indicating that Nursing students classified those images as less unpleasant than the Social Work students did. Additionally, the majority of Nursing students (65.4%) chose "neutral" as the word that best described what they felt while viewing the pictures. In the Social Work group, disgust (54.2%) was the emotion that was most frequently chosen. The evaluation of emotional stimuli differed according to the groups' personal/occupational relevance: Nursing students judged pictures of surgical procedure as less unpleasant than the Social Work students did, possibly reflecting an emotional regulation skill or some type of habituation that is critically relevant to their future professional work.
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Affiliation(s)
- Juliana Paes
- Laboratory of Cognitive Psychophysiology, Department of Natural Sciences, Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, Brazil
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Leticia de Oliveira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Mirtes Garcia Pereira
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Isabel David
- Laboratory of Neurophysiology of Behavior, Department of Physiology and Pharmacology, Biomedical Institute, Federal Fluminense University, Niterói, RJ, Brazil
| | - Gabriela Guerra Leal Souza
- Laboratory of Psychophysiology, Department of Biological Sciences, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Ana Paula Sobral
- Department of Engineering, Institute of Science and Technology, Federal Fluminense University, Rio das Ostras, RJ, Brazil
| | - Walter Machado-Pinheiro
- Laboratory of Cognitive Psychophysiology, Department of Natural Sciences, Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, Brazil
| | - Izabela Mocaiber
- Laboratory of Cognitive Psychophysiology, Department of Natural Sciences, Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, Brazil
- * E-mail:
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Gantiva C, Guerrero L, Rico A, Ramírez N, Díaz M, González M, Romo-González T. Influence of Cigarette Package Brand on the Emotional Impact of Tobacco-Warning Images That Cover 30% of Cigarette Packs in Smokers and Nonsmokers. Nicotine Tob Res 2016; 18:1324-30. [PMID: 26574553 DOI: 10.1093/ntr/ntv257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/04/2015] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Research on the emotional impact of tobacco-warning images (TWIs) has not evaluated the role of context (ie, cigarette packs) as a modulator of the emotional response to TWIs. The objective of the present study was to identify the influence of the cigarette package brand on the emotional impact of TWIs that cover 30% of cigarette packs in smokers and nonsmokers using a specific methodology for the study of emotion. METHODS The participants included 95 smokers and 111 nonsmokers who observed three TWIs under two conditions: TWIs that covered 30% of cigarette packs and TWIs alone, without brands. Additionally, 18 pictures from the International Affective Picture System were presented as comparison stimuli and to reduce the effect of habituation. The Self-Assessment Manikin was used to assess valence, arousal, and dominance dimensions. RESULTS TWIs that covered 30% of cigarette packs were evaluated as least aversive, with lower ratings of arousal and higher ratings of dominance in both groups. Differences in the valence, arousal, and dominance dimensions were found between groups. Smokers rated TWIs that covered 30% of cigarette packs as less aversive and more arousing and gave them lower dominance scores compared with nonsmokers. CONCLUSION The results suggest that cigarette packages modulate the emotional impact of TWIs, especially in smokers, and the minimum size of TWIs (ie, 30% of the front and back of the package) is not sufficiently large to generate an emotional impact associated with avoidance behavior. IMPLICATIONS Cigarette packages modulate the emotional impact of TWIs, especially in smokers. The cigarette package itself is an appetitive context that captures the attention of the observer and decreases the aversive emotional response to the TWIs. The minimum size of TWIs (ie, 30% of the front and back of the package) is not sufficiently large to generate an emotional impact associated with avoidance behavior.
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Affiliation(s)
- Carlos Gantiva
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia;
| | - Lorena Guerrero
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia
| | - Andrea Rico
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia
| | - Natalia Ramírez
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia
| | - Maite Díaz
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia
| | - Miyer González
- Department of Psychology, University of San Buenaventura, Bogotá, Bogotá, Colombia
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Development of the e-Baby serious game with regard to the evaluation of oxygenation in preterm babies: contributions of the emotional design. Comput Inform Nurs 2016; 32:428-36. [PMID: 25010051 DOI: 10.1097/cin.0000000000000078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study aimed to describe the development process of a serious game that enables users to evaluate the respiratory process in a preterm infant based on an emotional design model. The e-Baby serious game was built to feature the simulated environment of an incubator, in which the user performs a clinical evaluation of the respiratory process in a virtual preterm infant. The user learns about the preterm baby's history, chooses the tools for the clinical evaluation, evaluates the baby, and determines whether his/her evaluation is appropriate. The e-Baby game presents phases that contain respiratory process impairments of higher or lower complexity in the virtual preterm baby. Included links give the user the option of recording the entire evaluation procedure and sharing his/her performance on a social network. e-Baby integrates a Clinical Evaluation of the Preterm Baby course in the Moodle virtual environment. This game, which evaluates the respiratory process in preterm infants, could support a more flexible, attractive, and interactive teaching and learning process that includes simulations with features very similar to neonatal unit realities, thus allowing more appropriate training for clinical oxygenation evaluations in at-risk preterm infants. e-Baby allows advanced user-technology-educational interactions because it requires active participation in the process and is emotionally integrated.
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Wang AL, Lowen SB, Romer D, Giorno M, Langleben DD. Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers. Tob Control 2015; 24:225-32. [PMID: 25564288 PMCID: PMC4495960 DOI: 10.1136/tobaccocontrol-2014-051993] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Warning labels on cigarette packages are an important venue for information about the hazards of smoking. The 2009 US Family Smoking Prevention and Tobacco Control Act mandated replacing the current text-only labels with graphic warning labels. However, labels proposed by the Food and Drug Administration (FDA) were challenged in court by the tobacco companies, who argued successfully that the proposed labels needlessly encroached on their right to free speech, in part because they included images of high emotional salience that indiscriminately frightened rather than informed consumers. METHODS We used functional MRI to examine the effects of graphic warning labels' emotional salience on smokers' brain activity and cognition. Twenty-four smokers viewed a random sequence of blocks of graphic warning labels that have been rated high or low on an 'emotional reaction' scale in previous research. RESULTS We found that labels rated high on emotional reaction were better remembered, associated with reduction in the urge to smoke, and produced greater brain response in the amygdala, hippocampi, inferior frontal gyri and the insulae. CONCLUSIONS Recognition memory and craving are, respectively, correlates of effectiveness of addiction-related public health communications and interventions, and amygdala activation facilitates the encoding of emotional memories. Thus, our results suggest that emotional reaction to graphic warning labels contributes to their public health impact and may be an integral part of the neural mechanisms underlying their effectiveness. Given the urgency of the debate about the constitutional risks and public health benefits of graphic warning labels, these preliminary findings warrant consideration while longitudinal clinical studies are underway.
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Affiliation(s)
- An-Li Wang
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Steven B Lowen
- Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, MA 02178, USA
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mario Giorno
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel D Langleben
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, School of Medicine, University of Pennsylvania Philadelphia, PA 19104, USA
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Hiilamo H, Glantz SA. Implementation of effective cigarette health warning labels among low and middle income countries: state capacity, path-dependency and tobacco industry activity. Soc Sci Med 2014; 124:241-5. [PMID: 25462428 DOI: 10.1016/j.socscimed.2014.11.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We investigates the effects of ratifying the WHO Framework Convention of Tobacco Control (FTCT), state capacity, path-dependency and tobacco industry activity on the implementation of effective health warning labels (HWL) on cigarette packs among low and middle income countries (LMIC). Using logistic regression in separate analyses for FCTC Article 11 compliant HWLs and graphic HWLs (GHWL), we found that the odds of FCTC compliance increased by a factor of 1.31 for each year after FCTC entered into force in the country (p < 0.01). The odds of passing GHWLs increased by a factor of 1.46 (p < 0.05) per year after FCTC entered into force. The weaker the capacity of the states were, the less likely they were to have implemented FCTC compliant HWLs (p < 0.05). The countries with voluntary HWLs in 1992 were less likely (OR = 0.19, p < 0.01) to comply with FCTC 21 years later (in 2013). The FCTC has promoted HWL policies among LMICs. Public health regulations require investments in broader state capacity. As the theory of path-dependency predicts voluntary agreements have long lasting influence on the direction of tobacco control in a country. Adopting voluntary HWL policies reduced likelihood of having FCTC compliant HWLs decades later. The fact that voluntary agreements delayed effective tobacco regulations suggests that policymakers must be careful of accepting industry efforts for voluntary agreements in other areas of public health as well, such as alcohol and junk food.
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Affiliation(s)
| | - Stanton A Glantz
- Department of Medicine, Center for Tobacco Control Research & Education, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA.
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Hiilamo H, Crosbie E, Glantz SA. The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion. Tob Control 2014; 23:e2. [PMID: 23092884 PMCID: PMC3725195 DOI: 10.1136/tobaccocontrol-2012-050541] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyse the evolution and diffusion of health warnings on cigarette packs around the world, including tobacco industry attempts to block this diffusion. METHODS We analysed tobacco industry documents and public sources to construct a database on the global evolution and diffusion of health warning labels from 1966 to 2012, and also analysed industry strategies. RESULTS Health warning labels, especially labels with graphic elements, threaten the tobacco industry because they are a low-cost, effective measure to reduce smoking. Multinational tobacco companies did not object to voluntary innocuous warnings with ambiguous health messages, in part because they saw them as offering protection from lawsuits and local packaging regulations. The companies worked systematically at the international level to block or weaken warnings once stronger more specific warnings began to appear in the 1970s. Since 1985 in Iceland, the tobacco industry has been aware of the effectiveness of graphic health warning labels (GWHL). The industry launched an all-out attack in the early 1990s to prevent GHWLs, and was successful in delaying GHWLs internationally for nearly 10 years. CONCLUSIONS Beginning in 2005, as a result of the World Health Organisation Framework Convention on Tobacco Control (FCTC), GHWLs began to spread. Effective implementation of FCTC labelling provisions has stimulated diffusion of strong health warning labels despite industry opposition.
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Affiliation(s)
- Heikki Hiilamo
- Social Insurance Institution of Finland, Research Department, Helsinki, Finland
| | - Eric Crosbie
- Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Department of Medicine, Center for Tobacco Control Research & Education, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
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Paudel B, Paudel K, Timilsina D. Reactions of nepali adults to warning labels on cigarette packages: a survey with employee and medical students of a tertiary care medical college of Western region of Nepal. J Clin Diagn Res 2013; 7:2216-22. [PMID: 24298480 DOI: 10.7860/jcdr/2013/5588.3475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 08/17/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND For the past 30 years, there have been no changes in the text-only cigarette warning labels in Nepal. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of the current study was primarily to compare the differences in reactions to different types of warning labels on cigarette packages, with a specific focus on whether the new warning label adopted by WHO FCTC was better than the text only label used by Nepal. MATERIAL AND METHODS This study was conducted in Gandaki Medical College Teaching Hospital (GMCTH) in 2012, in a tertiary care hospital located in the western region of Nepal. Eligible study participants included in this survey were those aged 18 years and over and those who are studying MBBS/Nursing or who were employees of GMCTH. 500 participants finished the survey. Participants were shown nine types of warning labels found on cigarette packages.They comprised one text only warning label used within Nepalese market and eight foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking. RESULTS On comparing the Nepalese warning label with other foreign labels with regards to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were found to be more effective. Both smokers and non-smokers thought that warning labels with text plus graphics were substantially more of a deterrent than text-only labels. CONCLUSION The findings from this study support previous research that has found that text-plus graphic warning labels were more salient and potentially more effective than text-only labels.Warning labels are one of the component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger Nepalese public health educational efforts.
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Affiliation(s)
- Badri Paudel
- Associate Professor, Department of Medicine, Gandaki Medicial College Teaching Hospital , Pokhara, Nepal
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Volchan E, David IA, Tavares G, Nascimento BM, Oliveira JM, Gleiser S, Szklo A, Perez C, Cavalcante T, Pereira MG, Oliveira L. Implicit motivational impact of pictorial health warning on cigarette packs. PLoS One 2013; 8:e72117. [PMID: 23977223 PMCID: PMC3744501 DOI: 10.1371/journal.pone.0072117] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/06/2013] [Indexed: 11/22/2022] Open
Abstract
Objective The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control. Methods Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs’ manipulation, and quantified judgments of warnings’ emotional strength and efficacy against smoking. Findings Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants’ judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking. Conclusions Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change.
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Affiliation(s)
- Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Isabel A. David
- Biomedical Institute, Universidade Federal Fluminense, Niteroi, Brazil
| | - Gisella Tavares
- Biomedical Institute, Universidade Federal Fluminense, Niteroi, Brazil
| | - Billy M. Nascimento
- Institute of Biophysics Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jose M. Oliveira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sonia Gleiser
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andre Szklo
- Coordination for Prevention and Surveillance, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Cristina Perez
- Executive Secretariat of the National Commission for FCTC Implementation in Brazil, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Tania Cavalcante
- Executive Secretariat of the National Commission for FCTC Implementation in Brazil, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Mirtes G. Pereira
- Biomedical Institute, Universidade Federal Fluminense, Niteroi, Brazil
| | - Leticia Oliveira
- Biomedical Institute, Universidade Federal Fluminense, Niteroi, Brazil
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Brown KG, Reidy JG, Weighall AR, Arden MA. Graphic imagery is not sufficient for increased attention to cigarette warnings: the role of text captions. Addiction 2013; 108:820-5. [PMID: 23072564 DOI: 10.1111/add.12008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/16/2012] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Abstract
AIMS The present study aims to assess the extent to which attention to UK cigarette warnings is attributable to the graphic nature of the content. DESIGN A visual dot probe task was utilised, with the warnings serving as critical stimuli that were manipulated for the presence of graphic versus neutral image content, and the accompanying text caption. This mixed design yielded image content (graphic versus neutrally-matched images) and presence (versus absence) of text caption as within subjects variables and smoking status as a between-participants variable. SETTING The experiment took place within the laboratories of a UK university. PARTICIPANTS Eighty-six psychology undergraduates (51% smokers, 69% female), predominantly of Caucasian ethnicity took part. MEASUREMENTS Reaction times towards probes replacing graphic images relative to probes replacing neutral images were utilised to create an index of attentional bias. FINDINGS Bias scores (M = 10.20 ± 2.56) highlighted that the graphic image content of the warnings elicited attentional biases (relative to neutral images) for smokers. This only occurred in the presence of an accompanying text caption [t (43) = 3.950, P < 0.001] as opposed to when no caption was present [t (43) = 0.029, P = 0.977]. Non-smokers showed no biases in both instances. CONCLUSIONS Graphic imagery on cigarette packets increases attentional capture, but only when accompanied by a text message about health risks.
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Affiliation(s)
- Kyle G Brown
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, UK.
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26
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Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med 2012; 9:e1001336. [PMID: 23139643 PMCID: PMC3491001 DOI: 10.1371/journal.pmed.1001336] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. METHODS AND FINDINGS The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. CONCLUSIONS Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- David Levy
- Population Sciences, Department of Oncology, Georgetown University, Washington DC, USA.
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27
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Azagba S, Sharaf MF. The effect of graphic cigarette warning labels on smoking behavior: evidence from the Canadian experience. Nicotine Tob Res 2012; 15:708-17. [PMID: 22990228 DOI: 10.1093/ntr/nts194] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION There is a substantial literature that graphic tobacco warnings are effective; however, there is limited evidence based on actual smoking behavior. The objective of this paper is to assess the effect of graphic cigarette warning labels on smoking prevalence and quit attempts. METHODS A nationally representative sample of individuals aged 15 years and older from the Canadian National Population Health Survey 1998-2008 is used. The sample consists of 4,853 individuals for the smoking prevalence regression and 1,549 smokers for quit attempts. The generalized estimating equation (GEE) model was used to examine the population-averaged (marginal) effects of tobacco graphic warnings on smoking prevalence and quit attempts. To assess the effect of graphic tobacco health warnings on smoking behavior, we used a scaled variable that takes the value of 0 for the first 6 months in 2001, then increases gradually to 1 from December 2001. RESULTS We found that graphic warnings had a statistically significant effect on smoking prevalence and quit attempts. In particular, the warnings decreased the odds of being a smoker (odds ratio [OR] = 0.875; 95% CI = 0.821-0.932) and increased the odds of making a quit attempt (OR = 1.330, CI = 1.187-1.490). Similar results were obtained when we allowed for more time for the warnings to appear in retail outlets. CONCLUSION This study adds to the growing body of evidence on the effectiveness of graphic warnings. Our findings suggest that warnings had a significant effect on smoking prevalence and quit attempts in Canada.
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Affiliation(s)
- Sunday Azagba
- Department of Economics, Concordia University, Montréal, QC, Canada.
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28
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Eye movement responses to health messages on cigarette packages. BMC Public Health 2012; 12:352. [PMID: 22583956 PMCID: PMC3464951 DOI: 10.1186/1471-2458-12-352] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions. METHODS Eye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo. RESULTS Results of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos. CONCLUSIONS Non-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion.
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Lin PN, Zimmermann MH, Bover Manderski MT, Schmelzer AC, Steinberg MB. Evaluation of Graphic Cigarette Warning Images on Cravings to Smoke. J Smok Cessat 2011. [DOI: 10.1375/jsc.6.2.85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractWhile health warnings are present on cigarette packs around the world, the nature of the warnings varies considerably between countries. In the United States, a small text warning citing the dangers of cigarette smoking is found on the side of all packs. This pilot study sought to determine whether graphic cigarette warning images, like those found in the United Kingdom and Canada, were better at decreasing cravings to smoke than existing text warnings found on cigarette packs in the United States. Twenty-five smokers seeking treatment to quit at a specialty tobacco treatment program were administered the Brief Questionnaire of Smoking Urges (QSU — BRIEF), a validated measure of craving, prior to and following exposure to cigarette pack warning images. The graphic cigarette warning images reduced cravings to smoke (6.20 point decrease) more than neutral images (3.36 point decrease) and current text warnings used in the United States (5.75 point decrease), although this difference was not statistically significant. Based on these pilot data, a larger study could further examine the effectiveness of graphic warning images and whether such warnings hold an advantage over the currently used text warnings.
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Estimating the impact of pictorial health warnings and "plain" cigarette packaging: evidence from experimental auctions among adult smokers in the United States. Health Policy 2011; 102:41-8. [PMID: 21763026 DOI: 10.1016/j.healthpol.2011.06.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 06/15/2011] [Accepted: 06/19/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To estimate differences in demand for cigarette packages with different packaging and health warning label formats. METHODS Adult smokers (n=404) in four states participated in experimental auctions. Participants bid on two of four experimental conditions, each involving a different health warning label format but with the same warning message: (1) text on 50% of pack side; (2) text on 50% of the pack front and back; (3) text with a graphic picture on 50% of the pack front and back; and (4) same as previous format, but without brand imagery. RESULTS Mean bids decreased across conditions (1: $3.52; 2: $3.43; 3: $3.11; 4: $2.93). Bivariate and multivariate random effects models indicated that there was no statistically significant difference in demand for packs with either of the two text only warnings; however, demand was significantly lower for both packs with prominent pictorial warnings, with the lowest demand associated with the plain, unbranded pack. CONCLUSIONS Results suggest that prominent health warnings with graphic pictures will reduce demand for cigarettes. Regulators should not only consider this type of warning label, but also plain packaging policies for tobacco products.
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Chang FC, Chung CH, Yu PT, Chao KY. The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan. HEALTH EDUCATION RESEARCH 2011; 26:179-191. [PMID: 21084424 DOI: 10.1093/her/cyq073] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking.
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Affiliation(s)
- Fong-ching Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei 10610, Taiwan.
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32
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Thrasher JF, Villalobos V, Szklo A, Fong GT, Pérez C, Sebrié E, Sansone N, Figueiredo V, Boado M, Arillo-Santillán E, Bianco E. Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico. SALUD PUBLICA DE MEXICO 2010; 52 Suppl 2:S206-15. [PMID: 21243191 PMCID: PMC4604598 DOI: 10.1590/s0036-36342010000800016] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/02/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the impact of different health warning labels (HWL). MATERIAL AND METHODS Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. RESULTS HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. CONCLUSIONS This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.
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Affiliation(s)
- James F Thrasher
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
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Raute LJ, Pednekar MS, Gupta PC. Pictorial Health Warnings on Cigarette Packs: A Population Based Study Findings from India. Tob Use Insights 2009. [DOI: 10.4137/tui.s2751] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Although tobacco is the leading preventable cause of the death among adults in India, the general public including tobacco users has little awareness about possible consequences of tobacco use. One way of bringing more awareness is to place more information on tobacco products in the form of pictorial warnings. Strong pictorial warnings were mandated by the Indian government but were diluted later on. The question that needs to be investigated whether general public in India needs pictorial warnings on tobacco products and how the warnings would look like? Material and Method A survey of 712 individuals was conducted in Mumbai and Thane. A structured questionnaire was designed and data were collected by trained field investigators. The questionnaire contains several questions on awareness of health warnings on tobacco products, opinion on strength of the warnings and on delays in implementing warnings. Results Among 712 respondents, 89.9% were aware about health warning messages on cigarettes pack. 88.5% of people were strongly agreed for strengthening the pictorial health warnings. Strong pictorial health warnings would make 23.2% male tobacco users thinking to quit smoking and 33.1% never tobacco users will think twice before starting smoking. Conclusion Positive response was shown by general population for implementation of pictorial warnings on tobacco products. Majority of the people were strongly agreed for strong pictorial warnings which were diluted by government notifications in year 2008.
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Affiliation(s)
- Lalit J. Raute
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Prakash C. Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
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