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Sample records for cigarette package warnings

  1. 76 FR 66074 - Small Entity Compliance Guide: Required Warnings for Cigarette Packages and Advertisements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-25

    ... Cigarette Packages and Advertisements; Availability AGENCY: Food and Drug Administration, HHS. ACTION... industry entitled ``Required Warnings for Cigarette Packages and Advertisements--Small Entity Compliance... entitled ``Required Warnings for Cigarette Packages and Advertisements--Small Entity Compliance Guide'' to...

  2. 76 FR 36627 - Required Warnings for Cigarette Packages and Advertisements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-22

    ...The Food and Drug Administration (FDA) is amending its regulations to add a new requirement for the display of health warnings on cigarette packages and in cigarette advertisements. This rule implements a provision of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) that requires FDA to issue regulations requiring color graphics, depicting the negative health......

  3. Required warnings for cigarette packages and advertisements. Final rule.

    PubMed

    2011-06-22

    The Food and Drug Administration (FDA) is amending its regulations to add a new requirement for the display of health warnings on cigarette packages and in cigarette advertisements. This rule implements a provision of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) that requires FDA to issue regulations requiring color graphics, depicting the negative health consequences of smoking, to accompany the nine new textual warning statements required under the Tobacco Control Act. The Tobacco Control Act amends the Federal Cigarette Labeling and Advertising Act (FCLAA) to require each cigarette package and advertisement to bear one of nine new textual warning statements. This final rule specifies the color graphic images that must accompany each of the nine new textual warning statements.

  4. 76 FR 67197 - Small Entity Compliance Guide: Required Warnings for Cigarette Packages and Advertisements...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-31

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND... Cigarette Packages and Advertisements; Availability; Correction AGENCY: Food and Drug Administration, HHS... of a guidance for industry entitled ``Required Warnings for Cigarette Packages and...

  5. Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers.

    PubMed

    Mays, Darren; Niaura, Raymond S; Evans, W Douglas; Hammond, David; Luta, George; Tercyak, Kenneth P

    2015-03-01

    This study examined the impact of pictorial cigarette-warning labels, warning-label message framing and plain cigarette packaging, on young adult smokers' motivation to quit. Smokers aged 18-30 years (n=740) from a consumer research panel were randomised to one of four experimental conditions where they viewed online images of four cigarette packs with warnings about lung disease, cancer, stroke/heart disease and death, respectively. Packs differed across conditions by warning-message framing (gain vs loss) and packaging (branded vs plain). Measures captured demographics, smoking behaviour, covariates and motivation to quit in response to cigarette packs. Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pretest motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer and mortality warnings (p<0.05), compared with loss-framed warnings on plain packs. Warnings combining pictorial depictions of smoking-related health risks with text-based messages about how quitting reduces risks, may achieve better outcomes among young adults, especially in countries considering or implementing plain packaging regulations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers

    PubMed Central

    Mays, Darren; Niaura, Raymond S.; Evans, W. Douglas; Hammond, David; Luta, George; Tercyak, Kenneth P.

    2014-01-01

    Objective This study examined the impact of pictorial cigarette warning labels, warning label message framing, and plain cigarette packaging on young adult smokers’ motivation to quit. Methods Smokers ages 18–30 (n=740) from a consumer research panel were randomized to one of four experimental conditions where they viewed online images of 4 cigarette packs with warnings about lung disease, cancer, stroke/heart disease, and death, respectively. Packs differed across conditions by warning message framing (gain versus loss) and packaging (branded versus plain). Measures captured demographics, smoking behavior, covariates, and motivation to quit in response to cigarette packs. Results Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pre-test motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer, and mortality warnings (p < 0.05), compared with loss-framed warnings on plain packs. Conclusions Warnings combining pictorial depictions of smoking-related health risks with text-based messages about how quitting reduces risks may achieve better outcomes among young adults, especially in countries considering or implementing plain packaging regulations. PMID:24420310

  7. Testing warning messages on smokers’ cigarette packages: A standardized protocol

    PubMed Central

    Brewer, Noel T.; Hall, Marissa G.; Lee, Joseph G. L.; Peebles, Kathryn; Noar, Seth M.; Ribisl, Kurt M.

    2015-01-01

    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 labeling 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<.05). Conclusion Our findings suggest a feasible pack labeling 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 randomized 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 labeling policy. PMID:25564282

  8. Longer Term Impact of Cigarette Package Warnings in Australia Compared with the United Kingdom and Canada

    ERIC Educational Resources Information Center

    Li, Lin; Borland, Ron; Yong, Hua; Cummings, Kenneth M.; Thrasher, James F.; Hitchman, Sara C.; Fong, Geoffrey T.; Hammond, David; Bansal-Travers, Maansi

    2015-01-01

    This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK…

  9. Longer Term Impact of Cigarette Package Warnings in Australia Compared with the United Kingdom and Canada

    ERIC Educational Resources Information Center

    Li, Lin; Borland, Ron; Yong, Hua; Cummings, Kenneth M.; Thrasher, James F.; Hitchman, Sara C.; Fong, Geoffrey T.; Hammond, David; Bansal-Travers, Maansi

    2015-01-01

    This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK…

  10. Testing warning messages on smokers' cigarette packages: a standardised protocol.

    PubMed

    Brewer, Noel T; Hall, Marissa G; Lee, Joseph G L; Peebles, Kathryn; Noar, Seth M; Ribisl, Kurt M

    2016-03-01

    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. 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. 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). 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. NCT02247908. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Communicating Risk to Smokers: The Impact of Health Warnings on Cigarette Packages

    PubMed Central

    Hammond, David; Fong, Geoffrey T.; Borland, Ron; Cummings, K. Michael; McNeill, Ann; Driezen, Pete

    2007-01-01

    Background Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the U.S. The current study examined the effectiveness of health warnings on cigarette packages in four countries. Methods Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (N= 14,975): Canada (n =3687); the U.S. (n =4273); the UK (n= 3634); and Australia (n =3381). Surveys were conducted between 2002 and 2005, before and at three time points following new warnings on UK packages. Results . At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave. Conclusions Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness. PMID:17296472

  12. Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study.

    PubMed

    Hammond, David; Fong, Geoffrey T; Borland, Ron; Cummings, K Michael; McNeill, Ann; Driezen, Pete

    2007-03-01

    Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the United States. The current study examined the effectiveness of health warnings on cigarette packages in four countries. Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (n=14,975): Canada (n=3687), United States (n=4273), UK (n=3634), and Australia (n=3381). Surveys were conducted between 2002 and 2005, before and at three time points following implementation of new package warnings in the UK. At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave. Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.

  13. Young children's perceptions of health warning labels on cigarette packages: a study in six countries.

    PubMed

    Borzekowski, Dina L G; Cohen, Joanna E

    2014-01-01

    Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children. Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia. Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding. While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.

  14. Effects of and attention to graphic warning labels on cigarette packages.

    PubMed

    Süssenbach, Philipp; Niemeier, Sarah; Glock, Sabine

    2013-01-01

    The present study investigates the effects of graphic cigarette warnings compared to text-only cigarette warnings on smokers' explicit (i.e. ratings of the packages, cognitions about smoking, perceived health risk, quit intentions) and implicit attitudes. In addition, participants' visual attention towards the graphic warnings was recorded using eye-tracking methodology. Sixty-three smokers participated in the present study and either viewed graphic cigarette warnings with aversive and non-aversive images or text-only warnings. Data were analysed using analysis of variance and correlation analysis. Especially, graphic cigarette warnings with aversive content drew attention and elicited high threat. However, whereas attention directed to the textual information of the graphic warnings predicted smokers' risk perceptions, attention directed to the images of the graphic warnings did not. Moreover, smokers' in the graphic warning condition reported more positive cognitions about smoking, thus revealing cognitive dissonance. Smokers employ defensive psychological mechanisms when confronted with threatening warnings. Although aversive images attract attention, they do not promote health knowledge. Implications for graphic health warnings and the importance of taking their content (i.e. aversive vs. non-aversive images) into account are discussed.

  15. Longer term impact of cigarette package warnings in Australia compared with the United Kingdom and Canada

    PubMed Central

    Li, Lin; Borland, Ron; Yong, Hua; Cummings, Kenneth M.; Thrasher, James F.; Hitchman, Sara C.; Fong, Geoffrey T.; Hammond, David; Bansal-Travers, Maansi

    2015-01-01

    This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK warnings was higher than the Australian and Canadian pictorial warnings, this did not lead to greater levels of cognitive reactions, forgoing or avoiding. There was no difference in ratings between the Australian and UK warnings for cognitive responses and forgoing, but the Canadian warnings were responded to more strongly. Avoidance of the Australian warnings was greater than to UK ones, but less than to the Canadian warnings. The impact of warnings declined over time in all three countries. Declines were comparable between Australia and the United Kingdom on all measures except avoiding, where Australia had a greater rate of decline; and for salience where the decline was slower in Canada. Having two rotating sets of warnings does not appear to reduce wear-out over a single set of warnings. Warning size may be more important than warning type in preventing wear-out, although both probably contribute interactively. PMID:25492056

  16. Longer term impact of cigarette package warnings in Australia compared with the United Kingdom and Canada.

    PubMed

    Li, Lin; Borland, Ron; Yong, Hua; Cummings, Kenneth M; Thrasher, James F; Hitchman, Sara C; Fong, Geoffrey T; Hammond, David; Bansal-Travers, Maansi

    2015-02-01

    This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK warnings was higher than the Australian and Canadian pictorial warnings, this did not lead to greater levels of cognitive reactions, forgoing or avoiding. There was no difference in ratings between the Australian and UK warnings for cognitive responses and forgoing, but the Canadian warnings were responded to more strongly. Avoidance of the Australian warnings was greater than to UK ones, but less than to the Canadian warnings. The impact of warnings declined over time in all three countries. Declines were comparable between Australia and the United Kingdom on all measures except avoiding, where Australia had a greater rate of decline; and for salience where the decline was slower in Canada. Having two rotating sets of warnings does not appear to reduce wear-out over a single set of warnings. Warning size may be more important than warning type in preventing wear-out, although both probably contribute interactively. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Estimating the impact of different cigarette package warning label policies: the auction method.

    PubMed

    Thrasher, James F; Rousu, Matthew C; Anaya-Ocampo, Rafael; Reynales-Shigematsu, Luz Myriam; Arillo-Santillán, Edna; Hernández-Avila, Mauricio

    2007-12-01

    The study estimated the reduction in demand associated with implementing cigarette package warning labels that contain imagery illustrating the consequences of smoking. The experimental auction method was used, wherein adult smokers in Mexico (n=89) placed separate bids on two packs of cigarettes: one with a text-only warning label and the other with a warning label that included text and a graphic image. Differences in the values attributed to each pack were assessed using t-tests and multivariate regression. The pack with the graphic image had a mean attributed value which was 17% lower ($3.21 pesos) than the pack with the text-only warning, and this difference remained statistically significant within subgroups defined by sociodemographics, amount of smoking, number of quit attempts, and levels of perceived smoking risks. In the multivariate model, the difference in attributed values was greater among females than males, but no such differences were found for other sociodemographic or smoking-related variables. The consistently lower value that smokers attributed to cigarette packages with the graphic warning label indicates that these labels are likely to reduce cigarette demand.

  18. Motivation to quit smoking and acceptability of shocking warnings on cigarette packages in Lebanon

    PubMed Central

    Layoun, Nelly; Salameh, Pascal; Waked, Mirna; Aoun Bacha, Z; Zeenny, Rony M; El Hitti, Eric; Godin, Isabelle; Dramaix, Michèle

    2017-01-01

    Introduction Health warnings on tobacco packages have been considered an essential pillar in filling the gap of knowledge and communicating the health risks of tobacco use to consumers. Our primary objective was to report the perception of smokers on the textual health warnings already appearing on tobacco packages in Lebanon versus shocking pictures about the health-related smoking consequences and to evaluate their impact on smoking behaviors and motivation. Methods A pilot cross-sectional study was undertaken between 2013 and 2015 in five hospitals in Lebanon. Participants answered a questionnaire inquiring about sociodemographic characteristics, chronic respiratory symptoms, smoking behavior and motivation to quit smoking. Only-text warning versus shocking pictures was shown to the smokers during the interview. Results Exactly 66% of the participants reported that they thought shocking pictorial warnings would hypothetically be more effective tools to reduce/quit tobacco consumption compared to only textual warnings. Also, 31.9% of the smokers who were motivated to stop smoking reported that they actually had stopped smoking for at least 1 month secondary to the textual warnings effects. A higher motivation to quit cigarette smoking was seen among the following groups of smokers: males (odds ratio [OR] =1.8, P=0.02), who had stopped smoking for at least 1 month during the last year due to textual warning (OR =2.79, P<0.001), who considered it very important to report health warning on cigarette packs (OR =1.92, P=0.01), who had chronic expectoration (OR =1.81, P=0.06) and who would change their favorite cigarette pack if they found shocking images on the pack (OR =1.95, P=0.004). Conclusion Low-dependent smokers and highly motivated to quit smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit was associated with sensitivity to warnings, but not with the presence of all chronic respiratory symptoms. PMID

  19. Motivation to quit smoking and acceptability of shocking warnings on cigarette packages in Lebanon.

    PubMed

    Layoun, Nelly; Salameh, Pascal; Waked, Mirna; Aoun Bacha, Z; Zeenny, Rony M; El Hitti, Eric; Godin, Isabelle; Dramaix, Michèle

    2017-01-01

    Health warnings on tobacco packages have been considered an essential pillar in filling the gap of knowledge and communicating the health risks of tobacco use to consumers. Our primary objective was to report the perception of smokers on the textual health warnings already appearing on tobacco packages in Lebanon versus shocking pictures about the health-related smoking consequences and to evaluate their impact on smoking behaviors and motivation. A pilot cross-sectional study was undertaken between 2013 and 2015 in five hospitals in Lebanon. Participants answered a questionnaire inquiring about sociodemographic characteristics, chronic respiratory symptoms, smoking behavior and motivation to quit smoking. Only-text warning versus shocking pictures was shown to the smokers during the interview. Exactly 66% of the participants reported that they thought shocking pictorial warnings would hypothetically be more effective tools to reduce/quit tobacco consumption compared to only textual warnings. Also, 31.9% of the smokers who were motivated to stop smoking reported that they actually had stopped smoking for at least 1 month secondary to the textual warnings effects. A higher motivation to quit cigarette smoking was seen among the following groups of smokers: males (odds ratio [OR] =1.8, P=0.02), who had stopped smoking for at least 1 month during the last year due to textual warning (OR =2.79, P<0.001), who considered it very important to report health warning on cigarette packs (OR =1.92, P=0.01), who had chronic expectoration (OR =1.81, P=0.06) and who would change their favorite cigarette pack if they found shocking images on the pack (OR =1.95, P=0.004). Low-dependent smokers and highly motivated to quit smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit was associated with sensitivity to warnings, but not with the presence of all chronic respiratory symptoms.

  20. Potential Impact of Graphic Health Warnings on Cigarette Packages in Reducing Cigarette Demand and Smoking-Related Deaths in Vietnam.

    PubMed

    Minh, Hoang Van; Chung, Le Hong; Giang, Kim Bao; Duc, Duong Minh; Hinh, Nguyen Duc; Mai, Vu Quynh; Cuong, Nguyen Manh; Manh, Pham Duc; Duc, Ha Anh; Yang, Jui-Chen

    2016-01-01

    Two years after implementation of the graphic health warning intervention in Vietnam, it is very important to evaluate the intervention's potential impact. The objective of this paper was to predict effects of graphic health warnings on cigarette packages, particularly in reducing cigarette demand and smoking-associated deaths in Vietnam. In this study, a discrete choice experiment (DCE) method was used to evaluate the potential impact of graphic tobacco health warnings on smoking demand. To predict the impact of GHWs on reducing premature deaths associated with smoking, we constructed different static models. We adapted the method developed by University of Toronto, Canada and found that GHWs had statistically significant impact on reducing cigarette demand (up to 10.1% through images of lung damage), resulting in an overall decrease of smoking prevalence in Vietnam. We also found that between 428,417- 646,098 premature deaths would be prevented as a result of the GHW intervention. The potential impact of the GHW labels on reducing premature smoking-associated deaths in Vietnam were shown to be stronger among lower socio-economic groups.

  1. Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults.

    PubMed

    Macy, Jonathan T; Chassin, Laurie; Presson, Clark C; Yeung, Ellen

    2016-01-01

    To test the effect of exposure to the US Food and Drug Administration's proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking. A two-session web-based study was conducted with 2192 young adults 18-25-years-old. During session one, demographics, smoking behaviour, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current US Surgeon General's text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p = .004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General's text warnings (p = .014), but there was no difference compared to those who viewed text-only warnings. Graphic health warnings on cigarette packages can influence young adult smokers' implicit attitudes towards smoking.

  2. Exposure to Graphic Warning Labels on Cigarette Packages: Effects on Implicit and Explicit Attitudes toward Smoking among Young Adults

    PubMed Central

    Macy, Jonathan T.; Chassin, Laurie; Presson, Clark C.; Yeung, Ellen

    2015-01-01

    Objective Test the effect of exposure to the U.S. Food and Drug Administration’s proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes toward smoking. Design and methods A two-session web-based study was conducted with 2192 young adults 18–25 years old. During session one, demographics, smoking behavior, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current U.S Surgeon General’s text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. Results Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p=.004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current U.S. Surgeon General’s text warnings (p=.014), but there was no difference compared to those who viewed text-only warnings. Conclusion Graphic health warnings on cigarette packages can influence young adult smokers’ implicit attitudes toward smoking. PMID:26442992

  3. The Effect of Cigarette Plain Packaging on Individuals' Health Warning Recall

    PubMed Central

    Al-Hamdani, Mohammed

    2013-01-01

    Purpose: To examine the extent to which increasingly plainer packaging might increase recall of health warnings. Design: A 4 (pack ID levels) x 2 (smoking status: smokers and non-smokers) between-subjects design in which participants were randomly assigned to view one package. Sample: Two hundred and twenty students from three universities in Nova Scotia, Canada, participated in the survey. Measures: Participants were asked to recall the health warning on their package. Analysis: A sequential binary logistic regression test to examine whether plain packaging and/or smoking status affects health warning recall. Results: The odds of recalling the correct health warnings were significantly higher for the two plainest packages relative to the original package. The odds of recalling the correct health warning were also higher for non-smokers relative to smokers. Conclusions: The results provide compelling evidence that health warnings on plain packages can be more easily recalled. PMID:23968628

  4. The effect of cigarette plain packaging on individuals' health warning recall.

    PubMed

    Al-Hamdani, Mohammed

    2013-02-01

    To examine the extent to which increasingly plainer packaging might increase recall of health warnings. A 4 (pack ID levels) x 2 (smoking status: smokers and non-smokers) between-subjects design in which participants were randomly assigned to view one package. Two hundred and twenty students from three universities in Nova Scotia, Canada, participated in the survey. Participants were asked to recall the health warning on their package. A sequential binary logistic regression test to examine whether plain packaging and/or smoking status affects health warning recall. The odds of recalling the correct health warnings were significantly higher for the two plainest packages relative to the original package. The odds of recalling the correct health warning were also higher for non-smokers relative to smokers. The results provide compelling evidence that health warnings on plain packages can be more easily recalled. Copyright © 2013 Longwoods Publishing.

  5. Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia.

    PubMed

    Rahman, M M; Arif, M T; Abd, Razak Mf; Suhaili, M R; Tambi, Z; Akoi, C; Gabriel Bain, M; Hussain, H

    2015-01-01

    Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak. Cross-sectional data were collected from 10 villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Nonprobability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software IBM SPSS 20.0 version. Analysis showed that 28.8% of the respondents were current smokers, 7.8% were past smokers and the rest were non-smokers. Six items of pictorial health warnings were evaluated with five point Likert's scales for attractiveness, fearfulness and adequacy of the information. Analysis revealed that the majority of the respondents had perceived awareness on PHWs, but the smokers believed that this was not adequate to make them quit smoking. Only one-fifth (19.7%) of them reported that current pictorial health warnings were sufficient to motivate people to quit smoking. Though the PHWs on cigarette packages are appealing, it is not sufficient as a reason to stop smoking. Thus, an approach using an integrated anti-tobacco public health programme should be focused into the specific targeted community.

  6. Systematic Review of the Effect of Pictorial Warnings on Cigarette Packages in Smoking Behavior

    PubMed Central

    Liu, Bojing; Greiner, Felix; Bremberg, Sven; Galanti, Rosaria

    2014-01-01

    We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods. PMID:25122019

  7. Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence

    PubMed Central

    Shankleman, M.; Sykes, C.; Mandeville, K.L.; Di Costa, S.; Yarrow, K.

    2015-01-01

    Objective To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings. Study design A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK. Methods Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet. Results An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) <100 lifetime cigarettes smoked; 3) gaze position successfully tracked for > 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p < 0.001). There was no evidence that this effect varied based on the type of warning label (black & white text vs. colour text vs. colour image & text; interaction p = 0.295). Conclusions During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design. PMID:25542740

  8. Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence.

    PubMed

    Shankleman, M; Sykes, C; Mandeville, K L; Di Costa, S; Yarrow, K

    2015-01-01

    To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings. A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK. Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet. An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) <100 lifetime cigarettes smoked; 3) gaze position successfully tracked for > 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p < 0.001). There was no evidence that this effect varied based on the type of warning label (black & white text vs. colour text vs. colour image & text; interaction p = 0.295). During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Responses of young adults to graphic warning labels for cigarette packages

    PubMed Central

    Cameron, Linda D.; Pepper, Jessica K.; Brewer, Noel T.

    2013-01-01

    Background In 2010, the US Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults. Methods We conducted an experimental study in 2010–2011 with 325 smokers and non-smokers ages 18–30 years whom we recruited through community distribution lists in North Carolina and through a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings) in a random order, evaluating each label on understandability and its effects on fear-related reactions and discouragement from wanting to smoke. Results Respondents found most of the proposed labels easy to understand. Of the 36 labels, 64% induced greater fear-related reactions and 58% discouraged respondents from wanting to smoke more than the corresponding text-only labels did. Labels with the greatest effects had photographs (as compared with drawings or other art graphics) or depicted diseased body parts or suffering or dead people. In almost every comparison, smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers. Conclusions Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations. PMID:23624558

  10. Responses of young adults to graphic warning labels for cigarette packages.

    PubMed

    Cameron, Linda D; Pepper, Jessica K; Brewer, Noel T

    2015-03-01

    In 2010, the US Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults. We conducted an experimental study in 2010-2011 with 325 smokers and non-smokers ages 18-30 years whom we recruited through community distribution lists in North Carolina and through a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings) in a random order, evaluating each label on understandability and its effects on fear-related reactions and discouragement from wanting to smoke. Respondents found most of the proposed labels easy to understand. Of the 36 labels, 64% induced greater fear-related reactions and 58% discouraged respondents from wanting to smoke more than the corresponding text-only labels did. Labels with the greatest effects had photographs (as compared with drawings or other art graphics) or depicted diseased body parts or suffering or dead people. In almost every comparison, smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers. Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Does the effect go up in smoke? A randomized controlled trial of pictorial warnings on cigarette packaging.

    PubMed

    Schneider, Sven; Gadinger, Michael; Fischer, Andreas

    2012-01-01

    Placing a combination of a written warning and a graphic image on cigarette packaging (so called "pictorial warnings") is one of the WHO Framework Convention on Tobacco Control's most controversial recommendations. Our randomized controlled trial investigated if pictorial warnings lead to significantly higher motivation to quit, as compared to written warnings alone. Four pictorial warnings were selected from the EU Commission's official image catalogue. Study arm 1 (44 adult smokers) viewed only the written warnings while study arm 2 (44 adult smokers) viewed the corresponding pictorial warnings. Self-affirmation was a second randomly manipulated factor, and nicotine dependence a quasi-experimental third factor. The main outcome measured was the motivation to quit, with fear intensity as one of the secondary outcomes. Pictorial warnings were associated with a significantly higher motivation to quit. A pictorial warning was also associated with higher fear intensity. The effect of warnings appears to be independent of nicotine dependence and self-affirmation. Nationwide implementation of pictorial warnings may be effective in increasing heavy smokers' motivation to quit. Due to the fact that perceived vulnerability, response and self-efficacy are not more strongly affected by pictorial warnings this effect may turn out to be short-term. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. [Impact of cigarette packages warning labels in relation to tobacco-smoking dependence and motivation to quit].

    PubMed

    Mannocci, Alice; Antici, Daniele; Boccia, Antonio; La Torre, Giuseppe

    2012-01-01

    the principal aim was to assess the impact of health warnings on cigarette packages in Italy, the reduction of daily number of cigarette smoked, in relationship to the tobacco-smoking dependence and motivation to quit. The second aim was to compare the impact of text warnings versus graphi depictions. cross-sectional study (survey). the study was conducted through interviews to an opportunistic sample of smokers.The subject enrolled were adult smokers (years ≥ 18), living in the province of Rome. Data were collected in two outpatient clinics located in Morlupo and Rome. Interviews were administered in the waiting rooms, to patients or to their relatives/ helpers. The survey was conducted in June-September 2010. The sample size (266 participants) was computed using a power of 80%, a confidence level of 95%, an expected frequency of smokers with a low motivation to quit who reduced number of cigarettes due to warnings of 15%, and a frequency of smokers with a higher motivation to quit who reduced number of cigarettes due to warnings of 30%. the effect of the health warnings used in Italy on smoking reduction was measured with the following self-reported items: "Are you or have you been influenced by the health warnings on cigarettes packages (in relation to the daily number of cigarettes smoked)?"; "Have you changed your smoking habits due to the warnings (for example: don't smoking after a coffee.)?"; "Have you ever stopped smoking due to the warnings?" The effect of labels that used shock images on cigarette boxes was measured using followed self-reported questions: "If shocking images were used on cigarette boxes, would they have greater effect than simple warning text currently used?"; "If your favourite cigarettes brand decide to change the look of its cigarette boxes with shocking images on smoking health damages, would you be driven to change it?" thanks to the health warnings, 95% of the 270 participants were informed on smoking damages, 14% (34 smokers

  13. 75 FR 75936 - Required Warnings for Cigarette Packages and Advertisements; Research Report

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-07

    ... Cigarette Packages and Advertisements; Research Report AGENCY: Food and Drug Administration, HHS. ACTION...'' (Experimental Study Report) and it describes the results from a research study that quantitatively evaluated the... of such images. FDA worked with various experts in the fields of health communications, marketing...

  14. The Impact of Cigarette Plain Packaging on Health Warning Salience and Perceptions: Implications for Public Health Policy.

    PubMed

    Auemaneekul, Naruemon; Silpasuwan, Pimpan; Sirichotiratana, Nithat; Satitvipawee, Pratana; Sompopcharoen, Malinee; Viwatwongkasem, Chukiat; Sujirarat, Dusit

    2015-11-01

    The study employed a mixed methods design using focus group interviews with 6 student groups and self-administered questionnaires with 1239 students. The participants were nonsmoking, current smokers, and quit-smoking teenagers from secondary schools and colleges. Focus group revealed that although nonsmoking teenagers perceived fear appeals to warning messages, current smokers did not perceive fear appeals to health. Black and white backgrounds of the cigarette package were chosen as the best color for plain packaging. However, most participants suggested various pictorials and a bigger size of pictorial warnings for greater and more effective fear appeal. Odds ratio showed that males had 2.43 times the odds to perceive intention not to smoke. Teenagers who had never smoked and those who had quit smoking had 13.27 and 3.61 times the odds, respectively, to perceive intention not to smoke.

  15. Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers.

    PubMed

    Munafò, Marcus R; Roberts, Nicole; Bauld, Linda; Leonards, Ute

    2011-08-01

    To assess the impact of plain packaging on visual attention towards health warning information on cigarette packs. Mixed-model experimental design, comprising smoking status as a between-subjects factor, and package type (branded versus plain) as a within-subjects factor. University laboratory. Convenience sample of young adults, comprising non-smokers (n = 15), weekly smokers (n = 14) and daily smokers (n = 14). Number of saccades (eye movements) towards health warnings on cigarette packs, to directly index visual attention. Analysis of variance indicated more eye movements (i.e. greater visual attention) towards health warnings compared to brand information on plain packs versus branded packs. This effect was observed among non-smokers and weekly smokers, but not daily smokers. Among non-smokers and non-daily cigarette smokers, plain packaging appears to increase visual attention towards health warning information and away from brand information. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  16. Has the introduction of plain packaging with larger graphic health warnings changed adolescents’ perceptions of cigarette packs and brands?

    PubMed Central

    White, Victoria; Williams, Tahlia; Wakefield, Melanie

    2015-01-01

    Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on adolescents’ perceptions of pack image and perceived brand differences. Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of new cigarette packaging) and in 2013 (7–12 months afterwards). Students aged 12–17 years (2011 n=6338; 2013 n=5915) indicated whether they had seen a cigarette pack in previous 6 months. Students rated the character of four popular cigarette brands, indicated level of agreement regarding differences between brands in ease of smoking, quitting, addictiveness, harmfulness and look of pack; and indicated positive and negative perceptions of pack image. Changes in responses of students seeing cigarette packs in the previous 6 months (2011: 60%; 2013: 65%) were examined. Results Positive character ratings for each brand reduced significantly between 2011 and 2013. Changes were found for four of five statements reflecting brand differences. Significantly fewer students in 2013 than 2011 agreed that ‘some brands have better looking packs than others’ (2011: 43%; 2013: 25%, p<0.001), with larger decreases found among smokers (interaction p<0.001). Packs were rated less positively and more negatively in 2013 than in 2011 (p<0.001). The decrease in positive image ratings was greater among smokers. Conclusions The introduction of standardised packaging has reduced the appeal of cigarette packs. Further research could determine if continued exposure to standardised packs creates more uncertainty or disagreement regarding brand differences in ease of smoking and quitting, perceived addictiveness and harms. PMID:28407611

  17. When health policy and empirical evidence collide: the case of cigarette package warning labels and economic consumer surplus.

    PubMed

    Song, Anna V; Brown, Paul; Glantz, Stanton A

    2014-02-01

    In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost "pleasure" smokers experience when they stop smoking; this is quantified as lost "consumer surplus." Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health.

  18. When Health Policy and Empirical Evidence Collide: The Case of Cigarette Package Warning Labels and Economic Consumer Surplus

    PubMed Central

    Song, Anna V.; Brown, Paul

    2014-01-01

    In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost “pleasure” smokers experience when they stop smoking; this is quantified as lost “consumer surplus.” Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health. PMID:24328661

  19. The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy

    PubMed Central

    Osman, Amira; Abad-Vivero, Erika N.; Hammond, David; Bansal-Travers, Maansi; Cummings, K. Michael; Hardin, James W.; Moodie, Crawford

    2015-01-01

    Background: Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt. Methods: Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18–64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n = 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave. Results: At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. Conclusions: HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers. PMID:25480931

  20. The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy.

    PubMed

    Thrasher, James F; Osman, Amira; Abad-Vivero, Erika N; Hammond, David; Bansal-Travers, Maansi; Cummings, K Michael; Hardin, James W; Moodie, Crawford

    2015-07-01

    Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt. Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18-64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n = 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave. At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Evaluating the perceived effectiveness of pregnancy-related cigarette package health warning labels among different gender/age groups.

    PubMed

    Kollath-Cattano, Christy; Osman, Amira; Thrasher, James F

    2017-03-01

    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. 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. 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. HWLs that depict graphic effects to illustrate smoking-related pregnancy risks appear to be perceived as particularly effective among women of reproductive age. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Avoidance of cigarette pack health warnings among regular cigarette smokers.

    PubMed

    Maynard, Olivia M; Attwood, Angela; O'Brien, Laura; Brooks, Sabrina; Hedge, Craig; Leonards, Ute; Munafò, Marcus R

    2014-03-01

    Previous research with adults and adolescents indicates that plain cigarette packs increase visual attention to health warnings among non-smokers and non-regular smokers, but not among regular smokers. This may be because regular smokers: (1) are familiar with the health warnings, (2) preferentially attend to branding, or (3) actively avoid health warnings. We sought to distinguish between these explanations using eye-tracking technology. A convenience sample of 30 adult dependent smokers participated in an eye-tracking study. Participants viewed branded, plain and blank packs of cigarettes with familiar and unfamiliar health warnings. The number of fixations to health warnings and branding on the different pack types were recorded. Analysis of variance indicated that regular smokers were biased towards fixating the branding rather than the health warning on all three pack types. This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings. Time-course analysis showed that for branded and plain packs, attention was preferentially directed to the branding location for the entire 10s of the stimulus presentation, while for blank packs this occurred for the last 8s of the stimulus presentation. Familiarity with health warnings had no effect on eye gaze location. Smokers actively avoid cigarette pack health warnings, and this remains the case even in the absence of salient branding information. Smokers may have learned to divert their attention away from cigarette pack health warnings. These findings have implications for cigarette packaging and health warning policy. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  3. Was the media campaign that supported Australia’s new pictorial cigarette warning labels and plain packaging policy associated with more attention to and talking about warning labels?

    PubMed Central

    Nagelhout, Gera E.; Osman, Amira; Yong, Hua-Hie; Huang, Li-Ling; Borland, Ron; Thrasher, James F.

    2016-01-01

    Background Population-level interventions can possibly enhance each other’s effects when they are implemented simultaneously. When the plain packaging policy was implemented in Australia, pictorial health warning labels (HWLs) on cigarette packages were also updated and a national mass media campaign was aired. This study examined whether smokers who recalled the media campaign reported more attention to and talking about HWLs. Methods Longitudinal survey data was obtained among Australian adult smokers, aged 18 years and older, from an online consumer panel. One survey wave was conducted before (September 2012) and two waves were conducted after (January 2013 and May 2013) the interventions. The sample was replenished to maintain a sample size of 1000 participants at each wave. Generalized Estimating Equations analyses were performed. Results Compared to wave 1, attention to HWLs increased at wave 2 (b = 0.32, SE = 0.06, p < 0.001), but not at wave 3 (b = 0.10, SE = 0.08, p = 0.198). Talking about HWLs increased over time (IRR = 1.82, 95% CI = 1.58–2.09 and IRR = 1.25, 95% CI = 1.05–1.47, at wave 2 and wave 3 respectively). Campaign recall was significantly associated with more attention to HWLs (b = 0.29, SE = 0.05, p < 0.001) and with more talking about HWLs (IRR = 1.17, 95% CI = 1.06–1.29) with similar effects across waves 2 and 3. Conclusions Recall of the campaign was associated with more attention to and talking about HWLs. When adjusting for campaign recall, there was still an increasing trend in attention and talking. This suggests that the media campaign and the new packaging and labeling policies had independent and positive effects on attention to and talking about HWLs. PMID:26050643

  4. Was the media campaign that supported Australia's new pictorial cigarette warning labels and plain packaging policy associated with more attention to and talking about warning labels?

    PubMed

    Nagelhout, Gera E; Osman, Amira; Yong, Hua-Hie; Huang, Li-Ling; Borland, Ron; Thrasher, James F

    2015-10-01

    Population-level interventions can possibly enhance each other's effects when they are implemented simultaneously. When the plain packaging policy was implemented in Australia, pictorial health warning labels (HWLs) on cigarette packages were also updated and a national mass media campaign was aired. This study examined whether smokers who recalled the media campaign reported more attention to and talking about HWLs. Longitudinal survey data was obtained among Australian adult smokers, aged 18 years and older, from an online consumer panel. One survey wave was conducted before (September 2012) and two waves were conducted after (January 2013 and May 2013) the interventions. The sample was replenished to maintain a sample size of 1000 participants at each wave. Generalized Estimating Equations analyses were performed. Compared to wave 1, attention to HWLs increased at wave 2 (b=0.32, SE=0.06, p<0.001), but not at wave 3 (b=0.10, SE=0.08, p=0.198). Talking about HWLs increased over time (IRR=1.82, 95% CI=1.58-2.09 and IRR=1.25, 95% CI=1.05-1.47, at wave 2 and wave 3 respectively). Campaign recall was significantly associated with more attention to HWLs (b=0.29, SE=0.05, p<0.001) and with more talking about HWLs (IRR=1.17, 95% CI=1.06-1.29) with similar effects across waves 2 and 3. Recall of the campaign was associated with more attention to and talking about HWLs. When adjusting for campaign recall, there was still an increasing trend in attention and talking. This suggests that the media campaign and the new packaging and labeling policies had independent and positive effects on attention to and talking about HWLs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content.

    PubMed

    Thrasher, James F; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

    2012-03-01

    The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering). Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering. Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

  6. Can pictorial warning labels on cigarette packages address smoking-related health disparities?: Field experiments in Mexico to assess warning label content

    PubMed Central

    Thrasher, James F.; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

    2012-01-01

    Objective This study aimed to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Methods Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers), wherein participants reported responses to different HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs didactic) and the other involved manipulating imagery type (diseased organs vs human suffering). Results Tests of mean ratings and rankings indicated that HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance and impact was found for graphic imagery of diseased organs than imagery of human suffering. Conclusions Pictorial HWLs with didactic textual forms appear to work better than with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases. PMID:22350859

  7. Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults.

    PubMed

    Tan, Andy S L; Bigman, Cabral A; Nagler, Rebekah H; Minsky, Sara; Viswanath, Kasisomayajula

    2017-09-02

    In 2012, the U.S. Food and Drug Administration proposed nine graphic health warnings (GHWs) on cigarette packaging that were rated equally effective across racial/ethnic, education, or income groups of adult smokers. However, data on GHW effectiveness among sexual and gender minority (SGM) adults, who have higher smoking prevalence, are currently lacking. This study analyzed whether perceived effectiveness of GHWs differed by gender and sexual orientation. Data came from a randomized experiment among 1,200 adults with an oversample from low socioeconomic status groups, conducted between 2013 and 2014 in three Massachusetts communities. Participants viewed and rated the effectiveness of nine GHWs. Mixed effects regression models predicted perceived effectiveness with gender and sexual orientation, adjusting for repeated measurements, GHWs viewed, age, race, ethnicity, smoking status, and health status. Female heterosexuals rated GHWs as more effective than male heterosexual, lesbian, and transgender and other gender respondents. There was no significant difference between female and male heterosexuals versus gay, male bisexual, or female bisexual respondents. Differences by gender and sexual orientation were consistent across all nine GHWs. Significant correlates of higher perceived effectiveness included certain GHWs, older age, being African-American (vs white), being Hispanic (vs non-Hispanic), having less than high school education (vs associate degree or higher), and being current smokers (vs non-smokers). Perceived effectiveness of GHWs was lower in certain SGM groups. We recommend further studies to understand the underlying mechanisms for these findings and investments in research and policy to communicate anti-smoking messages more effectively to SGM populations.

  8. Desensitisation to cigarette package graphic health warnings: a cohort comparison between London and Singapore

    PubMed Central

    Ratneswaran, Culadeeban; Chisnall, Ben; Li, Mingyue; Tan, Sarah; Douiri, Abdel; Anantham, Devanand; Steier, Joerg

    2016-01-01

    Objectives We compared 2 sociocultural cohorts with different duration of exposure to graphic health warning labels (GHWL), to investigate a possible desensitisation to their use. We further studied how a differing awareness and emotional impact of smoking-associated risks could be used to prevent this. Setting Structured interviews of patients from the general respiratory department were undertaken between 2012 and 2013 in 2 tertiary hospitals in Singapore and London. Participants 266 participants were studied, 163 Londoners (35% smokers, 54% male, age 52±18 years) and 103 Singaporeans (53% smokers, p=0.003; 78% male, p<0.001; age 58±15 years, p=0.012). Main outcomes and measures 50 items assessed demographics, smoking history, knowledge and the deterring impact of smoking-associated risks. After showing 10 GHWL, the impact on emotional response, cognitive processing and intended smoking behaviour was recorded. Results Singaporeans scored lower than the Londoners across all label processing constructs, and this was consistent for the smoking and non-smoking groups. Londoners experienced more ‘disgust’ and felt GHWL were more effective at preventing initiation of, or quitting, smoking. Singaporeans had a lower awareness of lung cancer (82% vs 96%, p<0.001), despite ranking it as the most deterring consequence of smoking. Overall, ‘blindness’ was the least known potential risk (28%), despite being ranked as more deterring than ‘stroke’ and ‘oral cancer’ in all participants. Conclusions The length of exposure to GHWL impacts on the effectiveness. However, acknowledging the different levels of awareness and emotional impact of smoking-associated risks within different sociocultural cohorts could be used to maintain their impact. PMID:27798017

  9. The Moderating Effects of Self-Esteem and Self-Efficacy on Responses to Graphic Health Warnings on Cigarette Packages: A Comparison of Smokers and Nonsmokers.

    PubMed

    Chun, Seungwoo; Park, Joon Woo; Heflick, Nathan; Lee, Seon Min; Kim, Daejin; Kwon, Kyenghee

    2017-06-16

    Do graphic pictorial health warnings (GPHWs) on cigarette packaging work better for some people than others? According to the Extended Parallel Process Model (EPPM), fear appeals should heighten positive change only if a person believes he or she is capable of change (i.e., self-efficacy). We exposed 242 smokers and 241 nonsmokers (aged 18-29) in the Republic of Korea to either a GPHW or a text-only warning in a between-subjects experiment. Results indicated that the GPHW increased intentions and motivations to quit smoking (for smokers) and intentions and motivations to not start smoking (for nonsmokers). However, these effects were moderated by self-efficacy related to quitting or not starting smoking. For smokers, a GPHW was especially effective in increasing desires and intentions to quit for people high in self-efficacy and high in self-esteem. However, for nonsmokers, a GPHW was effective only when self-efficacy was high, regardless of self-esteem level. For smokers and nonsmokers, results were mediated by heightened perceived health estimation. Implications for understanding the effectiveness of warning labels on cigarettes, for the introduction of GPHWs in the Republic of Korea, and for the Extended Parallel Process Model, are discussed.

  10. Graphic warning labels on plain cigarette packs: will they make a difference to adolescents?

    PubMed

    McCool, Judith; Webb, Lisa; Cameron, Linda D; Hoek, Janet

    2012-04-01

    Graphic warning labels and plain cigarette packaging are two initiatives developed to increase quit behaviour among smokers. Although a little is known about how adolescents interpret graphic warning labels, very few studies have examined how plain cigarette packaging would affect adolescents' perceptions of cigarette smoking and smoking behaviour. We explored how teens interpret and respond to graphic warning labels and the plain packaging of cigarettes, to assess the potential these strategies may offer in deterring smoking initiation. Twelve focus group interviews with a sample of 80 14-16 year old students from a diverse range of schools in Auckland, New Zealand were undertaken between June and August 2009. Textual analysis revealed that graphic warning labels may influence adolescents by reiterating a negative image of smokers. Graphic warning on a plain cigarette pack increased the attention paid to graphic warning labels and the overall perceptions of harm caused by cigarette smoking, and reduced the social appeal of cigarette smoking. This research offers evidence on how adolescents are appraising and interpreting graphic warning labels, and explores how dominant appraisals may affect the role graphic warning labels play in preventing smoking. Not only would plain cigarette packaging enhance the salience and impact of graphic warning labels, but it would potentially bolster the overall message that cigarette smoking is harmful. In the context of a comprehensive tobacco control programme, graphic warning labels on plain cigarette packaging present an explicit message about the risks (to health and image) associated with cigarette smoking.

  11. Graphic warning labels in cigarette advertisements: recall and viewing patterns.

    PubMed

    Strasser, Andrew A; Tang, Kathy Z; Romer, Daniel; Jepson, Christopher; Cappella, Joseph N

    2012-07-01

    The Family Smoking Prevention and Control Act gave the U.S. Food and Drug Administration (FDA) legal authority to mandate graphic warning labels on cigarette advertising and packaging. The FDA requires that these graphic warning labels be embedded into cigarette advertising and packaging by September 2012. The aim of this study was to examine differences in recall and viewing patterns of text-only versus graphic cigarette warning labels and the association between viewing patterns and recall. Participants (current daily smokers; N=200) were randomized to view a cigarette advertisement with either text-only or graphic warning labels. Viewing patterns were measured using eye-tracking, and recall was later assessed. Sessions were conducted between November 2008 and November 2009. Data analysis was conducted between March 2011 and July 2011. There was a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% vs 83% (χ(2)=23.74, p=0.0001). Time to first viewing of the graphic warning label text and dwell time duration (i.e., time spent looking) on the graphic image were significantly associated with correct recall. Warning labels that drew attention more quickly and resulted in longer dwell times were associated with better recall. Graphic warning labels improve smokers' recall of warning and health risks; these labels do so by drawing and holding attention. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Graphic Warning Labels in Cigarette Advertisements: Recall and Viewing Patterns

    PubMed Central

    Strasser, Andrew A.; Tang, Kathy Z.; Romer, Daniel; Jepson, Chris; Cappella, Joseph N.

    2012-01-01

    Background The Family Smoking Prevention and Control Act gave the U.S. Food and Drug Administration (FDA) legal authority to mandate graphic warning labels on cigarette advertising and packaging. The FDA requires that these graphic warning labels be embedded into cigarette advertising and packaging by September 2012. Purpose The aim of this study was to examine differences in recall and viewing patterns of text-only versus graphic cigarette warning labels; and, the association between viewing patterns and recall. Methods Participants (current daily smokers; N=200) were randomized to view a cigarette advertisement with either text-only or graphic warning labels. Viewing patterns were measured using eye-tracking, and recall was later assessed. Sessions were conducted between November 2008 and November 2009. Data analysis was conducted between March 2011 and July 2011. Results There was a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% versus 83% (χ2 =23.74, p=0.0001). Time to first view of the graphic warning label text, and dwell time duration (i.e., time spent looking) on the graphic image were significantly associated with correct recall. Warning labels that drew attention more quickly and resulted in longer dwell times were associated with better recall. Conclusions Graphic warning labels improve smokers’ recall of warning and health risks; they do so by drawing and holding attention. PMID:22704744

  13. Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts

    PubMed Central

    Thrasher, James F.; Abad-Vivero, Erika N.; Huang, Liling; O’Connor, Richard J.; Hammond, David; Bansal-Travers, Maansi; Yong, Hua-Hie; Borland, Ron; Markovsky, Barry; Hardin, James

    2016-01-01

    This study evaluated the relationship between interpersonal communication about cigarette health warning labels (HWLs), psychological responses to HWLs, and smoking cessation attempts. Data were analyzed from online consumer panels of adult smokers in Australia, Canada and Mexico, during implementation of new pictorial health warning labels (HWLs) on cigarette packs. Approximately 1000 adult smokers were surveyed in each country every four months (September 2012, January 2013, May 2013, September 2013, January 2014). Only smokers followed for at least two waves were included in the analytic sample. Participants reported the frequency of talking about HWLs in the last month (in general, with family members, and with friends). For each country, poisson generalized estimating equation (GEE) models were estimated to assess the bivariate and adjusted correlates of talking about HWLs. Logistic GEE models regressed having attempted to quit by the subsequent wave on HWL talk, socio-demographics and psychological responses to HWLs. The frequency of HWL talk gradually decreased in Canada (48%–36%) after new HWLs were implemented; an increase (30%–58%) in Australia corresponded with implementation of new HWLs, after which talking stabilized; and the frequency of HWL talk in Mexico was stable over time, where new HWLs are implemented every six months. Talk about HWLs was an independent predictor of subsequent quit attempts in Canada (AOR = 1.50; 95% CI = 1.11 –2.02), Australia (AOR = 1.41; 95% CI = 1.05–1.89), and Mexico (AOR = 1.53; 95% CI = 1.11–2.10), as was cognitive responses to HWLs (Australia AOR = 1.66; 95% CI = 1.22–2.24; Canada AOR = 1.56; 95% CI = 1.15–2.11; Mexico AOR = 1.30; 95% CI = 0.91–1.85). No interaction between talk and cognitive reactions to HWLs were found. These results suggest that interpersonal communication about HWLs influences smoking cessation attempts independent of other established predictors of smoking cessation, including

  14. Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts.

    PubMed

    Thrasher, James F; Abad-Vivero, Erika N; Huang, Liling; O'Connor, Richard J; Hammond, David; Bansal-Travers, Maansi; Yong, Hua-Hie; Borland, Ron; Markovsky, Barry; Hardin, James

    2016-09-01

    This study evaluated the relationship between interpersonal communication about cigarette health warning labels (HWLs), psychological responses to HWLs, and smoking cessation attempts. Data were analyzed from online consumer panels of adult smokers in Australia, Canada and Mexico, during implementation of new pictorial health warning labels (HWLs) on cigarette packs. Approximately 1000 adult smokers were surveyed in each country every four months (September 2012, January 2013, May 2013, September 2013, January 2014). Only smokers followed for at least two waves were included in the analytic sample. Participants reported the frequency of talking about HWLs in the last month (in general, with family members, and with friends). For each country, poisson generalized estimating equation (GEE) models were estimated to assess the bivariate and adjusted correlates of talking about HWLs. Logistic GEE models regressed having attempted to quit by the subsequent wave on HWL talk, sociodemographics and psychological responses to HWLs. The frequency of HWL talk gradually decreased in Canada (48%-36%) after new HWLs were implemented; an increase (30%-58%) in Australia corresponded with implementation of new HWLs, after which talking stabilized; and the frequency of HWL talk in Mexico was stable over time, where new HWLs are implemented every six months. Talk about HWLs was an independent predictor of subsequent quit attempts in Canada (AOR = 1.50; 95% CI = 1.11-2.02), Australia (AOR = 1.41; 95% CI = 1.05-1.89), and Mexico (AOR = 1.53; 95% CI = 1.11-2.10), as was cognitive responses to HWLs (Australia AOR = 1.66; 95% CI = 1.22-2.24; Canada AOR = 1.56; 95% CI = 1.15-2.11; Mexico AOR = 1.30; 95% CI = 0.91-1.85). No interaction between talk and cognitive reactions to HWLs were found. These results suggest that interpersonal communication about HWLs influences smoking cessation attempts independent of other established predictors of smoking cessation, including

  15. [Impact of cigarette package health warnings with pictures in Mexico: results from a survey of smokers in Guadalajara].

    PubMed

    Thrasher, James F; Pérez-Hernández, Rosaura; Arillo-Santillán, Edna; Barrientos-Gutiérrez, Inti

    2012-06-01

    Evaluate the impact of the first pictorial health warning labels (HWLs) on cigarette packs in Mexico. Cross-sectional survey of a representative sample of 1 765 adult smokers from Guadalajara, Mexico, 2010. Logistic regression models were estimated to determine the association between recall of having purchased a pack with a pictorial HWL and psychosocial variables indicating their impact. 58% reported having purchased a pack with one of the pictorial HWLs, and these were considered the exposed population. Exposed smokers reported a greater frequency of thinking about smoking-related risks (34 vs. 25% p=0.003), and thinking about quitting smoking (23 vs. 14% p=0.001). Exposure to pictorial HWLs was also associated with a greater acceptability of HWLs as a means of communicating with smokers (93 vs. 87% p<0.001), as was the perception that the government communicates well about tobacco-related health risks (68 vs. 55% p<0.001). Pictorial HWLs have made smokers think more about these risks and about quitting smoking. This policy should continue to be exploited as a cost-effective educational intervention.

  16. Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay, and Mexico

    PubMed Central

    Thrasher, James F; Villalobos, Victor; Szklo, André; Fong, Geoffrey T; Pérez, Cristina; Sebrié, Ernesto; Sansone, Natalie; Figueiredo, Valeska; Boado, Marcelo; Arillo-Santillán, Edna; Bianco, Eduardo

    2015-01-01

    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. PMID:21243191

  17. Non-Smoking Male Adolescents' Reactions to Cigarette Warnings

    PubMed Central

    Pepper, Jessica K.; Cameron, Linda D.; Reiter, Paul L.; McRee, Annie-Laurie; Brewer, Noel T.

    2013-01-01

    Background The U.S. Food and Drug Administration (FDA) is working to introduce new graphic warning labels for cigarette packages, the first change in cigarette warnings in more than 25 years. We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age. Methods A national sample of 386 non-smoking American males ages 11–17 participated in an online experiment during fall 2010. We randomly assigned participants to view warnings using a 2×2 between-subjects design. The warnings described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette package warnings. Analyses tested whether age moderated the warnings' impact on risk perceptions and smoking motivations. Results The warnings discouraged most adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings did (60% vs. 34% were “very much” discouraged, p<.001). Including an image had no effect on discouragement. The warnings affected several beliefs about the harms from smoking, and age moderated these effects. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They also believed that their true likelihood of experiencing any harm was lower than what an expert would say. Conclusions Our findings suggest that warnings focusing on lung cancer, rather than addiction, are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking. Including images on warnings had little effect on non-smoking male adolescents' discouragement or beliefs, though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels. PMID:23950861

  18. Can cigarette warnings counterbalance effects of smoking scenes in movies?

    PubMed

    Golmier, Isabelle; Chebat, Jean-Charles; Gélinas-Chebat, Claire

    2007-02-01

    Scenes in movies where smoking occurs have been empirically shown to influence teenagers to smoke cigarettes. The capacity of a Canadian warning label on cigarette packages to decrease the effects of smoking scenes in popular movies has been investigated. A 2 x 3 factorial design was used to test the effects of the same movie scene with or without electronic manipulation of all elements related to smoking, and cigarette pack warnings, i.e., no warning, text-only warning, and text+picture warning. Smoking-related stereotypes and intent to smoke of teenagers were measured. It was found that, in the absence of warning, and in the presence of smoking scenes, teenagers showed positive smoking-related stereotypes. However, these effects were not observed if the teenagers were first exposed to a picture and text warning. Also, smoking-related stereotypes mediated the relationship of the combined presentation of a text and picture warning and a smoking scene on teenagers' intent to smoke. Effectiveness of Canadian warning labels to prevent or to decrease cigarette smoking among teenagers is discussed, and areas of research are proposed.

  19. Promoting cessation resources through cigarette package warning labels: a longitudinal survey with adult smokers in Canada, Australia and Mexico

    PubMed Central

    Thrasher, James F; Osman, Amira; Moodie, Crawford; Hammond, David; Bansal-Travers, Maansi; Cummings, K Michael; Borland, Ron; Yong, Hua-Hie; Hardin, James

    2015-01-01

    Introduction Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. Methods Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. Results At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. Conclusions HWLs are an important source of cessation information. PMID:25052860

  20. Promoting cessation resources through cigarette package warning labels: a longitudinal survey with adult smokers in Canada, Australia and Mexico.

    PubMed

    Thrasher, James F; Osman, Amira; Moodie, Crawford; Hammond, David; Bansal-Travers, Maansi; Cummings, K Michael; Borland, Ron; Yong, Hua-Hie; Hardin, James

    2015-03-01

    Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. HWLs are an important source of cessation information. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Alcohol Warning Label Perceptions: Do Warning Sizes and Plain Packaging Matter?

    PubMed

    Al-Hamdani, Mohammed; Smith, Steven M

    2017-01-01

    There is a dearth of research on the effectiveness of stringent alcohol warning labels. Our experiment tested whether increasing the size of an alcohol health warning lowers product-based ratings. We examined whether plain packaging lowers ratings of alcohol products and the consumers who use them, increases ratings of bottle "boringness," and enhances warning recognition compared with branded packaging. A total of 440 adults (51.7% female) viewed one of three warning sizes (50%, 75%, or 90% of label surface) on either a plain or branded bottle of distilled spirits, wine, and beer. Participants also rated alcohol bottles on product-based (assessing the product itself), consumer-based (assessing perceptions of consumers of the product), and bottle boringness ratings, and then attempted to recognize the correct warning out of four choices. As expected, the size of warning labels lowered product-based ratings. Similarly, plain packaging lowered product-based and consumer-based ratings and increased bottle boringness but only for wine bottles. Further, plain packaging increased the odds of warning recognition on bottles of distilled spirits. This study shows that plain packaging and warning size (similar to the graphic warnings on cigarette packages) affect perceptions about alcohol bottles. It also shows that plain packaging increases the likelihood for correct health warning recognition, which builds the case for alcohol warning and packaging research and policy.

  2. Cigarette package design: opportunities for disease prevention

    PubMed Central

    DiFranza, JR; Clark, DM; Pollay, RW

    2003-01-01

    Objective To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. Methods A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Data Synthesis Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. Conclusion The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers.

  3. Cigarette package design: opportunities for disease prevention

    PubMed Central

    DiFranza, JR; Clark, DM; Pollay, RW

    2003-01-01

    Objective To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. Methods A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Data Synthesis Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. Conclusion The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers. PMID:19570250

  4. Cigarette package design: opportunities for disease prevention.

    PubMed

    Difranza, J R; Clark, D M; Pollay, R W

    2002-06-15

    To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers.

  5. Most Americans Favor Larger Health Warnings on Cigarette Packs

    MedlinePlus

    ... html Most Americans Favor Larger Health Warnings on Cigarette Packs Even many smokers think these warnings should ... 31, 2017 FRIDAY, March 31, 2017 (HealthDay News) -- Cigarette packs carry health warnings, but many Americans think ...

  6. Predictive and External Validity of a Pre-Market Study to Determine the Most Effective Pictorial Health Warning Label Content for Cigarette Packages.

    PubMed

    Huang, Li-Ling; Thrasher, James F; Reid, Jessica L; Hammond, David

    2016-05-01

    Studies examining cigarette package pictorial health warning label (HWL) content have primarily used designs that do not allow determination of effectiveness after repeated, naturalistic exposure. This research aimed to determine the predictive and external validity of a pre-market evaluation study of pictorial HWLs. Data were analyzed from: (1) a pre-market convenience sample of 544 adult smokers who participated in field experiments in Mexico City before pictorial HWL implementation (September 2010); and (2) a post-market population-based representative sample of 1765 adult smokers in the Mexican administration of the International Tobacco Control Policy Evaluation Survey after pictorial HWL implementation. Participants in both samples rated six HWLs that appeared on cigarette packs, and also ranked HWLs with four different themes. Mixed effects models were estimated for each sample to assess ratings of relative effectiveness for the six HWLs, and to assess which HWL themes were ranked as the most effective. Pre- and post-market data showed similar relative ratings across the six HWLs, with the least and most effective HWLs consistently differentiated from other HWLs. Models predicting rankings of HWL themes in post-market sample indicated: (1) pictorial HWLs were ranked as more effective than text-only HWLs; (2) HWLs with both graphic and "lived experience" content outperformed symbolic content; and, (3) testimonial content significantly outperformed didactic content. Pre-market data showed a similar pattern of results, but with fewer statistically significant findings. The study suggests well-designed pre-market studies can have predictive and external validity, helping regulators select HWL content. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Young Adult Smokers’ Neural Response to Graphic Cigarette Warning Labels

    PubMed Central

    Green, Adam E.; Mays, Darren; Falk, Emily B.; Vallone, Donna; Gallagher, Natalie; Richardson, Amanda; Tercyak, Kenneth P.; Abrams, David B.; Niaura, Raymond S.

    2016-01-01

    Introduction The study examined young adult smokers’ neural response to graphic warning labels (GWLs) on cigarette packs using functional magnetic resonance imaging (fMRI). Methods Nineteen young adult smokers (M age 22.9, 52.6% male, 68.4% non-white, M 4.3 cigarettes/day) completed pre-scan, self-report measures of demographics, cigarette smoking behavior, and nicotine dependence, and an fMRI scanning session. During the scanning session participants viewed cigarette pack images (total 64 stimuli, viewed 4 seconds each) that varied based on the warning label (graphic or visually occluded control) and pack branding (branded or plain packaging) in an event-related experimental design. Participants reported motivation to quit (MTQ) in response to each image using a push-button control. Whole-brain blood oxygenation level-dependent (BOLD) functional images were acquired during the task. Results GWLs produced significantly greater self-reported MTQ than control warnings (p < .001). Imaging data indicate stronger neural activation in response to GWLs than the control warnings at a cluster-corrected threshold p <.001 in medial prefrontal cortex, amygdala, medial temporal lobe, and occipital cortex. There were no significant differences in response to warnings on branded versus plain cigarette packages. Conclusions In this sample of young adult smokers, GWLs promoted neural activation in brain regions involved in cognitive and affective decision-making and memory formation and the effects of GWLs did not differ on branded or plain cigarette packaging. These findings complement other recent neuroimaging GWL studies conducted with older adult smokers and with adolescents by demonstrating similar patterns of neural activation in response to GWLs among young adult smokers. PMID:27019865

  8. Young Adult Smokers' Neural Response to Graphic Cigarette Warning Labels.

    PubMed

    Green, Adam E; Mays, Darren; Falk, Emily B; Vallone, Donna; Gallagher, Natalie; Richardson, Amanda; Tercyak, Kenneth P; Abrams, David B; Niaura, Raymond S

    2016-06-01

    The study examined young adult smokers' neural response to graphic warning labels (GWLs) on cigarette packs using functional magnetic resonance imaging (fMRI). Nineteen young adult smokers (M age 22.9, 52.6% male, 68.4% non-white, M 4.3 cigarettes/day) completed pre-scan, self-report measures of demographics, cigarette smoking behavior, and nicotine dependence, and an fMRI scanning session. During the scanning session participants viewed cigarette pack images (total 64 stimuli, viewed 4 seconds each) that varied based on the warning label (graphic or visually occluded control) and pack branding (branded or plain packaging) in an event-related experimental design. Participants reported motivation to quit (MTQ) in response to each image using a push-button control. Whole-brain blood oxygenation level-dependent (BOLD) functional images were acquired during the task. GWLs produced significantly greater self-reported MTQ than control warnings (p < .001). Imaging data indicate stronger neural activation in response to GWLs than the control warnings at a cluster-corrected threshold p <.001 in medial prefrontal cortex, amygdala, medial temporal lobe, and occipital cortex. There were no significant differences in response to warnings on branded versus plain cigarette packages. In this sample of young adult smokers, GWLs promoted neural activation in brain regions involved in cognitive and affective decision-making and memory formation and the effects of GWLs did not differ on branded or plain cigarette packaging. These findings complement other recent neuroimaging GWL studies conducted with older adult smokers and with adolescents by demonstrating similar patterns of neural activation in response to GWLs among young adult smokers.

  9. [Graphic images on cigarette packages not effective].

    PubMed

    Kok, Gerjo; Peters, Gjalt-Jorn Y; Ruiter, Robert A C

    2013-01-01

    The Dutch Government intends to make graphic images on cigarette packages mandatory. However, contrary to other policy measures to reduce smoking, health warnings do not work. There is no acceptable evidence in favour of graphic images and behaviour change theories suggest methods of change that improve skills, self-efficacy and social support. Thus, theory- and evidence-based policy should focus on prohibiting the tobacco industry from glamourizing packaging and make health communications on packages mandatory. As to the type of communications to be used, theory and evidence suggest that warning of the negative consequences of smoking is not an effective approach. Rather, targeting the most important determinants of the initiation of smoking and its successful cessation - such as skills, self-efficacy and subjective norm - along with the most effective behaviour change methods appears to be the most expedient strategy.

  10. Tobacco branding, plain packaging, pictorial warnings, and symbolic consumption.

    PubMed

    Hoek, Janet; Gendall, Philip; Gifford, Heather; Pirikahu, Gill; McCool, Judith; Pene, Gina; Edwards, Richard; Thomson, George

    2012-05-01

    We use brand association and symbolic consumption theory to explore how plain cigarette packaging would influence the identities young adults cocreate with tobacco products. Group discussions and in-depth interviews with 86 young adult smokers and nonsmokers investigated how participants perceive tobacco branding and plain cigarette packaging with larger health warnings. We examined the transcript data using thematic analysis and explored how removing tobacco branding and replacing this with larger warnings would affect the symbolic status of tobacco brands and their social connotations. Smokers used tobacco brand imagery to define their social attributes and standing, and their connection with specific groups. Plain cigarette packaging usurped this process by undermining aspirational connotations and exposing tobacco products as toxic. Replacing tobacco branding with larger health warnings diminishes the cachet brand insignia creates, weakens the social benefits brands confer on users, and represents a potentially powerful policy measure.

  11. Avoidance of Cigarette Pack Health Warnings among Regular Cigarette Smokers

    PubMed Central

    Maynard, Olivia M.; Attwood, Angela; O’Brien, Laura; Brooks, Sabrina; Hedge, Craig; Leonards, Ute; Munafò, Marcus R.

    2016-01-01

    Background Previous research with adults and adolescents indicates that plain cigarette packs increase visual attention to health warnings among non-smokers and non-regular smokers, but not among regular smokers. This may be because regular smokers: 1) are familiar with the health warnings, 2) preferentially attend to branding, or 3) actively avoid health warnings. We sought to distinguish between these explanations using eye-tracking technology. Method A convenience sample of 30 adult dependant smokers were recruited to participate in an eye-tracking study. Participants viewed branded, plain and blank packs of cigarettes with familiar and unfamiliar health warnings. The number of fixations to health warnings and branding on the different pack types were recorded. Results Analysis of variance indicated that regular smokers were biased towards fixating the branding location rather than the health warning location on all three pack types (p < 0.002). This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings. Time-course analysis showed that for branded and plain packs, attention was preferentially directed to the branding location for the entire 10 seconds of the stimulus presentation, while for blank packs this occurred for the last 8 seconds of the stimulus presentation. Familiarity with health warnings had no effect on eye gaze location. Conclusion Smokers actively avoid cigarette pack health warnings, and this remains the case even in the absence of salient branding information. Smokers may have learned to divert their attention away from cigarette pack health warnings. These findings have policy implications for the design of health warning on cigarette packs. PMID:24485554

  12. Implicit motivational impact of pictorial health warning on cigarette packs.

    PubMed

    Volchan, Eliane; David, Isabel A; Tavares, Gisella; Nascimento, Billy M; Oliveira, Jose M; Gleiser, Sonia; Szklo, Andre; Perez, Cristina; Cavalcante, Tania; Pereira, Mirtes G; Oliveira, Leticia

    2013-01-01

    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. 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. 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. 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.

  13. Linking mass media campaigns to pictorial warning labels on cigarette packages: a cross-sectional study to evaluate effects among Mexican smokers.

    PubMed

    Thrasher, James F; Murukutla, Nandita; Pérez-Hernández, Rosaura; Alday, Jorge; Arillo-Santillán, Edna; Cedillo, Claudia; Gutierrez, Juan Pablo

    2013-05-01

    This study assessed the effects of pictorial health warning labels (HWLs) and a linked media campaign in Mexico. Cross-sectional data were collected from a population-based sample of 1756 adult smokers, aged 18-55 years, during the initial implementation of pictorial HWLs, which some smokers had seen on cigarette packages while others had seen only the text-based HWLs. Exposure to the campaign and pictorial HWLs was assessed with aided recall methods, and other questions addressed attention and cognitive impact of HWLs, knowledge related to HWL and campaign content, and quit-related thoughts and behaviours. Logistic and linear regression models were estimated to determine associations between key outcomes and intervention exposure. In bivariate and multivariate adjusted models, recall of pictorial HWLs and of the campaign were positively associated with greater attention to and cognitive impact of HWLs, whereas only pictorial HWL exposure was associated with having refrained from smoking due to HWLs. Both recall of pictorial HWLs and of the campaign were independently associated with greater knowledge of secondhand smoke harms and toxic tobacco constituents. Smokers who recalled only the pictorial HWLs were more likely to try to quit than smokers who recalled neither the pictorial HWLs nor the campaign (17% vs 6%, p<0.001). Consistent with other studies, adult smokers' exposure to new pictorial HWLs in Mexico was associated with psychosocial and behavioural responses related to quit behaviour. Exposure to the complementary media campaign was associated with independent additive effects on campaign-related knowledge, and it enhanced psychosocial responses to pictorial HWLs.

  14. Implicit Motivational Impact of Pictorial Health Warning on Cigarette Packs

    PubMed Central

    Volchan, Eliane; David, Isabel A.; Tavares, Gisella; Nascimento, Billy M.; Oliveira, Jose M.; Gleiser, Sonia; Szklo, Andre; Perez, Cristina; Cavalcante, Tania; Pereira, Mirtes G.; Oliveira, Leticia

    2013-01-01

    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. PMID:23977223

  15. Public attitudes toward larger cigarette pack warnings: Results from a nationally representative U.S. sample

    PubMed Central

    2017-01-01

    A large body of evidence supports the effectiveness of larger health warnings on cigarette packages. However, there is limited research examining attitudes toward such warning labels, which has potential implications for implementation of larger warning labels. The purpose of the current study was to examine attitudes toward larger warning sizes on cigarette packages and examine variables associated with more favorable attitudes. In a nationally representative survey of U.S. adults (N = 5,014), participants were randomized to different warning size conditions, assessing attitude toward “a health warning that covered (25, 50, 75) % of a cigarette pack.” SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Across experimental groups, nearly three-quarters (72%) of adults had attitudes supportive of larger warning labels on cigarette packs. Among the full sample and smokers only (N = 1,511), most adults had favorable attitudes toward labels that covered 25% (78.2% and 75.2%, respectively), 50% (70% and 58.4%, respectively), and 75% (67.9% and 61%, respectively) of a cigarette pack. Young adults, females, racial/ethnic minorities, and non-smokers were more likely to have favorable attitudes toward larger warning sizes. Among smokers only, females and those with higher quit intentions held more favorable attitudes toward larger warning sizes. Widespread support exists for larger warning labels on cigarette packages among U.S. adults, including among smokers. Our findings support the implementation of larger health warnings on cigarette packs in the U.S. as required by the 2009 Tobacco Control Act. PMID:28253257

  16. Smokers' and E-Cigarette Users' Perceptions about E-Cigarette Warning Statements.

    PubMed

    Wackowski, Olivia A; Hammond, David; O'Connor, Richard J; Strasser, Andrew A; Delnevo, Cristine D

    2016-06-30

    Cigarette warning labels are important sources of risk information, but warning research for other tobacco products is limited. This study aimed to gauge perceptions about warnings that may be used for e-cigarettes. We conducted six small focus groups in late 2014/early 2015 with adult current e-cigarette users and cigarette-only smokers. Participants rated and discussed their perceptions of six e-cigarette warning statements, and warnings in two existing Vuse and MarkTen e-cigarette ads. Participants were open to e-cigarette warnings and provided the strongest reactions to statements warning that e-liquid/e-vapor or e-cigarettes can be poisonous, contain toxins, or are "not a safe alternative to smoking". However, many also noted that these statements were exaggerated, potentially misleading, and could scare smokers away from reducing their harm by switching to e-cigarettes. Opinions on the Food and Drug Administration's proposed nicotine addiction warning and warnings that e-cigarettes had not been approved for smoking cessation or had unknown health effects were mixed. Participants perceived MarkTen's advertisement warning to be stronger and more noticeable than Vuse's. Care should be taken in developing e-cigarette warnings given their relative recentness and potential for harm reduction compared to other tobacco products. Additional research, including with varied audiences, would be instructive.

  17. Smokers’ and E-Cigarette Users’ Perceptions about E-Cigarette Warning Statements

    PubMed Central

    Wackowski, Olivia A.; Hammond, David; O’Connor, Richard J.; Strasser, Andrew A.; Delnevo, Cristine D.

    2016-01-01

    Cigarette warning labels are important sources of risk information, but warning research for other tobacco products is limited. This study aimed to gauge perceptions about warnings that may be used for e-cigarettes. We conducted six small focus groups in late 2014/early 2015 with adult current e-cigarette users and cigarette-only smokers. Participants rated and discussed their perceptions of six e-cigarette warning statements, and warnings in two existing Vuse and MarkTen e-cigarette ads. Participants were open to e-cigarette warnings and provided the strongest reactions to statements warning that e-liquid/e-vapor or e-cigarettes can be poisonous, contain toxins, or are “not a safe alternative to smoking”. However, many also noted that these statements were exaggerated, potentially misleading, and could scare smokers away from reducing their harm by switching to e-cigarettes. Opinions on the Food and Drug Administration’s proposed nicotine addiction warning and warnings that e-cigarettes had not been approved for smoking cessation or had unknown health effects were mixed. Participants perceived MarkTen’s advertisement warning to be stronger and more noticeable than Vuse’s. Care should be taken in developing e-cigarette warnings given their relative recentness and potential for harm reduction compared to other tobacco products. Additional research, including with varied audiences, would be instructive. PMID:27376310

  18. Dissuasive cigarette sticks: the next step in standardised ('plain') packaging?

    PubMed

    Hoek, Janet; Gendall, Philip; Eckert, Christine; Louviere, Jordan

    2016-11-01

    Standardised (or 'plain') packaging has reduced the appeal of smoking by removing imagery that smokers use to affiliate themselves with the brand they smoke. We examined whether changing the appearance of cigarette sticks could further denormalise smoking and enhance the negative impact of standardised packaging. We conducted an online study of 313 New Zealand smokers who comprised a Best-Worst Choice experiment and a rating task. The Best-Worst experiment used a 2×3×3×6 orthogonal design to test the following attributes: on-pack warning message, branding level, warning size and stick appearance. We identified three segments whose members' choice patterns were strongly influenced by the stick design, warning theme and size, and warning theme, respectively. Each of the dissuasive sticks tested was less preferred and rated as less appealing than the most common stick in use; a 'minutes of life lost' stick was the most aversive of the stimuli tested. Dissuasive sticks could enhance the effect of standardised packaging, particularly among older smokers who are often more heavily addicted and resistant to change. Countries introducing standardised packaging legislation should take the opportunity to denormalise the appearance of cigarette sticks, in addition to removing external tobacco branding from packs and increasing the warning size. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs.

    PubMed

    Peebles, Kathryn; Hall, Marissa G; Pepper, Jessica K; Byron, M Justin; Noar, Seth M; Brewer, Noel T

    2016-12-01

    Pictorial cigarette pack warnings are a promising policy solution to increase smoking cessation among adults. However, little is known regarding adolescents' responses to pictorial warnings, particularly in real-world settings. Participants were 112 adolescent children, ages 13-17, whose parents received either text-only warnings on the side of their cigarette packs or pictorial warnings on the top half of the front and back of their cigarette packs for 4 weeks as part of a trial. We measured adolescents' recall and recognition of these warnings, negative emotional reactions to the warnings, perceived effectiveness of the warnings, social interactions about the warnings, and smoking risk beliefs. Adolescents accurately recalled pictorial warnings more often than text-only warnings (82% vs. 19%, p < .001). Recognition of warnings was also higher for pictorial than text-only warnings (82% vs. 34%, p < .001). Pictorial warnings drew greater attention (p < .001), elicited greater negative emotional reactions (p < .05), and sparked more social interactions (p < .01) than text-only warnings. Pictorial warnings on cigarette packs may have important effects on adolescent children of smokers. Future research should further investigate the impact of such messages on adolescents' susceptibility to smoking initiation and interest in quitting smoking, particularly as the United States and other countries work to implement pictorial warning regulations. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. Effects of standardised cigarette packaging on craving, motivation to stop and perceptions of cigarettes and packs.

    PubMed

    Brose, Leonie S; Chong, Chwen B; Aspinall, Emily; Michie, Susan; McEwen, Andy

    2014-01-01

    To assess whether standardised packs of the form introduced in Australia are associated with a reduction in acute craving and/or an increase in motivation to stop, and to replicate previous findings on perceptions of packaging, perceptions of smokers using it and perceived effects on behaviour. Following abstinence of at least 12 h, 98 regular and occasional smokers were randomised to exposure to their own cigarette package, another branded package or a standardised package. Craving (QSU-brief), motivation to stop, both at baseline and post-exposure. Ratings of 10 attributes concerning package design, perceived smoker characteristics and effects on behaviour, post-exposure only. For craving, a mixed model ANCOVA showed a significant interaction of packaging and time of measurement (F(2,94) = 8.77, p < .001, partial η(2) = .16). There was no significant main effect or interaction for motivation to stop smoking (p = .9). The standardised pack was perceived to be significantly less appealing and less motivating to buy cigarettes, smokers using them were perceived as less popular and cigarettes from them expected to taste worse. Standardised cigarette packaging may reduce acute (hedonic) craving and is associated with more negative perceptions than branded packaging with less prominent health warnings.

  1. Neural biomarkers for assessing different types of imagery in pictorial health warning labels for cigarette packaging: a cross-sectional study

    PubMed Central

    Newman-Norlund, Roger D; Thrasher, James F; Fridriksson, Johann; Brixius, William; Froeliger, Brett; Hammond, David; Cummings, Michael K

    2014-01-01

    Objective Countries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about smoking-related risks. Research on how pictorial HWLs work has primarily analysed self-reported responses to HWLs; studies at the neural level comparing the brain's response to different types of HWLs may provide an important complement to prior studies, especially if self-reported responses are systematically biased. In this study we characterise the brain's response to three types of pictorial HWLs for which prior self-report studies indicated different levels of efficacy. Methods Current smokers rated pictorial HWLs and then observed the same HWLs during functional MRI (fMRI) scanning. Fifty 18–50-year-old current adult smokers who were free from neurological disorders were recruited from the general population and participated in the study. Demographics, smoking-related behaviours and self-reported ratings of pictorial HWL stimuli were obtained prior to scanning. Brain responses to HWLs were assessed using fMRI, focusing on a priori regions of interest. Results Pictorial HWL stimuli elicited activation in a broad network of brain areas associated with visual processing and emotion. Participants who rated the stimuli as more emotionally arousing also showed greater neural responses at these sites. Conclusions Self-reported ratings of pictorial HWLs are correlated with neural responses in brain areas associated with visual and emotional processing. Study results cross-validate self-reported ratings of pictorial HWLs and provide insights into how pictorial HWLs are processed. PMID:25552613

  2. 19 CFR 11.3 - Package and notice requirements for cigars and cigarettes; package requirements for cigarette...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... cigarettes; package requirements for cigarette papers and tubes. 11.3 Section 11.3 Customs Duties U.S... STAMPING; MARKING Packing and Stamping § 11.3 Package and notice requirements for cigars and cigarettes; package requirements for cigarette papers and tubes. Exemptions from tax on cigars, cigarettes, and...

  3. 19 CFR 11.3 - Package and notice requirements for cigars and cigarettes; package requirements for cigarette...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... cigarettes; package requirements for cigarette papers and tubes. 11.3 Section 11.3 Customs Duties U.S... STAMPING; MARKING Packing and Stamping § 11.3 Package and notice requirements for cigars and cigarettes; package requirements for cigarette papers and tubes. Exemptions from tax on cigars, cigarettes, and...

  4. Interpretations of cigarette advertisement warning labels by Philadelphia Puerto Ricans.

    PubMed

    Morris, Nancy; Gilpin, Dawn R; Lenos, Melissa; Hobbs, Renee

    2011-09-01

    This study examined Philadelphia Puerto Ricans' interpretations of the Surgeon General's warnings that appear on cigarette packaging and in advertisements. In-home family focus groups in which participants were asked to comment on magazine cigarette advertisements showed a great variety of interpretations of the legally mandated warning labels. These findings (a) corroborate and add to research in public health and communications regarding the possibility of wide variations in message interpretations and (b) support the call for public health messages to be carefully tested for effectiveness among different social groups. The article's focus on Puerto Ricans addresses the problem of misleading conclusions that can arise from aggregating all Latino subpopulations into one group. The use of a naturalistic setting to examine interpretations of messages about smoking departs from the experimental methods typically used for such research and provides new evidence that even a seemingly straightforward message can be interpreted in multiple ways. Understanding and addressing differences in message interpretation can guide public health campaigns aimed at reducing health disparities. Copyright © Taylor & Francis Group, LLC

  5. Social Interactions Sparked by Pictorial Warnings on Cigarette Packs

    PubMed Central

    Hall, Marissa G.; Peebles, Kathryn; Bach, Laura E.; Noar, Seth M.; Ribisl, Kurt M.; Brewer, Noel T.

    2015-01-01

    The Message Impact Framework suggests that social interactions may offer smokers the opportunity to process pictorial warnings on cigarette packs more deeply. We aimed to describe adult smokers’ social interactions about pictorial cigarette pack warnings in two longitudinal pilot studies. In Pilot Study 1, 30 smokers used cigarette packs with one of nine pictorial warnings for two weeks. In Pilot Study 2, 46 smokers used cigarette packs with one of five pictorial warnings for four weeks. Nearly all smokers (97%/96% in Pilot Study 1/2) talked about the warnings with other people, with the most common people being friends (67%/87%) and spouses/significant others (34%/42%). Pilot Study 2 found that 26% of smokers talked about the warnings with strangers. Discussions about the health effects of smoking and quitting smoking were more frequent during the first week of exposure to pictorial warnings than in the week prior to beginning the study (both p < 0.05). Pictorial warnings sparked social interactions about the warnings, the health effects of smoking, and quitting smoking, indicating that pictorial warnings may act as a social intervention reaching beyond the individual. Future research should examine social interactions as a potential mediator of the impact of pictorial warnings on smoking behavior. PMID:26506363

  6. Social Interactions Sparked by Pictorial Warnings on Cigarette Packs.

    PubMed

    Hall, Marissa G; Peebles, Kathryn; Bach, Laura E; Noar, Seth M; Ribisl, Kurt M; Brewer, Noel T

    2015-10-21

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

  7. 21 CFR 1141.10 - Required warnings.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Cigarette Package and Advertising... cigarettes the package of which fails to bear, in accordance with section 4 of the Federal Cigarette Labeling... “Cigarette Required Warnings,” which is incorporated by reference at § 1141.12, and accurately reproduced...

  8. 19 CFR 11.3 - Package and notice requirements for cigars and cigarettes; package requirements for cigarette...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... cigarettes; package requirements for cigarette papers and tubes. 11.3 Section 11.3 Customs Duties U.S...; package requirements for cigarette papers and tubes. Exemptions from tax on cigars, cigarettes, and cigarette papers and tubes apply in accordance with the regulations of the Bureau of Alcohol, Tobacco,...

  9. 19 CFR 11.3 - Package and notice requirements for cigars and cigarettes; package requirements for cigarette...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... cigarettes; package requirements for cigarette papers and tubes. 11.3 Section 11.3 Customs Duties U.S...; package requirements for cigarette papers and tubes. Exemptions from tax on cigars, cigarettes, and cigarette papers and tubes apply in accordance with the regulations of the Bureau of Alcohol, Tobacco,...

  10. 19 CFR 11.3 - Package and notice requirements for cigars and cigarettes; package requirements for cigarette...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... cigarettes; package requirements for cigarette papers and tubes. 11.3 Section 11.3 Customs Duties U.S...; package requirements for cigarette papers and tubes. Exemptions from tax on cigars, cigarettes, and cigarette papers and tubes apply in accordance with the regulations of the Bureau of Alcohol, Tobacco,...

  11. Neural mechanisms underlying visual attention to health warnings on branded and plain cigarette packs.

    PubMed

    Maynard, Olivia M; Brooks, Jonathan C W; Munafò, Marcus R; Leonards, Ute

    2017-04-01

    To (1) test if activation in brain regions related to reward (nucleus accumbens) and emotion (amygdala) differ when branded and plain packs of cigarettes are viewed, (2) test whether these activation patterns differ by smoking status and (3) examine whether activation patterns differ as a function of visual attention to health warning labels on cigarette packs. Cross-sectional observational study combining functional magnetic resonance imaging (fMRI) with eye-tracking. Non-smokers, weekly smokers and daily smokers performed a memory task on branded and plain cigarette packs with pictorial health warnings presented in an event-related design. Clinical Research and Imaging Centre, University of Bristol, UK. Non-smokers, weekly smokers and daily smokers (n = 72) were tested. After exclusions, data from 19 non-smokers, 19 weekly smokers and 20 daily smokers were analysed. Brain activity was assessed in whole brain analyses and in pre-specified masked analyses in the amygdala and nucleus accumbens. On-line eye-tracking during scanning recorded visual attention to health warnings. There was no evidence for a main effect of pack type or smoking status in either the nucleus accumbens or amygdala, and this was unchanged when taking account of visual attention to health warnings. However, there was evidence for an interaction, such that we observed increased activation in the right amygdala when viewing branded as compared with plain packs among weekly smokers (P = 0.003). When taking into account visual attention to health warnings, we observed higher levels of activation in the visual cortex in response to plain packaging compared with branded packaging of cigarettes (P = 0.020). Based on functional magnetic resonance imaging and eye-tracking data, health warnings appear to be more salient on 'plain' cigarette packs than branded packs. © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

  12. Neural mechanisms underlying visual attention to health warnings on branded and plain cigarette packs

    PubMed Central

    Brooks, Jonathan C. W.; Munafò, Marcus R.; Leonards, Ute

    2017-01-01

    Abstract Aims To (1) test if activation in brain regions related to reward (nucleus accumbens) and emotion (amygdala) differ when branded and plain packs of cigarettes are viewed, (2) test whether these activation patterns differ by smoking status and (3) examine whether activation patterns differ as a function of visual attention to health warning labels on cigarette packs. Design Cross‐sectional observational study combining functional magnetic resonance imaging (fMRI) with eye‐tracking. Non‐smokers, weekly smokers and daily smokers performed a memory task on branded and plain cigarette packs with pictorial health warnings presented in an event‐related design. Setting Clinical Research and Imaging Centre, University of Bristol, UK. Participants Non‐smokers, weekly smokers and daily smokers (n = 72) were tested. After exclusions, data from 19 non‐smokers, 19 weekly smokers and 20 daily smokers were analysed. Measurements Brain activity was assessed in whole brain analyses and in pre‐specified masked analyses in the amygdala and nucleus accumbens. On‐line eye‐tracking during scanning recorded visual attention to health warnings. Findings There was no evidence for a main effect of pack type or smoking status in either the nucleus accumbens or amygdala, and this was unchanged when taking account of visual attention to health warnings. However, there was evidence for an interaction, such that we observed increased activation in the right amygdala when viewing branded as compared with plain packs among weekly smokers (P = 0.003). When taking into account visual attention to health warnings, we observed higher levels of activation in the visual cortex in response to plain packaging compared with branded packaging of cigarettes (P = 0.020). Conclusions Based on functional magnetic resonance imaging and eye‐tracking data, health warnings appear to be more salient on ‘plain’ cigarette packs than branded packs. PMID:27886656

  13. [How would plain packaging and pictorial warning impact on smoking reduction, cessation and initiation?].

    PubMed

    Mannocci, Alice; Colamesta, Vittoria; Mipatrini, Daniele; Boccia, Antonio; Terzano, Claudio; La Torre, Giuseppe

    2013-01-01

    The European Commission has proposed a review of the directive on tobacco products on labeling and packaging of tobacco products by introducing warning text with pictorial warning that occupies 75% of the cigarette packages. The aim of the survey was to assess the impact of plain packaging and pictorial warning in smoking reduction, cessation and initiation among a sample of adult. The cross-sectional study was conducted in Rome between September and November 2012. The questionnaires administered were 227, with a response rate of 82.4%. 35.8% (No. 67) of the respondents considered the image of the gangrene the most effective in communicating smoking-related damages, followed by the image on lung cancer (No. 60; 32.1%). Distinguishing between smokers and non-smokers (both former and never smokers), the picture on lung cancer was the most effective for smokers (No. 22; 38.6%); if cigarette packages have pictorial warnings like the ones shown, more than half (No. 33; 57.9%) of smokers would change brand; 66.7% (No. 38) of them would feel uncomfortable in showing the package. Comparing the 3 packagings, classic packaging, plain packaging with textual warning, and plain packaging with both textual and pictorial warning, the majority of people declared that the third is the most effective in preventing smoking initiation (No. 169; 90.9%), in motivating to quit (No. 158; 84.9%), and in changing smoking habits (No. 149; 80.5%). The survey, although its small sample size and being not representative of all strata of Italian population, shows that the plain packaging with pictorial warning is the most convincing in the three outcomes considered.

  14. Adolescents' perceptions of cigarette brand image: does plain packaging make a difference?

    PubMed

    Germain, Daniella; Wakefield, Melanie A; Durkin, Sarah J

    2010-04-01

    To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs. We used a 5 (degree of plain packaging and graphic health warning)x 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings. When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers. Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced. Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

  15. Plain packaging of cigarettes and smoking behavior: study protocol for a randomized controlled study.

    PubMed

    Maynard, Olivia M; Leonards, Ute; Attwood, Angela S; Bauld, Linda; Hogarth, Lee; Munafò, Marcus R

    2014-06-25

    Previous research on the effects of plain packaging has largely relied on self-report measures. Here we describe the protocol of a randomized controlled trial investigating the effect of the plain packaging of cigarettes on smoking behavior in a real-world setting. In a parallel group randomization design, 128 daily cigarette smokers (50% male, 50% female) will attend an initial screening session and be assigned plain or branded packs of cigarettes to smoke for a full day. Plain packs will be those currently used in Australia where plain packaging has been introduced, while branded packs will be those currently used in the United Kingdom. Our primary study outcomes will be smoking behavior (self-reported number of cigarettes smoked and volume of smoke inhaled per cigarette as measured using a smoking topography device). Secondary outcomes measured pre- and post-intervention will be smoking urges, motivation to quit smoking, and perceived taste of the cigarettes. Secondary outcomes measured post-intervention only will be experience of smoking from the cigarette pack, overall experience of smoking, attributes of the cigarette pack, perceptions of the on-packet health warnings, behavior changes, views on plain packaging, and the rewarding value of smoking. Sex differences will be explored for all analyses. This study is novel in its approach to assessing the impact of plain packaging on actual smoking behavior. This research will help inform policymakers about the effectiveness of plain packaging as a tobacco control measure. Current Controlled Trials ISRCTN52982308 (registered 27 June 2013).

  16. Warning Statements and Safety Practices among Manufacturers and Distributors of Electronic Cigarette Liquids in the United States.

    PubMed

    Fagan, Pebbles; Pokhrel, Pallav; Herzog, Thaddeus A; Guy, Mignonne C; Sakuma, Kari-Lyn K; Trinidad, Dennis R; Cassel, Kevin; Jorgensen, Dorothy; Lynch, Tania; Felicitas-Perkins, Jamie Q; Palafox, Sherilyn; Hamamura, Faith; Maloney, Sarah; Degree, Kaylah; Sterling, Kymberle; Moolchan, Eric; Clanton, Mark S; Eissenberg, Thomas

    2017-05-18

    Prior to the Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample. Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four U.S. geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016. Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine". Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine". None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive". All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering. Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors. These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure

  17. Changes in smoking level after viewing graphic cigarette warnings: preliminary findings.

    PubMed

    Malouff, John M; Emmerton, Ashley J; Schutte, Nicola S

    2013-01-01

    Some countries require graphic warnings on cigarette packages, and other countries, including the United States, may follow that lead. A few studies have produced findings suggesting that graphic warnings may have effects on smoking-related attitudes and behaviors. The objective of the present study was to gather evidence on the effects of graphic warnings on smoking level and related behavior. This study was conducted with 89 adult smokers in the United States to examine the effects of warnings that included graphic images of cosmetically important physical harm caused by smoking. Participants completed measures of smoking level and cessation-related behavior before and after viewing 4 weekly health warnings about smoking, each with a graphic image showing cosmetically important health harm caused by smoking. The study results showed significant improvement on all measures, providing pre-post evidence of a significant decrease in smoking level after viewing graphic and written warnings. The more participants perceived the warnings as distressing and useful, the more their smoking decreased. The study findings provide preliminary evidence that graphic warnings can lead to increases in cessation-related behavior and decreases in level of smoking. Copyright © American Academy of Addiction Psychiatry.

  18. Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers' Quit Intentions Relative to Text-Only Warnings.

    PubMed

    Evans, Abigail T; Peters, Ellen; Shoben, Abigail B; Meilleur, Louise R; Klein, Elizabeth G; Tompkins, Mary Kate; Romer, Daniel; Tusler, Martin

    2017-10-01

    teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions versus text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions versus text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers' risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.

  19. Variation in health warning effectiveness on cigarette packs: a need for regulation?

    PubMed Central

    Misak, Monika; Munafò, Marcus R.

    2016-01-01

    The Tobacco Products Directive allows the possibility of strategic placement of health warnings on cigarette packs by manufacturers to reduce overall warning effectiveness. Information regarding health warning effectiveness was assessed in an online survey, and the prevalence of warnings on cigarette packs was assessed in a shop survey. Although we find no evidence of a strong correlation between health warning effectiveness ratings and their frequency on cigarette packs (r = −0.17, P = 0.56), there may be other ways this possibility is exploited. We suggest that this potential loophole is addressed and monitoring of the placement of health warnings on cigarette packs is continued. PMID:27385516

  20. Legibility of health warnings on billboards that advertise cigarettes.

    PubMed

    Cullingford, R; Da Cruz, L; Webb, S; Shean, R; Jamrozik, K

    1988-04-04

    At present only subjective criteria exist to determine the legibility of health warnings on billboards that display advertisements for cigarettes. We constructed a set of objective standards and used them to assess the legibility of warnings on a sample of 37 billboards in Perth, Western Australia. The three features that were analysed were the apparent size of the letters, the colour contrast between the letters and their background, and the obliqueness of the message. We also compared the size and legibility of the health warning with that of the brand name. Health warnings were not legible to passing motorists in 51% of cases and not legible to motorists who were stopped at nearby intersections in 74% of cases, whereas almost all the brand names could be read easily. These results indicate that the present system of voluntary regulation of advertisements for cigarettes has failed to ensure that health warnings on billboards are legible. For health warnings on advertisements to have any useful effect it is essential that they are legible. The only way to ensure legibility is to adopt objective requirements for it.

  1. 21 CFR 1141.12 - Incorporation by reference of required warnings.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Cigarette Package and Advertising Warnings § 1141.12 Incorporation by reference of required warnings. “Cigarette... Communication and Education, ATTN: Cigarette Warning File Requests, 9200 Corporate Blvd., Rockville, MD 20850,...

  2. Do the ends justify the means? A test of alternatives to the FDA proposed cigarette warning labels.

    PubMed

    Byrne, Sahara; Katz, Sherri Jean; Mathios, Alan; Niederdeppe, Jeff

    2015-01-01

    Three studies provide empirical, social scientific tests of alternatives to the originally proposed U.S. Food and Drug Administration (FDA) cigarette package warning labels on health risk beliefs, perceived fear, and effectiveness. Our research addresses questions at the root of the legal disputes surrounding FDA regulation of cigarette package warning labels. Specifically, we describe results from three studies that investigate the mediating role of health beliefs and perceived fear in shaping message effectiveness and intentions to quit. The first study featured nonsmoking young adults, while the second and third studies sampled adult daily smokers. Each study was a randomized experiment with five warning-label image conditions: full-color graphic warning labels, black-and-white graphic warning labels, warning text (no graphic image), Surgeon General's warning labels, and no warning. Results consistently indicate that graphic warning labels (in both color and black-and-white) promote increased perceptions of fear, which in turn are associated with greater (perceived and actual) effectiveness. We conclude with a discussion of the results, highlighting implications, public policy considerations, and suggestions for future research.

  3. Impact of plain packaging of cigarettes on the risk perception of Uruguayan smokers: an experimental study.

    PubMed

    Harris, Jeffrey E; Ares, Gastón; Gerstenblüth, Mariana; Machin, Leandro; Triunfo, Patricia

    2017-09-08

    Uruguay, a South American country of 3.4 million inhabitants that has already banned tobacco advertising, prohibited such terms as light, mild and low-tar and required graphic warnings covering 80% of cigarette packs, is considering the imposition of plain, standardised packaging. We conducted an experimental choice-based conjoint analysis of the impact of alternative cigarette package designs on the risk perceptions of 180 adult current Uruguayan smokers. We compared plain packaging, with a standardised brand description and the dark brown background colour required on Australian cigarette packages, to two controls: the current package design with distinctive brand elements and colours; and a modified package design, with distinctive brand elements and the dark brown background colour. Graphic warnings were also varied. Plain packaging significantly reduced the probability of perceiving the stimulus cigarettes as less harmful in comparison to the current package design (OR 0.398, 95% CI 0.333 to 0.476, p<0.001) and the modified package design (OR 0.729, 95% CI 0.626 to 0.849, p<0.001). Plain packaging enhanced the perceived risk of cigarette products even in a highly regulated setting such as Uruguay. Both the elimination of distinctive brand elements and the use of Australia's dark brown background colour contributed to the observed effect. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Ohio Appalachian residents’ views on smoke-free laws and cigarette warning labels

    PubMed Central

    Reiter, PL; Wewers, ME; Paskett, ED; Klein, EG; Katz, ML

    2013-01-01

    Introduction Smoke-free laws and the addition of graphic warning labels to cigarette packages represent public health policies that can potentially reduce smoking and smoking-related disease. The attitudes and beliefs relating to these policies were examined among residents of Ohio Appalachia, a mostly rural region with high smoking prevalence among its residents. Methods Focus groups were conducted with participants from Ohio Appalachia during the summer of 2007. Groups included healthcare providers (n=37), community leaders (n=31), parents (n=19), and young adult women aged 18–26 years (n=27). Results Most participants were female (94%), non-Hispanic White (94%), and married (65%). Participants believed that most non-smokers supported Ohio’s enforced statewide comprehensive smoke-free law that began in 2007, while some smokers opposed the law due to a perceived infringement of their rights. They also reported that most residents and local businesses were abiding by and enforcing the law. Participants supported the addition of graphic warning labels to cigarette packages in the USA. They believed that such warning labels could help deter adolescents and adult non-smokers from smoking initiation, particularly if the negative aesthetic effects of smoking were emphasized. However, they felt the labels would be less effective among current smokers and older individuals living in their communities. Conclusions Participants generally held positive views about both the smoke-free law and the addition of graphic warning labels to cigarette packages in the USA. These tobacco-related public health policies are promising strategies for potentially reducing smoking and its associated diseases among residents living in Appalachia. Additional research is needed to further examine support for these policies among more diverse Appalachian populations. PMID:22300190

  5. Availability, price, and packaging of electronic cigarettes and e-liquids in Guatemala City retailers.

    PubMed

    Chacon, Violeta; Arriaza, Astrid; Cavazos, Patricia; Barnoya, Joaquin

    2017-03-25

    Electronic cigarettes (e-cigarettes) have the potential to normalize smoking and undermine tobacco control efforts. However, if well regulated, they also have a potential as smoking cessation aids. This study sought to determine the availability and types of e-cigarettes and e-liquids in Guatemala. We also assessed packaging characteristics and price. We surveyed a convenient sample of 39 Guatemala City retailers and purchased all e-cigarettes and e-liquids available. Duplicate samples (same brand, e-liquid type, flavor, nicotine content, or packaging) were purchased when prices were different between each other. Country of manufacture, flavor, expiration date, nicotine concentration, and price were recorded. We also documented package marketing strategies and warning labels. We purchased 64 e-cigarettes (53 unique and 11 duplicates) and 57 e-liquids (52 unique and 5 duplicates), mostly found on mall retailers. Most e-cigarettes (42, 66%) were first generation, followed by second (18, 28%) and third generations (4, 6%). Price of e-cigarettes differed significantly by generation. Most e-cigarettes (31, 58%) and 24 (46%) e-liquids did not include warning labels. Nicotine content was reported in 21 (39%) e-cigarettes that included e-liquids and 41 (79%) e-liquids' packages. E-cigarettes and e-liquids are available among a variety of retailers in Guatemala City and the industry is taking advantage of the fact that e-cigarettes are not regulated (e.g., health claims, minimum sales age, taxation). Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala. To the best of our knowledge, this is the first study describing e-cigarettes and e-liquids available in retailers in a low/middle-income country like Guatemala. E-cigarettes and e-liquids were found in a variety of types, flavors, and nicotine concentrations in Guatemalan retailers. Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala.

  6. Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review

    PubMed Central

    Noar, Seth M.; Francis, Diane B.; Bridges, Christy; Sontag, Jennah M.; Brewer, Noel T.; Ribisl, Kurt M.

    2016-01-01

    The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally.

  7. The perceptions of UK youth of branded and standardized, 'plain' cigarette packaging.

    PubMed

    Hammond, David; White, Christine; Anderson, Will; Arnott, Deborah; Dockrell, Martin

    2014-08-01

    Tobacco packaging is an important form of promotion. Standardizing cigarette packages ('plain' packaging) represents a novel tobacco control policy. This study examined perceptions of branded and standardized cigarette packages among British youth. Seven hundred twelve youth aged 11-17 completed an online survey. Participants viewed pairs of packages altered using a 3 × 2 factorial design: health warning type (40% text, 40% pictorial or 80% pictorial) × standardized pack colour (white vs. brown). A discrete-choice task was used in which participants selected packs based on attractiveness, taste, tar, health risk, impact of health warning and enticement to start smoking. Participants also compared regular Silk Cut and 'Superslims' Silk Cut packs. Participants completed a final selection task from two standardized and two branded packs. Warning type was significantly associated with all six outcomes: packs with larger pictorial warnings were more likely to be perceived as less attractive, less smooth, greater health risk, higher tar delivery, more effective health warnings and less likely to encourage initiation. The same pattern was found for brown vs. white standardized packages, with the exception of attractiveness and initiation. Compared with the regular Silk Cut pack, the 'Superslims' Silk Cut pack was perceived as significantly more favourable on all six outcomes. Finally, among respondents who selected a pack in the pack selection task, 95.1% selected a branded pack vs. 4.9% who selected a standardized pack. Increasing the size of pictorial health warnings and standardizing the appearance and shape of packages may discourage smoking initiation among young people. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  8. Considerations and Future Research Directions for E-Cigarette Warnings-Findings from Expert Interviews.

    PubMed

    Wackowski, Olivia A; Hammond, David; O'Connor, Richard J; Strasser, Andrew A; Delnevo, Cristine D

    2017-07-14

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

  9. 21 CFR 1141.14 - Misbranding of cigarettes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Misbranding of cigarettes. 1141.14 Section 1141.14...) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Cigarette Package and Advertising Warnings § 1141.14 Misbranding of cigarettes. (a) A cigarette shall be deemed to be...

  10. Plain packaging of cigarettes and smoking behavior: study protocol for a randomized controlled study

    PubMed Central

    2014-01-01

    Background Previous research on the effects of plain packaging has largely relied on self-report measures. Here we describe the protocol of a randomized controlled trial investigating the effect of the plain packaging of cigarettes on smoking behavior in a real-world setting. Methods/Design In a parallel group randomization design, 128 daily cigarette smokers (50% male, 50% female) will attend an initial screening session and be assigned plain or branded packs of cigarettes to smoke for a full day. Plain packs will be those currently used in Australia where plain packaging has been introduced, while branded packs will be those currently used in the United Kingdom. Our primary study outcomes will be smoking behavior (self-reported number of cigarettes smoked and volume of smoke inhaled per cigarette as measured using a smoking topography device). Secondary outcomes measured pre- and post-intervention will be smoking urges, motivation to quit smoking, and perceived taste of the cigarettes. Secondary outcomes measured post-intervention only will be experience of smoking from the cigarette pack, overall experience of smoking, attributes of the cigarette pack, perceptions of the on-packet health warnings, behavior changes, views on plain packaging, and the rewarding value of smoking. Sex differences will be explored for all analyses. Discussion This study is novel in its approach to assessing the impact of plain packaging on actual smoking behavior. This research will help inform policymakers about the effectiveness of plain packaging as a tobacco control measure. Trial registration Current Controlled Trials ISRCTN52982308 (registered 27 June 2013). PMID:24965551

  11. What is included with your online e-cigarette order? An analysis of e-cigarette shipping, product and packaging features.

    PubMed

    Kong, Amanda Y; Derrick, Jason C; Abrantes, Anthony S; Williams, Rebecca S

    2016-06-29

    The electronic cigarette industry is growing, with youth using e-cigarettes at higher rates than they are using cigarettes, and retail and online sales projected to reach $10 billion in 2017. Minimal regulation of the production and marketing of e-cigarettes exists to date, which has allowed companies to promote unsupported claims. We assessed the shipping, product features and packaging of a wide variety of e-cigarettes purchased online by adults and youth. The most popular internet e-cigarette vendors were identified from a larger study of internet tobacco vendors. Between August 2013 and June 2014, adults made 56 purchase attempts from online vendors, and youth made 98 attempts. Packages received were assessed for exterior and internal packaging features, including product information, health warnings and additional materials. We analysed a total of 125 orders featuring 86 unique brands of e-cigarettes. The contents were rarely indicated on package exteriors. Product information came with just 60% of orders and just 38.4% included an instruction manual. Only 44.6% of products included a health warning, and some had unsupported claims, such as lack of secondhand smoke exposure. Additionally, some products were leaking e-liquid and battery fluid on arrival. A large variety of e-cigarette products are manufactured and marketed to consumers. Many products do not include instructions for use, and unsupported claims are being presented to consumers. Effective federal regulation of the manufacturing, packaging, product information and health claims surrounding e-cigarettes is necessary to ensure consumers are presented with accurate e-cigarette use information. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Graphic warning labels and the demand for cigarettes.

    PubMed

    Starr, Martha A; Drake, Keith

    2017-03-01

    In 2010, the US Food and Drug Administration (FDA) proposed requiring tobacco companies to add graphic warning labels (GWLs) to cigarette packs. GWLs are large prominently placed warnings that use both text and photographic images to depict health risks of smoking. The companies challenged FDA's authority on First Amendment grounds; the courts accepted that FDA could compel companies to add GWLs, but argued that FDA had not established that GWLs would significantly reduce smoking. This paper adds new evidence on the question of whether GWLs would have reduced cigarette demand, by examining whether tobacco companies' share prices fell unusually after news indicating a higher likelihood of having GWLs, and rose on the opposite news. Such findings would be expected if investors viewed GWLs as likely to reduce cigarette demand. An event-study approach is used to determine whether the stock prices of US tobacco companies rose or fell unusually after news events in the period when GWLs were proposed, finalised, challenged and withdrawn. Tobacco companies' stock prices indeed realised significant abnormal returns after GWL news, consistent with expected negative effects on cigarette demand. Our estimates suggest investors expected GWLs to reduce the number of smokers by an extra 2.4-6.9 million in the 10 years after the rule took effect. These findings support the view that the GWLs proposed by FDA would have curbed cigarette consumption in the USA in an appreciable way. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. Effectiveness of text versus pictorial health warning labels and predictors of support for plain packaging of tobacco products within the European Union.

    PubMed

    Agaku, Israel T; Filippidis, Filippos T; Vardavas, Constantine I

    2015-01-01

    Tobacco product warning labels are a key health communication medium with plain packaging noted as the next step in the evolution of tobacco packaging. We assessed the self-reported impact of text versus pictorial health warnings and the determinants of support for plain packaging of tobacco products in the European Union (EU). The Special Eurobarometer 385 survey was analyzed for 26,566 adults from 27 EU countries in 2012. The self-reported impact of warning labels (text or pictorial) and determinants of EU-wide support for plain packaging were assessed using multivariate logistic regression. Current smokers in countries where cigarette pictorial warnings were implemented had higher odds of reporting that health warning labels had any effect on their smoking behavior (making a quit attempt or reducing number of cigarettes smoked per day) compared to respondents in countries with text-only warning labels (adjusted odds ratio, aOR = 1.31; 95% confidence interval, 95% CI: 1.10-1.56). Population support for plain packaging of tobacco packs was higher in countries where cigarette pictorial warnings already existed (aOR = 1.17; 95% CI: 1.07-1.28). These findings indicate that the implementation of pictorial warnings at an EU level may have a positive behavioral impact among smokers and pave the way for population support for plain packaging in the EU.

  14. Cigarette Warning Label Policy Alternatives and Smoking-Related Health Disparities

    PubMed Central

    Thrasher, James F.; Carpenter, Matthew J.; Andrews, Jeannette O.; Gray, Kevin M.; Alberg, Anthony J.; Navarro, Ashley; Friedman, Daniela B.; Cummings, K. Michael

    2012-01-01

    Background Pictorial health warning labels on cigarette packaging have been proposed for the U.S., but their potential influences among populations that suffer tobacco-related health disparities are unknown. Purpose To evaluate pictorial health warning labels, including moderation of their influences by health literacy and race. Methods From July 2011 to January 2012, field experiments were conducted with 981 adult smokers who were randomized to control (i.e., text-only labels, n=207) and experimental conditions (i.e., pictorial labels, n=774). The experimental condition systematically varied health warning label stimuli by health topic and image type. Linear mixed effects (LME) models estimated the influence of health warning label characteristics and participant characteristics on label ratings. Data were analyzed from January 2012 to April 2012. Results Compared to text-only warning labels, pictorial warning labels were rated as more personally relevant (5.7 vs 6.8, p<0.001) and effective (5.4 vs 6.8, p<0.001), and as more credible, but only among participants with low health literacy (7.6 vs 8.2, p<0.001). Within the experimental condition, pictorial health warning labels with graphic imagery had significantly higher ratings of credibility, personal relevance, and effectiveness than imagery of human suffering and symbolic imagery. Significant interactions indicated that labels with graphic imagery produced minimal differences in ratings across racial groups and levels of health literacy, whereas other imagery produced greater group differences. Conclusions Pictorial health warning labels with graphic images have the most-pronounced short-term impacts on adult smokers, including smokers from groups that have in the past been hard to reach. PMID:23159254

  15. Cigarette warning label policy alternatives and smoking-related health disparities.

    PubMed

    Thrasher, James F; Carpenter, Matthew J; Andrews, Jeannette O; Gray, Kevin M; Alberg, Anthony J; Navarro, Ashley; Friedman, Daniela B; Cummings, K Michael

    2012-12-01

    Pictorial health warning labels on cigarette packaging have been proposed for the U.S., but their potential influences among populations that suffer tobacco-related health disparities are unknown. To evaluate pictorial health warning labels, including moderation of their influences by health literacy and race. From July 2011 to January 2012, field experiments were conducted with 981 adult smokers who were randomized to control (i.e., text-only labels, n=207) and experimental conditions (i.e., pictorial labels, n=774). The experimental condition systematically varied health warning label stimuli by health topic and image type. Linear mixed effects (LME) models estimated the influence of health warning label characteristics and participant characteristics on label ratings. Data were analyzed from January 2012 to April 2012. Compared to text-only warning labels, pictorial warning labels were rated as more personally relevant (5.7 vs 6.8, p<0.001) and effective (5.4 vs 6.8, p<0.001), and as more credible, but only among participants with low health literacy (7.6 vs 8.2, p<0.001). Within the experimental condition, pictorial health warning labels with graphic imagery had significantly higher ratings of credibility, personal relevance, and effectiveness than imagery of human suffering and symbolic imagery. Significant interactions indicated that labels with graphic imagery produced minimal differences in ratings across racial groups and levels of health literacy, whereas other imagery produced greater group differences. Pictorial health warning labels with graphic images have the most-pronounced short-term impacts on adult smokers, including smokers from groups that have in the past been hard to reach. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  16. The effect of e-cigarette warning labels on college students' perception of e-cigarettes and intention to use e-cigarettes.

    PubMed

    Lee, Hsiao-Yun; Lin, Hsien-Chang; Seo, Dong-Chul; Lohrmann, David K

    2018-01-01

    This study examined the effect of two e-cigarette warning labels on college students' perceived advantages and risks of e-cigarette use, as well as students' intentions to use e-cigarettes. The company-produced e-cigarette warning label carries abundant information with small font size while the governmental warning label has only two sentences presented in large font size. The effect of both labels have not yet been examined and verified. Data were collected in October 2015 from college students at a Midwestern university. A pretest-posttest design was employed with 338 students exposed to the warning label proposed by the FDA and 328 students exposed to the label created by e-cigarette companies. Structural equation modeling analysis was implemented to examine the effect of warning labels with the analytical model grounded in the Theory of Planned Behavior. Findings showed that college students' perceived advantages of e-cigarette use were positively related to their intentions to use e-cigarettes, while perceived risks were negatively associated with their intentions. When comparing two labels, the governmental label was found to reduce college students' intentions to use e-cigarettes via increasing perceived risks of e-cigarette use (β=0.10, p<0.05), however, not via decreasing perceived advantages of e-cigarette use. The warning label currently used by e-cigarette companies showed no influence on beliefs about or intentions to use e-cigarettes. The warning label proposed by the FDA is more effective than that created by e-cigarette companies, however, has room for improvement to make a greater impact on e-cigarette use intention. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Insights into pictorial health warnings on tobacco product packages marketed in Uttar Pradesh, India.

    PubMed

    D S, Aruna; Rajesh, G; Mohanty, Vikrant Ranjan

    2010-01-01

    The Government of India issued an undertaking in the Supreme Court mandating pictorial health warnings (PHWs) on packages of tobacco products from 31st May, 2009 under " Cigarettes and Other Tobacco Products Act " (COTPA) guidelines. This constitutes a key economic channel for educating people on devastating health impacts of deadly products within in a vivid and memorable way. Few studies have investigated PHWs on tobacco products marketed in India. To assess met guidelines for pictorial health warnings under packaging and labeling rules on packages of collected tobacco products specified by COTPA. Snowball/network sampling design was followed to obtain samples of 37 different tobacco brands, 18 in smoking form (12 cigarette, 6 bidi brands) and 19 in smokeless form (4 chewing tobacco, 11 Gutkha and 4 Khaini brands) marketed at retail outlets at Muradnagar. They were analyzed for their compliance with guidelines through checklist by one calibrated examiner. PHWs were absent on packages of 5 tobacco brands. Fifteen tobacco brands had PHWs smaller than stipulated 40% of principal display area; 6 brands of bidis had PHWs on deceptive backgrounds, 3 of which were placed on a curved axis. Misleading descriptors and promotional messages were also present. Locally marketed tobacco products were not compliant with packaging and labeling rules specified by COTPA. This highlights the need for more stringent implementation of COTPA guidelines to combat the ever-growing tobacco menace.

  18. Cigarette pack warning labels in Russia: how graphic should they be?

    PubMed

    Wade, Benjamin; Merrill, Ray M; Lindsay, Gordon B

    2011-06-01

    Tobacco warning labels on cigarette packs have been shown to reduce cigarette consumption. The current study measures the Russian population's acceptance and preference of graphic (picture + text) tobacco warning labels. Nationally representative data were collected from 1778 participants in the Russian Federation in October 2009. A cross-sectional survey was conducted through person-to-person household interviews with respondents aged ≥ 14 years. Survey questions included standard demographic queries and three study-specific questions. Participants rated the strength of 13 cigarette warning labels according to their effectiveness to deter from smoking. Smoking status and the population's acceptance of similar warning labels was also measured. A dose-response pattern is apparent between the degree of graphic content of cigarette warning labels and the public's perception regarding the warning label's ability to discourage smoking. Approximately 87% of all respondents thought Russian authorities should require tobacco manufacturers to place graphic warning labels on cigarette packs, while 80% of current smokers wanted their government to enact such enforcement. The Russian population would strongly support government policy that would require graphic warning labels to be placed on cigarette packs in their country. In order to best deter from smoking, future cigarette warning labels in Russia should be as graphic as possible.

  19. Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study

    PubMed Central

    Ford, Allison; Moodie, Crawford; Purves, Richard; MacKintosh, Anne Marie

    2016-01-01

    Objectives To explore perceptions of superslims packaging, including compact ‘lipstick’ packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks. Design Qualitative focus group study. Setting Informal community venues in Scotland, UK. Participants 75 female non-smokers and occasional smokers (age range 12–24). Results Compact ‘lipstick’-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, ‘lipstick’ packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning. Conclusions As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban ‘lipstick’-style cigarette packs in the EU and has implications for policy elsewhere. PMID:26747040

  20. Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study.

    PubMed

    Ford, Allison; Moodie, Crawford; Purves, Richard; MacKintosh, Anne Marie

    2016-01-08

    To explore perceptions of superslims packaging, including compact 'lipstick' packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks. Qualitative focus group study. Informal community venues in Scotland, UK. 75 female non-smokers and occasional smokers (age range 12-24). Compact 'lipstick'-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, 'lipstick' packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning. As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban 'lipstick'-style cigarette packs in the EU and has implications for policy elsewhere. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Awareness of FDA-mandated cigarette packaging changes among smokers of 'light' cigarettes.

    PubMed

    Falcone, M; Bansal-Travers, M; Sanborn, P M; Tang, K Z; Strasser, A A

    2015-02-01

    Previous research has clearly demonstrated that smokers associate cigarette descriptors such as 'light', 'ultra-light' and 'low tar' with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and Drug Administration went into effect to ban the use of 'light', 'mild' and 'low' on cigarette packaging. We surveyed smokers participating in human laboratory studies at our Center in Philadelphia, PA, USA shortly after the ban went into effect to determine the extent of awareness of recent cigarette packaging changes among smokers of light cigarettes. In our sample of 266 smokers, 76 reported smoking light cigarettes, but fewer than half of these smokers reported noticing changes to their cigarette packaging. Simple removal of a few misleading terms may be too subtle of a change to register with consumers of so-called 'low tar' cigarettes; more comprehensive regulation of cigarette packaging design may be necessary to gain smokers' attention and minimize misperceptions associated with tobacco pack design characteristics and color.

  2. Awareness of FDA-mandated cigarette packaging changes among smokers of ‘light’ cigarettes

    PubMed Central

    Falcone, M.; Bansal-Travers, M.; Sanborn, P. M.; Tang, K. Z.; Strasser, A. A.

    2015-01-01

    Previous research has clearly demonstrated that smokers associate cigarette descriptors such as ‘light’, ‘ultra-light’ and ‘low tar’ with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and Drug Administration went into effect to ban the use of ‘light’, ‘mild’ and ‘low’ on cigarette packaging. We surveyed smokers participating in human laboratory studies at our Center in Philadelphia, PA, USA shortly after the ban went into effect to determine the extent of awareness of recent cigarette packaging changes among smokers of light cigarettes. In our sample of 266 smokers, 76 reported smoking light cigarettes, but fewer than half of these smokers reported noticing changes to their cigarette packaging. Simple removal of a few misleading terms may be too subtle of a change to register with consumers of so-called ‘low tar’ cigarettes; more comprehensive regulation of cigarette packaging design may be necessary to gain smokers’ attention and minimize misperceptions associated with tobacco pack design characteristics and color. PMID:25492058

  3. Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement.

    PubMed

    Evans, Abigail T; Peters, Ellen; Shoben, Abigail B; Meilleur, Louise R; Klein, Elizabeth G; Tompkins, Mary Kate; Tusler, Martin

    2017-04-07

    Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g. 'exercise can undo the negative effects of smoking') and perceptions of cigarette danger versus other products. 736 adult and 469 teen smokers/vulnerable smokers viewed one of three warning label types (text-only, low emotion graphic or high emotion graphic) four times over two weeks. Emotional reactions to the warnings were reported during the first and fourth exposures. Participants reported how often they considered the warnings, smoking myth endorsement, risk perceptions and perceptions of cigarette danger relative to smokeless tobacco and electronic cigarettes. In structural equation models, emotional reactions influenced risk perceptions and smoking myth endorsement through two processes. Emotion acted as information about risk, directly increasing smoking risk perceptions and decreasing smoking myth endorsement. Emotion also acted as a spotlight, motivating consideration of the warning information. Warning consideration increased risk perceptions, but also increased smoking myth endorsement. Emotional reactions to warnings decreased perceptions of cigarette danger relative to other products. Emotional reactions to cigarette warnings increase smoking risk perceptions, but also smoking myth endorsement and misperceptions that cigarettes are less dangerous than potentially harm-reducing tobacco products.

  4. "Plain packaging" regulations for tobacco products: the impact of standardizing the color and design of cigarette packs.

    PubMed

    Hammond, David

    2010-01-01

    Tobacco packaging and labeling policies have emerged as prominent and cost-effective tobacco control measures. Although packaging policies have primarily focused on health warnings, there is growing recognition of the importance of packaging as a marketing tool for the tobacco industry. The current paper reviews evidence on the potential impact of standardizing the color and design of tobacco packages -so called "plain" packaging. The evidence indicates three primary benefits of plain packaging: increasing the effectiveness of health warnings, reducing false health beliefs about cigarettes, and reducing brand appeal especially among youth and young adults. Overall, the research to date suggests that "plain" packaging regulations would be an effective tobacco control measure, particularly in jurisdictions with comprehensive restrictions on other forms of marketing.

  5. Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers.

    PubMed

    Wang, An-Li; Lowen, Steven B; Romer, Daniel; Giorno, Mario; Langleben, Daniel D

    2015-05-01

    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. 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. 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Emotional reaction facilitates the brain and behavioral impact of graphic cigarette warning labels in smokers

    PubMed Central

    Wang, An-Li; Lowen, Steven B; Romer, Daniel; Giorno, Mario; Langleben, Daniel D

    2015-01-01

    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 PMID:25564288

  7. Nonsmokers' responses to new warning labels on smokeless tobacco and electronic cigarettes: an experimental study.

    PubMed

    Popova, Lucy; Ling, Pamela M

    2014-09-25

    Graphic warning labels are a tobacco control best practice that is mandated in the US for cigarettes under the 2009 Family Smoking Prevention and Tobacco Control Act. However, smokeless tobacco products are not required to carry graphic warning labels, and as of September 2014, electronic cigarettes in the US carry no warning labels and are aggressively marketed, including with "reduced harm" or "FDA Approved" messages. In this online experiment, 483 US adult non-users of tobacco were randomized to view print advertisements for moist snuff, snus, and e-cigarettes with either warning labels (current warning label, graphic warning label) or "endorsements" (a "lower risk" label proposed by a tobacco company, an "FDA Approved" label) or control (tobacco advertisement with no label, advertisement for a non-tobacco consumer products). Main outcome measures included changes in perceived harm, positive attitudes towards, openness to using, and interest in a free sample of moist snuff, snus, and e-cigarettes. The graphic warning label increased perceived harm of moist snuff and e-cigarettes. "Lower risk" and "FDA Approved" labels decreased perceived harm of moist snuff and snus respectively. Current warning label and graphic warning label significantly lowered positive attitudes towards e-cigarettes. In this sample of non-users of tobacco, 15% were interested in a free sample of alternative tobacco products (predominantly e-cigarettes). Proportion of participants interested in a free sample did not differ significantly across the conditions, but those interested in a free sample had significantly lower perceptions of harm of corresponding tobacco products. Regulatory agencies should not allow "lower risk" warning labels, which have similar effects to the "FDA Approved" label, which is prohibited, and should consider implementing graphic warning labels for smokeless tobacco products and e-cigarettes.

  8. Do cigarette health warning labels comply with requirements: A 14-country study.

    PubMed

    Cohen, Joanna E; Brown, Jennifer; Washington, Carmen; Welding, Kevin; Ferguson, Jacqueline; Smith, Katherine C

    2016-12-01

    The Framework Convention on Tobacco Control, a global health treaty ratified by over 175 countries, calls on countries to ensure that tobacco packages carry health warning labels (HWLs) describing the harmful effects of tobacco use. We assessed the extent of compliance with 14 countries' HWL requirements. Unique cigarette packs were purchased in 2013 using a systematic protocol in 12 distinct neighborhoods within three of the ten most populous cities in the 14 low- and middle-income countries with the greatest number (count) of smokers. HWL compliance codebooks were developed for each country based on the details of country-specific HWL requirements, with up to four common compliance indicators assessed for each country (location, size, label elements, text size). Packs (n=1859) were double coded for compliance. Compliance was examined by country and pack characteristics, including parent company and brand family. Overall, 72% of coded cigarette packs were compliant with all relevant compliance indicators, ranging from 17% in the Philippines to 94% in Mexico. Compliance was highest for location of the warning (ranging from 75%-100%) and lowest for warning size (ranging from 46%-99%). Compliance was higher for packs bought in high SES neighborhoods, and varied by parent company and brand family. This multi-country study found at least one pack in every country - and many packs in some countries - that were not compliant with key requirements for health warning labels in the country of purchase. Non-compliance may be exacerbating health disparities. Tobacco companies should be held accountable for complying with country HWL requirements. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  9. The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion.

    PubMed

    Hiilamo, Heikki; Crosbie, Eric; Glantz, Stanton A

    2014-01-01

    To analyse the evolution and diffusion of health warnings on cigarette packs around the world, including tobacco industry attempts to block this diffusion. 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. 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. 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.

  10. The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion

    PubMed Central

    Hiilamo, Heikki; Crosbie, Eric; Glantz, Stanton A

    2013-01-01

    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. PMID:23092884

  11. The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS).

    PubMed

    Shang, Ce; Huang, Jidong; Cheng, Kai-Wen; He, Yanyun; Chaloupka, Frank J

    2017-01-21

    The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment. We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents' self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test. At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; p ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases. Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels.

  12. The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS)

    PubMed Central

    Shang, Ce; Huang, Jidong; Cheng, Kai-Wen; He, Yanyun; Chaloupka, Frank J.

    2017-01-01

    Introduction: The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment. Methods: We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents’ self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test. Results: At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; p ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases. Conclusions: Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels. PMID:28117729

  13. Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior

    PubMed Central

    Brewer, Noel T.; Hall, Marissa G.; Noar, Seth M.; Parada, Humberto; Stein-Seroussi, Al; Bach, Laura E.; Hanley, Sean; Ribisl, Kurt M.

    2017-01-01

    IMPORTANCE Pictorial warnings on cigarette packs draw attention and increase quit intentions, but their effect on smoking behavior remains uncertain. OBJECTIVE To assess the effect of adding pictorial warnings to the front and back of cigarette packs. DESIGN, SETTING, AND PARTICIPANTS This 4-week between-participant randomized clinical trial was carried out in California and North Carolina. We recruited a convenience sample of adult cigarette smokers from the general population beginning September 2014 through August 2015. Of 2149 smokers who enrolled, 88% completed the trial. No participants withdrew owing to adverse events. INTERVENTIONS We randomly assigned participants to receive on their cigarette packs for 4 weeks either text-only warnings (one of the Surgeon General’s warnings currently in use in the United States on the side of the cigarette packs) or pictorial warnings (one of the Family Smoking Prevention and Tobacco Control Act’s required text warnings and pictures that showed harms of smoking on the top half of the front and back of the cigarette packs). MAIN OUTCOMES AND MEASURES The primary trial outcome was attempting to quit smoking during the study. We hypothesized that smokers randomized to receive pictorial warnings would be more likely to report a quit attempt during the study than smokers randomized to receive a text-only Surgeon General’s warning. RESULTS Of the 2149 participants who began the trial (1039 men, 1060 women, and 34 transgender people; mean [SD] age, 39.7 [13.4] years for text-only warning, 39.8 [13.7] for pictorial warnings), 1901 completed it. In intent-to-treat analyses (n = 2149), smokers whose packs had pictorial warnings were more likely than those whose packs had text-only warnings to attempt to quit smoking during the 4-week trial (40% vs 34%; odds ratio [OR], 1.29; 95% CI, 1.09–1.54). The findings did not differ across any demographic groups. Having quit smoking for at least the 7 days prior to the end of the

  14. Plain packaging of cigarettes: do we have sufficient evidence?

    PubMed Central

    Smith, Collin N; Kraemer, John D; Johnson, Andrea C; Mays, Darren

    2015-01-01

    Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized “plain” cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers’ interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts. PMID:25897269

  15. Plain packaging of cigarettes: do we have sufficient evidence?

    PubMed

    Smith, Collin N; Kraemer, John D; Johnson, Andrea C; Mays, Darren

    2015-01-01

    Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized "plain" cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers' interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts.

  16. Visual attention to health warnings on plain tobacco packaging in adolescent smokers and non-smokers.

    PubMed

    Maynard, Olivia M; Munafò, Marcus R; Leonards, Ute

    2013-02-01

    Previous research with adults indicates that plain packaging increases visual attention to health warnings in adult non-smokers and weekly smokers, but not daily smokers. The present research extends this study to adolescents aged 14-19 years. Mixed-model experimental design, with smoking status as a between-subjects factor and pack type (branded or plain pack) and eye gaze location (health warning or branding) as within-subjects factors. Three secondary schools in Bristol, UK. A convenience sample of adolescents comprising never-smokers (n = 26), experimenters (n = 34), weekly smokers (n = 13) and daily smokers (n = 14). Number of eye movements to health warnings and branding on plain and branded packs. Analysis of variance, irrespective of smoking status revealed more eye movements to health warnings than branding on plain packs, but an equal number of eye movements to both regions on branded packs (P = 0.033). This was observed among experimenters (P < 0.001) and weekly smokers (P = 0.047), but not among never-smokers or daily smokers. Among experimenters and weekly smokers, plain packaging increases visual attention to health warnings and away from branding. Daily smokers, even relatively early in their smoking careers, seem to avoid the health warnings on cigarette packs. Adolescent never-smokers attend the health warnings preferentially on both types of packs, a finding which may reflect their decision not to smoke. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  17. Perceptions of branded and plain cigarette packaging among Mexican youth.

    PubMed

    Mutti, Seema; Hammond, David; Reid, Jessica L; White, Christine M; Thrasher, James F

    2016-01-29

    Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and size of cigarette packs, represents a novel policy measure to reduce the appeal of cigarettes. Plain packaging has been studied primarily in high-income countries like Australia and the UK. It is unknown whether the effects of plain packaging may differ in low-and-middle income countries with a shorter history of tobacco regulation, such as Mexico. An experimental study was conducted in Mexico City to examine perceptions of branded and plain cigarette packaging among smoking and non-smoking Mexican adolescents (n = 359). Respondents were randomly assigned to a branded or plain pack condition and rated 12 cigarette packages for appeal, taste, harm to health and smoker-image traits. As a behavioral measure of appeal, respondents were offered (although not given) four cigarette packs (either branded or plain) and asked to select one to keep. The findings indicated that branded packs were perceived to be more appealing (β = 3.40, p < 0.001) and to contain better tasting cigarettes (β = 3.53, p < 0.001), but were not perceived as less harmful than plain packs. Participants rated people who smoke the branded packs as having relatively more positive smoker-image traits overall (β = 2.10, p < 0.001), with particularly strong differences found among non-smokers for the traits 'glamorous', 'stylish', 'popular' and 'sophisticated' (p < 0.001). No statistically significant difference was found for the proportion of youth that accepted when offered branded compared with plain packs. These results suggest that plain packaging may reduce brand appeal among Mexican youth, consistent with findings in high-income countries.

  18. Socioeconomically disadvantaged smokers’ ratings of plain and branded cigarette packaging: an experimental study

    PubMed Central

    Guillaumier, Ashleigh; Bonevski, Billie; Paul, Chris; Durkin, Sarah; D'Este, Catherine

    2014-01-01

    Objectives This study aimed to test the potential impact of plain packaging for cigarettes on brand appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia, which combines plain packaging with larger health warning labels. Design A 2×2 factorial design trial embedded within a cross-sectional computer touchscreen survey. Data were collected between March and December 2012. Setting Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales, Australia. Participants N=354 smokers. The majority of the sample had not completed high school (64%), earned less than $A300/week (55%) and received their income from Government payments (95%). Interventions Participants were randomised to one of the four different pack conditions determined by brand name: Winfield versus Benson & Hedges, and packaging type: branded versus plain. Participants were required to rate their assigned pack on measures of brand appeal and purchase intentions. Results Plain packaging was associated with significantly reduced smoker ratings of ‘positive pack characteristics’ (p<0.001), ‘positive smoker characteristics’ (p=0.003) and ‘positive taste characteristics’ (p=0.033) in the Winfield brand name condition only. Across the four pack conditions, no main differences were found for ‘negative smoker characteristics’ (p=0.427) or ‘negative harm characteristics’ (p=0.411). In comparison to plain packaging, the presentation of branded packaging was associated with higher odds of smokers’ purchase intentions (OR=2.18, 95% CI 1.34 to 3.54; p=0.002). Conclusions Plain packs stripped of branding elements, featuring larger health warning labels, were associated with reduced positive cigarette brand image and purchase intentions among highly socioeconomically disadvantaged smokers. PMID:24503299

  19. Socioeconomically disadvantaged smokers' ratings of plain and branded cigarette packaging: an experimental study.

    PubMed

    Guillaumier, Ashleigh; Bonevski, Billie; Paul, Chris; Durkin, Sarah; D'Este, Catherine

    2014-02-06

    This study aimed to test the potential impact of plain packaging for cigarettes on brand appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia, which combines plain packaging with larger health warning labels. A 2×2 factorial design trial embedded within a cross-sectional computer touchscreen survey. Data were collected between March and December 2012. Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales, Australia. N=354 smokers. The majority of the sample had not completed high school (64%), earned less than $A300/week (55%) and received their income from Government payments (95%). Participants were randomised to one of the four different pack conditions determined by brand name: Winfield versus Benson & Hedges, and packaging type: branded versus plain. Participants were required to rate their assigned pack on measures of brand appeal and purchase intentions. Plain packaging was associated with significantly reduced smoker ratings of 'positive pack characteristics' (p<0.001), 'positive smoker characteristics' (p=0.003) and 'positive taste characteristics' (p=0.033) in the Winfield brand name condition only. Across the four pack conditions, no main differences were found for 'negative smoker characteristics' (p=0.427) or 'negative harm characteristics' (p=0.411). In comparison to plain packaging, the presentation of branded packaging was associated with higher odds of smokers' purchase intentions (OR=2.18, 95% CI 1.34 to 3.54; p=0.002). Plain packs stripped of branding elements, featuring larger health warning labels, were associated with reduced positive cigarette brand image and purchase intentions among highly socioeconomically disadvantaged smokers.

  20. An experimental study of the effects of electronic cigarette warnings on young adult nonsmokers' perceptions and behavioral intentions.

    PubMed

    Mays, Darren; Smith, Clayton; Johnson, Andrea C; Tercyak, Kenneth P; Niaura, Raymond S

    2016-01-01

    Electronic cigarette ("e-cigarette") manufacturers use warning labels on their advertising that vary widely in content and the U.S. Food and Drug Administration has issued a warning label requirement for e-cigarettes. There is limited data on the effects of these warnings on e-cigarette perceptions and other potential predictors of future tobacco use behavior in populations of interest to inform future regulatory requirements. This study examined the effects of e-cigarette warnings on perceptions of e-cigarettes and cigarettes and other cognitive precursors to tobacco use among young adult non-smokers. Non-smoking young adults ages 18 to 30 years (n = 436) were recruited through an internet-based crowdsourcing platform for an online experiment. Participants completed pre-exposure measures of demographics, tobacco use, and other relevant constructs and were randomized to view 1 of 9 e-cigarette stimuli in a 3 (Ad/Warning condition: Ad Only, Ad with Warning, Warning Only) x 3 (E-cigarette brand: Blu, MarkTen, Vuse) design. After viewing e-cigarette stimuli, participants reported perceptions of e-cigarettes and behavioral intentions to use e-cigarettes. Participants in the Ad Only and Ad with Warning conditions also completed a heat-mapping task assessing aspects of the ads that captured their attention. Then, participants were randomized to view cigarette ads from 1 of 3 major cigarette brands and reported perceptions of cigarettes and intentions to smoke cigarettes. Participants in the Warning Only condition reported significantly greater perceived harm and addictiveness of e-cigarettes and thoughts about not using e-cigarettes than the Ad Only and Ad with Warning conditions (p's < .05). The Ad Only and Ad with Warning conditions did not differ on these outcomes. Participants in the Warning Only condition also reported the harms of e-cigarettes were closer to those of cigarettes than the Ad Only condition (p < .05), but neither differed from the Ad with

  1. The effects of repeated exposure to graphic fear appeals on cigarette packages: A field experiment.

    PubMed

    Dijkstra, Arie; Bos, Colin

    2015-03-01

    Experimental studies on the effects of graphic fear appeals on cigarette packages typically expose smokers in a single session to a fear appeal, although in practice the exposure is always repeated. The present study applied an improved study design with repeated exposure to fear appeals on cigarette packages. In this field-experiment, 118 smokers were assigned to 1 of 2 conditions with either graphic fear appeals or textual warnings on their cigarette packages. During 3 weeks, fear and disgust were assessed 6 times. The intention to quit smoking after 3 weeks and quitting activity during the 3 weeks were the dependent measures. The effects of 3 pretest individual difference moderators were tested: disengagement beliefs, number of cigarettes smoked a day, and readiness to quit. Three weeks of exposure to the graphic fear appeals led to a stronger intention to quit, but only when smokers scored low on disengagement beliefs, or were heavier smokers. In addition, smokers low in disengagement more often reported to have cut down on smoking in the graphic condition. There were no indications of habituation of fear and disgust over the 3 weeks. The effects of graphic fear appeals depended on smokers' characteristics: The moderators may explain the mixed findings in the literature. The lack of habituation may be caused by the renewal of the graphics every few days. The used field-experimental design with natural repeated exposure to graphics is promising.

  2. 21 CFR 1141.12 - Incorporation by reference of required warnings.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... 1141.12 Section 1141.12 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.12 Incorporation by reference of required warnings. “Cigarette Required...

  3. Pictorial cigarette pack warnings: a meta-analysis of experimental studies

    PubMed Central

    Noar, Seth M; Hall, Marissa G; Francis, Diane B; Ribisl, Kurt M; Pepper, Jessica K; Brewer, Noel T

    2016-01-01

    Objective To inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings. Data sources We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles. Study selection We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33 613) met criteria. Data extraction and synthesis Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures. Results Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes. Conclusions The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects. PMID:25948713

  4. A qualitative content analysis of cigarette health warning labels in Australia, Canada, the United Kingdom, and the United States.

    PubMed

    Haines-Saah, Rebecca J; Bell, Kirsten; Dennis, Simone

    2015-02-01

    The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization's Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced.

  5. A Qualitative Content Analysis of Cigarette Health Warning Labels in Australia, Canada, the United Kingdom, and the United States

    PubMed Central

    Bell, Kirsten; Dennis, Simone

    2015-01-01

    The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization’s Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced. PMID:25521883

  6. Influence of Health Warnings on Beliefs about the Health Effects of Cigarette Smoking, in the Context of an Experimental Study in Four Asian Countries

    PubMed Central

    Mutti-Packer, Seema; Gupta, Prakash C.; Li, Qiang; Yuan, Jiang; Nargis, Nigar; Hussain, A. K. M. Ghulam; Hammond, David

    2017-01-01

    Cigarette package health warnings can be an important and low-cost means of communicating the health risks of smoking. We examined whether viewing health warnings in an experimental study influenced beliefs about the health effects of smoking, by conducting surveys with ~500 adult male smokers and ~500 male and female youth (age 16–18) in Beijing, China (n = 1070), Mumbai area, India (n = 1012), Dhaka, Bangladesh (n = 1018), and Republic of Korea (n = 1362). Each respondent was randomly assigned to view and rate pictorial health warnings for 2 of 15 different health effects, after which they reported beliefs about whether smoking caused 12 health effects. Respondents who viewed relevant health warnings (vs. other warnings) were significantly more likely to believe that smoking caused that particular health effect, for several health effects in each sample. Approximately three-quarters of respondents in China (Beijing), Bangladesh (Dhaka), and Korea (which had general, text-only warnings) thought that cigarette packages should display more health information, compared to approximately half of respondents in the Mumbai area, India (which had detailed pictorial warnings). Pictorial health warnings that convey the risk of specific health effects from smoking can increase beliefs and knowledge about the health consequences of smoking, particularly for health effects that are lesser-known. PMID:28767068

  7. Challenging key assumptions embedded in Health Canada's cigarette packaging legislation: Findings from in situ interviews with smokers in Vancouver.

    PubMed

    Haines-Saah, Rebecca J; Bell, Kirsten

    2017-03-01

    The main objective of this study was to utilize qualitative research methods in order to explore variations in how smokers respond to the government-mandated graphic health warnings and messages on their cigarette packets. Sixty in situ interviews were carried out with people while they were smoking in public settings across the city of Vancouver, British Columbia. During the interviews, participants were asked to recall the warning label on their cigarette packet, and general questions about the effects the imagery and text have had on their smoking. The analysis of findings pointed to several ways that participants overlooked, dismissed or otherwise failed to accurately recall health messages and images on their cigarette packaging. In particular, a significant minority questioned the veracity of the content of the labels and highlighted their exaggerated nature. With regard to the health information inserts, participants identified them as rubbish to be discarded rather than messages to be read. Few smokers could remember the warning label on their packet and some described warning labels that do not currently exist. Finally, a substantial proportion of participants were not smoking cigarettes from a standard packet, raising questions about how universal exposure to the labels actually is. Prevailing assumptions about how cigarette packaging legislation works as a population-level tobacco control intervention appear to be based on flawed assumptions about how people interact with cigarette packets as they are used in their everyday lives. As such, continued efforts on the part of tobacco control to redevelop "bolder" or more "graphic" labels on tobacco packaging may require consideration.

  8. Effects of first exposure to plain cigarette packaging on smoking behaviour and attitudes: a randomised controlled study.

    PubMed

    Maynard, Olivia M; Leonards, Ute; Attwood, Angela S; Bauld, Linda; Hogarth, Lee; Munafò, Marcus R

    2015-03-13

    Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes. In a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging. There was no evidence that pack type had an effect on either of the primary measures (ps > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (-0.52, 95% CI -0.82 to -0.22, p = 0.001), rated the pack attributes more negatively (-1.59, 95% CI -1.80 to -1.39, p < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p < 0.001). Plain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term. Current Controlled Trials ISRCTN52982308. Registered 27 June 2013.

  9. Impact of graphic and text warnings on cigarette packs: findings from four countries over five years.

    PubMed

    Borland, R; Wilson, N; Fong, G T; Hammond, D; Cummings, K M; Yong, H-H; Hosking, W; Hastings, G; Thrasher, J; McNeill, A

    2009-10-01

    To examine the impact of health warnings on smokers by comparing the short-term impact of new graphic (2006) Australian warnings with: (i) earlier (2003) United Kingdom larger text-based warnings; (ii) and Canadian graphic warnings (late 2000); and also to extend our understanding of warning wear-out. The International Tobacco Control Policy Evaluation Survey (ITC Project) follows prospective cohorts (with replenishment) of adult smokers annually (five waves: 2002-2006), in Canada, United States, UK and Australia (around 2000 per country per wave; total n = 17 773). Measures were of pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings. All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, they stimulated more cognitive responses than the UK (text-only) changes, and were avoided more, did not significantly increase forgoing cigarettes, but were read and noticed less. The findings also extend previous work showing partial wear-out of both graphic and text-only warnings, but the Canadian warnings have more sustained effects than UK ones. Australia's new health warnings increased reactions that are prospectively predictive of cessation activity. Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings. While there is partial wear-out in the initial impact associated with all warnings, stronger warnings tend to sustain their effects for longer. These findings support arguments for governments to exceed minimum FCTC requirements on warnings.

  10. Impact of Graphic and Text Warnings on Cigarette Packs: Findings from Four Countries over Five Years

    PubMed Central

    Borland, Ron; Wilson, Nick; Fong, Geoffrey T.; Hammond, David; Cummings, K. Michael; Yong, Hua-Hie; Hosking, Warwick; Hastings, Gerard; Thrasher, James; McNeill, Ann

    2015-01-01

    Objectives To examine the impact of health warnings on smokers by comparing the short-term impact of new graphic (2006) Australian warnings with: (i) earlier (2003) United Kingdom (UK) larger text-based warnings; (ii) and Canadian graphic warnings (late 2000); and secondarily, to extend our understanding of warning wear-out. Methods The International Tobacco Control Policy Evaluation Survey (ITC Project) follows prospective cohorts (with replenishment) of adult smokers annually (5 waves: 2002–2006), in Canada, United States, UK, and Australia (around 2000 per country per wave; total n=17,773). Measures were of pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings. Results All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, they stimulated more cognitive responses than the UK (text-only) changes, and were avoided more, did not significantly increase forgoing cigarettes, but were read and noticed less. The findings also extend previous work showing partial wear-out of both graphic and text-only warnings, but the Canadian warnings have more sustained effects than UK ones. Conclusions Australia’s new health warnings increased reactions that are prospectively predictive of cessation activity. Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings. While there is partial wear-out in the initial impact associated with all warnings, stronger warnings tend to sustain their effects for longer. These findings support arguments for governments to exceed minimum FCTC requirements on warnings. PMID:19561362

  11. A cross-sectional investigation of positive and negative smoker stereotypes and evaluations of cigarette warnings.

    PubMed

    Magnan, Renee E; Cameron, Linda D

    2017-05-01

    Although graphic cigarette warnings have important benefits that may aid in motivating smoking quit attempts and discouraging smoking initiation, 1 possible negative consequence might be psychological reactance to graphic warnings. Reactance to warnings might be shaped by stereotypical views of smokers. This research examined the associations of positive and negative smoker stereotypes with perceptions of the educational value of warnings as well as affective and motivational responses to them. Using a cross-sectional design, young adult smokers and nonsmokers (N = 396) completed an online questionnaire assessing positive and negative smoker stereotypes and then evaluated a series of graphic-plus-text and text-only cigarette warnings on perceived new knowledge gained from the warning, understandability of the warning, worry about the consequences of smoking elicited by the warning, and discouragement from smoking elicited by the warning. Negative smoker stereotypes were associated with all warning perceptions-more negative stereotypes were associated with higher levels of perceived new knowledge, perceived understandability, worry, and discouragement from smoking. Positive smoker stereotypes were only associated with more perceived new knowledge. Neither smoking status nor warning type moderated the relationships between smoking stereotypes and warning evaluations. Focusing on enhancing negative smoker portrayals, rather than reducing positive portrayals, may be more effective for antismoking campaigns. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. Effect of the Written and Combined Warnings on the Cigarette Pockets on University Students

    ERIC Educational Resources Information Center

    Gercek, Cem; Dogan, Nuri

    2012-01-01

    The general aim of this study is to analyze the effects of the written and combined (written and pictures) warning statements on the cigarette pockets on university students. The sample of the study includes a total of 231 undergraduate students. The participants were divided into two groups: the first group was presented only written warnings,…

  13. Flemish adolescents’ perceptions of cigarette plain packaging: a qualitative study with focus group discussions

    PubMed Central

    Van Hal, Guido; Van Roosbroeck, Sofie; Vriesacker, Bart; Arts, Matheus; Hoeck, Sarah; Fraeyman, Jessica

    2012-01-01

    Objectives To find out whether there is a potential impact of the appearance of a plain cigarette package on the smoking perceptions and behavioural intentions of Flemish adolescents. Design We performed a cross-sectional study using the qualitative method of focus group discussions. Setting Flemish adolescents. Participants We performed eight focus group discussions, in which 55 adolescents took part, 32 female and 23 male. Inclusion criteria were: Flemish male and female 15-year-olds to 16-year-olds and 17-year-olds to 18-year-olds attending regular high-school education or vocational training who were current or had ever been smokers. Outcome measure (planned as well as measured) The opinions and perceptions of young Flemish smokers regarding the impact of cigarette packaging on their smoking behaviour. Results Plain packages are perceived as less attractive, cheap and unreliable for young people. Because of the unattractiveness of the plain packaging, the health warnings catch the eye much more strongly. Conclusions In this first scientific study in Flanders on this topic, it emerged that plain packaging could be a strong policy tool to reduce the number of adolescents starting smoking. Validation of these findings by conducting a quantitative survey in the same target group is recommended. PMID:23242481

  14. Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms?

    PubMed Central

    White, Victoria; Williams, Tahlia; Faulkner, Agatha; Wakefield, Melanie

    2015-01-01

    Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on Australian adolescents’ cognitive processing of warnings and awareness of different health consequences of smoking. Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of standardised packaging, n=6338) and 2013 (7–12 months afterwards, n=5915). Students indicated frequency of attending to, reading, thinking or talking about warnings. Students viewed a list of diseases or health effects and were asked to indicate whether each was caused by smoking. Two—‘kidney and bladder cancer’ and ‘damages gums and teeth’—were new while the remainder had been promoted through previous health warnings and/or television campaigns. The 60% of students seeing a cigarette pack in previous 6 months in 2011 and 65% in 2013 form the sample for analysis. Changes in responses over time are examined. Results Awareness that smoking causes bladder cancer increased between 2011 and 2013 (p=0.002). There was high agreement with statements reflecting health effects featured in previous warnings or advertisements with little change over time. Exceptions to this were increases in the proportion agreeing that smoking was a leading cause of death (p<0.001) and causes blindness (p<0.001). The frequency of students reading, attending to, thinking or talking about the health warnings on cigarette packs did not change. Conclusions Acknowledgement of negative health effects of smoking among Australian adolescents remains high. Apart from increased awareness of bladder cancer, new requirements for packaging and health warnings did not increase adolescents’ cognitive processing of warning information. PMID:28407612

  15. Effectiveness of the European Union text-only cigarette health warnings: findings from four countries

    PubMed Central

    Mons, Ute; Nagelhout, Gera E.; Guignard, Romain; Mcneill, Ann; Willemsen, Marc C.; Driezen, Pete; Wilquin, Jean-Louis; Beck, François; Du-Roscöat, Enguerrand; Pötschke-Langer, Martina; Hammond, David; Fong, Geoffrey T.

    2012-01-01

    Background: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States. Methods: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers’ ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour. Results: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day. Conclusion: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated. PMID:21920847

  16. Impact on the Australian Quitline of new graphic cigarette pack warnings including the Quitline number.

    PubMed

    Miller, C L; Hill, D J; Quester, P G; Hiller, J E

    2009-06-01

    In March 2006, Australia introduced graphic pictorial warnings on cigarette packets. For the first time, packs include the Quitline number. To measure the combined effect of graphic cigarette pack warnings and printing the Quitline number on packs on calls to the Australian Quitline service. Calls to the Australian Quitline were monitored over 4 years, 2 years before and after the new packets were introduced. There were twice as many calls to the Quitline in 2006 (the year of introduction), as there were in each of the preceding 2 years. The observed increase in calls exceeds that explained by the accompanying television advertising alone. While call volume tapered back in 2007, it remained at a level higher than before the introduction of new packets. No change was observed in the proportion of first time callers. Introducing graphic cigarette packet warnings and the Quitline number on cigarette packets boosts demand for Quitline services, with likely flow on effects to cessation.

  17. Educational differences in the impact of pictorial cigarette warning labels on smokers: findings from the International Tobacco Control (ITC) Europe surveys.

    PubMed

    Nagelhout, Gera E; Willemsen, Marc C; de Vries, Hein; Mons, Ute; Hitchman, Sara C; Kunst, Anton E; Guignard, Romain; Siahpush, Mohammad; Yong, Hua-Hie; van den Putte, Bas; Fong, Geoffrey T; Thrasher, James F

    2016-05-01

    To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Neural correlates of graphic cigarette warning labels predict smoking cessation relapse.

    PubMed

    Owens, Max M; MacKillop, James; Gray, Joshua C; Hawkshead, Brittany E; Murphy, Cara M; Sweet, Lawrence H

    2017-04-30

    Exposure to graphic warning labels (GWLs) on cigarette packaging has been found to produce heightened activity in brain regions central to emotional processing and higher-order cognitive processes. The current study extends this literature by using functional magnetic resonance imaging (fMRI) to investigate neural activation in response to GWLs and use it to predict relapse in an evidence-based smoking cessation treatment program. Participants were 48 treatment-seeking nicotine-dependent smokers who completed an fMRI paradigm in which they were exposed to GWLs, text-only warning labels (TOLs), and matched control stimuli. Subsequently, they enrolled in smoking cessation treatment and their smoking behavior was monitored. Activation in bilateral amygdala, right dorsolateral prefrontal cortex, right inferior frontal gyrus, left medial temporal gyrus, bilateral occipital lobe, and bilateral fusiform gyrus was greater during GWLs than TOLs. Neural response in the ventromedial prefrontal cortex (vmPFC) during exposure to GWLs (relative to a visual control image) predicted relapse during treatment beyond baseline demographic and dependence severity, but response in the amygdala to GWLs did not. These findings suggest that neurocognitive processes in the vmPFC may be critical to understanding how GWL's induce behavior change and may be useful as a predictor of smoking cessation treatment prognosis. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  19. 21 CFR 1141.10 - Required warnings.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.10..., offer to sell, distribute, or import for sale or distribution within the United States any...

  20. 21 CFR 1141.10 - Required warnings.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.10..., offer to sell, distribute, or import for sale or distribution within the United States any...

  1. Smokers' recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008.

    PubMed

    Miller, Caroline L; Quester, Pascale G; Hill, David J; Hiller, Janet E

    2011-04-17

    In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images. Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n=504), 2006 (n=525), 2007 (n=414) and 2008 (n=464). Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images. Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.

  2. Smokers' recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008

    PubMed Central

    2011-01-01

    Background In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images. Methods Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n = 504), 2006 (n = 525), 2007 (n = 414) and 2008 (n = 464). Results Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images. Conclusions Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact. PMID:21496314

  3. Effect of warning statements in e-cigarette advertisements: an experiment with young adults in the United States.

    PubMed

    Sanders-Jackson, Ashley; Schleicher, Nina C; Fortmann, Stephen P; Henriksen, Lisa

    2015-12-01

    This on-line experiment examined whether the addition of ingredient- or industry-themed warning statements in television advertisements for e-cigarettes would affect young adults' craving for and risk perceptions of e-cigarettes and combustible cigarettes, as well as intent to purchase e-cigarettes. Advertisements for two leading e-cigarette brands were edited to contain a warning statement about product ingredients or about the tobacco industry. Participants were assigned randomly to one of eight treatments or one of two brand-specific control conditions without any warning statement. Young adults (n=900, aged 18-34 years) in a web panel were recruited from three groups: recent e-cigarette users, current smokers who used combustible cigarettes exclusively and non-users of either product. Craving and risk perceptions (addictiveness, harmful to health in general, harmful to others) were measured separately for e-cigarettes and combustible cigarettes. The Juster scale measured intention to purchase e-cigarettes. Exposure to both types of warnings was associated with lower craving for e-cigarettes among e-cigarette users and smokers who experienced any craving (P<0.01) and lower intention to purchase among all participants (P<0.001). Only exposure to ingredient-themed warnings was associated with lower craving for combustible cigarettes (P<0.05). Participants who saw industry-themed warnings reported greater perceptions of general harm (P<0.001), but also rated e-cigarettes as less addictive than the control conditions (P<0.05). The addition of ingredient- or industry-themed warning statements to e-cigarette television advertising similarly reduces craving and purchase intent for e-cigarettes, but has inconsistent effects on perceived risks. © 2015 Society for the Study of Addiction.

  4. Effect of warning statements in e-cigarette advertisements: an experiment with young adults in the US

    PubMed Central

    Sanders-Jackson, Ashley; Schleicher, Nina C.; Fortmann, Stephen P.; Henriksen, Lisa

    2016-01-01

    Background and Aims This on-line experiment examined whether the addition of ingredient- or industry-themed warning statements in television advertisements for e-cigarettes would affect young adults’ craving for and risk perceptions of e-cigarettes and combustible cigarettes, as well as intent to purchase e-cigarettes. Design Advertisements for two leading e-cigarette brands were edited to contain a warning statement about product ingredients or about the tobacco industry. Participants were assigned randomly to one of eight treatments or one of two brand-specific control conditions without any warning statement. Participants Young adults (n=900, ages 18–34 years) in a web panel were recruited from three groups: recent e-cigarette users, current smokers who used combustible cigarettes exclusively and non-users of either product. Measurements Craving and risk perceptions (addictiveness, harmful to health in general, harmful to others) were measured separately for e-cigarettes and combustible cigarettes. The Juster scale measured intention to purchase e-cigarettes. Findings Exposure to both types of warnings was associated with lower craving for e-cigarettes among e-cigarette users and smokers who experienced any craving (P <0.01) and lower intention to purchase among all participants (P <0.001). Only exposure to ingredient-themed warnings was associated with lower craving for combustible cigarettes (P<0.05). Participants who saw industry-themed warnings reported greater perceptions of general harm (P<0.001), but also rated e-cigarettes as less addictive than the control conditions (P<0.05). Conclusion The addition of ingredient- or industry-themed warning statements to e-cigarette television advertising similarly reduces craving and purchase intent for e-cigarettes, but has inconsistent effects on perceived risks. PMID:25557128

  5. Perceptions and perceived impact of graphic cigarette health warning labels on smoking behavior among U.S. young adults.

    PubMed

    Villanti, Andrea C; Cantrell, Jennifer; Pearson, Jennifer L; Vallone, Donna M; Rath, Jessica M

    2014-04-01

    In 2011, the Food and Drug Administration published a final rule requiring cigarette packages and advertisements to include graphic health warning labels (HWLs) with new warning statements. Implementation of this rule has been stalled by legal challenge. This study assessed correlates of smoking-related intentions related to graphic HWLs among current cigarette smokers and nonsmokers in a national sample of U.S. young adults aged 18-34. Data were collected from 4,236 participants aged 18-34 using an online panel in January 2012 for the Legacy Young Adult Cohort Study. Analyses were weighted to provide nationally representative estimates. Our main outcome was assessed with a single item: "Do you think that new warning labels with graphic pictures would make you think about not smoking?" Twenty-two percent of the young adults were current cigarette smokers. Fifty-three percent endorsed that new graphic HWLs would make them think about not smoking (40% among current smokers compared with 56% among nonsmokers). Among nonsmokers, those aged 18-24, females, Hispanics, and those who were aware of graphic cigarette HWLs were more likely to report intention to not smoke related to graphic HWLs. Among current smokers, intending to quit within the next 6 months was correlated with intention resulting from graphic HWLs. Hispanic ethnicity and intention to quit within 30 days were strong correlates of intention in light, nondaily, and self-identified social/occasional smokers. This study supports previous findings that graphic HWLs play an important role in preventing smoking, in addition to encouraging cessation in young adults.

  6. Perceptions and Perceived Impact of Graphic Cigarette Health Warning Labels on Smoking Behavior Among U.S. Young Adults

    PubMed Central

    2014-01-01

    Introduction: In 2011, the Food and Drug Administration published a final rule requiring cigarette packages and advertisements to include graphic health warning labels (HWLs) with new warning statements. Implementation of this rule has been stalled by legal challenge. This study assessed correlates of smoking-related intentions related to graphic HWLs among current cigarette smokers and nonsmokers in a national sample of U.S. young adults aged 18–34. Methods: Data were collected from 4,236 participants aged 18–34 using an online panel in January 2012 for the Legacy Young Adult Cohort Study. Analyses were weighted to provide nationally representative estimates. Our main outcome was assessed with a single item: “Do you think that new warning labels with graphic pictures would make you think about not smoking?” Results: Twenty-two percent of the young adults were current cigarette smokers. Fifty-three percent endorsed that new graphic HWLs would make them think about not smoking (40% among current smokers compared with 56% among nonsmokers). Among nonsmokers, those aged 18–24, females, Hispanics, and those who were aware of graphic cigarette HWLs were more likely to report intention to not smoke related to graphic HWLs. Among current smokers, intending to quit within the next 6 months was correlated with intention resulting from graphic HWLs. Hispanic ethnicity and intention to quit within 30 days were strong correlates of intention in light, nondaily, and self-identified social/occasional smokers. Conclusions: This study supports previous findings that graphic HWLs play an important role in preventing smoking, in addition to encouraging cessation in young adults. PMID:24212476

  7. Systematic Review of Measures Used in Pictorial Cigarette Pack Warning Experiments.

    PubMed

    Francis, Diane B; Hall, Marissa G; Noar, Seth M; Ribisl, Kurt M; Brewer, Noel T

    2017-10-01

    We sought to describe characteristics and psychometric properties of measures used in pictorial cigarette pack warning experiments and provide recommendations for future studies. Our systematic review identified 68 pictorial cigarette pack warning experiments conducted between 2000 and 2016 in 22 countries. Two independent coders coded all studies on study features, including sample characteristics, theoretical framework, and constructs assessed. We also coded measurement characteristics, including construct, number of items, source, reliability, and validity. We identified 278 measures representing 61 constructs. The most commonly assessed construct categories were warning reactions (62% of studies) and perceived effectiveness (60%). The most commonly used outcomes were affective reactions (35%), perceived likelihood of harm (22%), intention to quit smoking (22%), perceptions that warnings motivate people to quit smoking (18%), and credibility (16%). Only 4 studies assessed smoking behavior. More than half (54%) of all measures were single items. For multi-item measures, studies reported reliability data 68% of the time (mean α = 0.88, range α = 0.68-0.98). Studies reported sources of measures only 33% of the time and rarely reported validity data. Of 68 studies, 37 (54%) mentioned a theory as informing the study. Our review found great variability in constructs and measures used to evaluate the impact of cigarette pack pictorial warnings. Many measures were single items with unknown psychometric properties. Recommendations for future studies include a greater emphasis on theoretical models that inform measurement, use of reliable and validated (preferably multi-item) measures, and better reporting of measure sources. Robust and consistent measurement is important for building a strong, cumulative evidence base to support pictorial cigarette pack warning policies. This systematic review of experimental studies of pictorial cigarette warnings demonstrates the

  8. Plain packaging implementation: perceptions of risk and prestige of cigarette brands among Aboriginal and Torres Strait Islander people.

    PubMed

    Maddox, Raglan; Durkin, Sarah; Lovett, Ray

    2016-06-01

    To assess the impact of plain packaging with larger graphic health warnings on perceptions of risk and prestige related to different cigarette brands among Aboriginal and Torres Strait Islander people in the Australian Capital Territory. We hypothesised that the changes would decrease perceptions that 'some cigarette brands are more harmful than others', and that 'some brands are more prestigious than others', and this would be stronger among participants aged ≤35 years, and among smokers compared with non-smokers. Participants completed the survey prior to packaging changes, and were followed up 12 months later (n=98). Repeated measures ANCOVAs assessed perception changes. Following plain packaging implementation, there was a significant reduction in perceptions that 'some cigarette brands are more harmful than others'. There was no overall change in perceptions of prestige. However, there was a significant interaction for age. Analyses indicated a reduction in perceptions that 'some cigarette brands are more prestigious than others' among younger participants (p=0.05), but no change among older participants (p>0.20). There was no interaction for smoking status for perceptions of prestige, indicating smokers' and non-smokers' perceptions did not differ on this measure. These findings provide support for the packaging changes. © 2015 Public Health Association of Australia.

  9. Immediate effects of plain packaging health warnings on quitting intention and potential mediators: Results from two ecological momentary assessment studies.

    PubMed

    Schüz, Natalie; Eid, Michael; Schüz, Benjamin; Ferguson, Stuart G

    2016-03-01

    The purpose of this study is to examine the immediate, everyday impact of health warnings on cigarette packages on potential smoking cessation mediators and to test for differences in immediate reactions to branded and plain tobacco packaging during the transition phase when plain packs where first introduced in Australia. Two Ecological Momentary Assessment studies tested whether smokers report higher risk appraisals, self-efficacy, and quitting intentions immediately after seeing a warning compared to random times of the day (Study 1), and whether smoking from plain packs results in higher quitting intention, risk appraisal, and self-efficacy than smoking from branded packs (Study 2). There was no immediate increase in self-efficacy, risk appraisal, or intention after encountering health warnings, and no differences in cognitions when using plain compared with branded packs. Moreover, cognitions were not different when warnings were encountered in proximity to smoking compared to nonsmoking events. However, self-efficacy and risk appraisal were significantly associated with quitting intention. Current health warnings do not seem to have an immediate impact on important predictors of quitting intention and might benefit from including messages that place a stronger focus on increasing smokers' confidence that they can quit. Replication of the results with larger sample and cluster sizes is warranted.

  10. Effect of Health Warnings on Cigarette Pockets on Behaviour: Educational Perspective

    ERIC Educational Resources Information Center

    Gercek, Cem; Dogan, Nuri; Gundeger, Ceylan; Yakar, Levent

    2017-01-01

    Purpose: Health warnings printed on cigarette packets are an important vehicle in that they demonstrate and inform people of the threats and health risks related to smoking. Increasing the effectiveness of this vehicle is one of the purposes of this study. Research Methods: Since this research aims to describe the associations between dependent…

  11. Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers.

    PubMed

    Hammond, David; Fong, Geoffrey T; McDonald, Paul W; Brown, K Stephen; Cameron, Roy

    2004-08-01

    We assessed the impact of graphic Canadian cigarette warning labels. We used a longitudinal telephone survey of 616 adult smokers. Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes.

  12. Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy.

    PubMed

    Fathelrahman, Ahmed I; Omar, Maizurah; Awang, Rahmat; Borland, Ron; Fong, Geoffrey T; Hammond, David; Zain, Zarihah

    2009-03-01

    This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were "noticing warning labels during last month," "reading or looking closely at warning labels," "avoiding looking at labels during last month," "thinking about health risks of smoking because of the warning labels, "more likely to quit because of the warning labels," and "stopping from having a cigarette when about to smoke one because of the labels." A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses. The responses "more likely to quit because of the warning labels" and "stopped from having a cigarette when about to smoke one" significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change. Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.

  13. The Impact of Cigarette Pack Design, Descriptors, and Warning Labels on Risk Perception in the U.S

    PubMed Central

    Bansal-Travers, Maansi; Hammond, David; Smith, Philip; Cummings, K. Michael

    2011-01-01

    Background In the U.S., limited evidence exists on the impact of colors and brand imagery used in cigarette pack design. Purpose This study examined the impact of pack design, product descriptors, and health warnings on risk perception and brand appeal. Methods A cross-sectional mall-intercept study was conducted with 197 adult smokers and 200 nonsmokers in Buffalo, NY from June to July 2009 (data analysis from July 2009 to December 2010). Participants were shown 12 sets of packs randomly; each set varied by a particular design feature (color, descriptor) or warning label style (text vs graphic, size, attribution, message framing). Packs were rated on criteria including risk perceptions, quit motivation, and purchase interest. Results Participants selected larger, pictorial, and loss-framed warning labels as more likely to attract attention, encourage thoughts about health risks, motivate quitting, and most effective. Participants were more likely to select packs with lighter color shading and descriptors such as light, silver, and smooth as delivering less tar, smoother taste, and lower health risk, compared to darker-shaded or full flavor packs. Additionally, participants were more likely to select the branded compared to plain white pack when asked which delivered the most tar, smoothest taste, was more attractive, appealed to youth aged <18 years, and contained cigarettes of better quality. Conclusions The findings support larger, graphic health warnings that convey loss-framed messages as most effective in communicating health risks to U.S. adults. The results also indicate that color and product descriptors are associated with false beliefs about risks. Plain packaging may reduce many of the erroneous misperceptions of risk communicated through pack design features. PMID:21565661

  14. The impact of cigarette pack design, descriptors, and warning labels on risk perception in the U.S.

    PubMed

    Bansal-Travers, Maansi; Hammond, David; Smith, Philip; Cummings, K Michael

    2011-06-01

    In the U.S., limited evidence exists on the impact of colors and brand imagery used in cigarette pack design. This study examined the impact of pack design, product descriptors, and health warnings on risk perception and brand appeal. A cross-sectional mall-intercept study was conducted with 197 adult smokers and 200 nonsmokers in Buffalo NY from June to July 2009 (data analysis from July 2009 to December 2010). Participants were shown 12 sets of packs randomly; each set varied by a particular design feature (color, descriptor) or warning label style (text versus graphic, size, attribution, message framing). Packs were rated on criteria including risk perceptions, quit motivation, and purchase interest. Participants selected larger, pictorial, and loss-framed warning labels as more likely to attract attention, encourage thoughts about health risks, motivate quitting, and be most effective. Participants were more likely to select packs with lighter color shading and descriptors such as light, silver, and smooth as delivering less tar, smoother taste, and lower health risk, compared to darker-shaded or full-flavor packs. Additionally, participants were more likely to select the branded compared to plain white pack when asked which delivered the most tar, smoothest taste, was more attractive, appealed to youth aged <18 years, and contained cigarettes of better quality. The findings support larger, graphic health warnings that convey loss-framed messages as most effective in communicating health risks to U.S. adults. The results also indicate that color and product descriptors are associated with false beliefs about risks. Plain packaging may reduce many of the erroneous misperceptions of risk communicated through pack design features. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Desire versus Efficacy in Smokers’ Paradoxical Reactions to Pictorial Health Warnings for Cigarettes

    PubMed Central

    Romer, Daniel; Peters, Ellen; Strasser, Andrew A.; Langleben, Daniel

    2013-01-01

    Pictorial health warnings on cigarette packs create aversive emotional reactions to smoking and induce thoughts about quitting; however, contrary to models of health behavior change, they do not appear to alter intentions to quit smoking. We propose and test a novel model of intention to quit an addictive habit such as smoking (the efficacy-desire model) that can explain this paradoxical effect. At the core of the model is the prediction that self-efficacy and desire to quit an addictive habit are inversely related. We tested the model in an online experiment that randomly exposed smokers (N = 3297) to a cigarette pack with one of three increasing levels of warning intensity. The results supported the model’s prediction that despite the effects of warnings on aversion to smoking, intention to quit smoking is an inverted U-shape function of the smoker’s self-efficacy for quitting. In addition, smokers with greater (lesser) quit efficacy relative to smoking efficacy increase (decrease) intentions to quit. The findings show that previous failures to observe effects of pictorial warning labels on quit intentions can be explained by the contradictory individual differences that warnings produce. Thus, the model explains the paradoxical finding that quit intentions do not change at the population level, even though smokers recognize the implications of warnings. The model suggests that pictorial warnings are effective for smokers with stronger quit-efficacy beliefs and provides guidance for how cigarette warnings and tobacco control strategies can be designed to help smokers quit. PMID:23383006

  16. Larger and More Prominent Graphic Health Warnings on Plain-Packaged Tobacco Products and Avoidant Responses in Current Smokers: a Qualitative Study.

    PubMed

    Hardcastle, Sarah J; Chan, Derwin C K; Caudwell, Kim M; Sultan, Sarwat; Cranwell, Jo; Chatzisarantis, Nikos L D; Hagger, Martin S

    2016-02-01

    The introduction of tobacco plain packaging legislation in Australia meant that all tobacco products were to be sold in plain dark-brown packaging with 75% front-of-pack graphic health warnings and standardised font type and size for brand name and product variant. The change in the size and prominence of the warnings has been proposed as a reason for behaviour change in smokers in terms of increased intentions to quit and quit attempts. The current research examined attitudes and beliefs of cigarette smokers toward the increased size and prominence of the warnings and effects on their behaviour. Participants (N = 160) completed open-ended responses to questions on beliefs, attitudes and responses to plain packaging. Responses were subjected to inductive thematic content analysis for key themes. Four themes emerged from the analysis: emotional response to packaging, scepticism of health warnings, warnings and cessation behaviour, and avoidant coping behaviours. Participants reported increased negative emotional responses to the packaging and made specific reference to the graphic health warnings. Some participants attempted to discredit the messages. Others reported increased intentions to quit or quitting attempts. There were pervasive reports of avoidant responses including covering or hiding the warnings. Consistent with theories of illness perceptions and coping, current findings indicate that the larger, prominent graphic health warnings on plain-packaged tobacco products had pervasive effects on threat perceptions and subsequent behavioural responses. While some of the reported responses were adaptive (e.g. attempts to quit), others were maladaptive (e.g. avoiding the warnings).

  17. 19 CFR 18.4 - Sealing conveyances and compartments; labeling packages; warning cards.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... packages; warning cards. 18.4 Section 18.4 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF... Provisions § 18.4 Sealing conveyances and compartments; labeling packages; warning cards. (a)(1) Conveyances... secured with Customs seals, bright red cards, 8 by 101/4 inches in size, which shall be attached near such...

  18. 19 CFR 18.4 - Sealing conveyances and compartments; labeling packages; warning cards.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... packages; warning cards. 18.4 Section 18.4 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF... Provisions § 18.4 Sealing conveyances and compartments; labeling packages; warning cards. (a)(1) Conveyances... secured with Customs seals, bright red cards, 8 by 101/4 inches in size, which shall be attached near such...

  19. 19 CFR 18.4 - Sealing conveyances and compartments; labeling packages; warning cards.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... packages; warning cards. 18.4 Section 18.4 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF... Provisions § 18.4 Sealing conveyances and compartments; labeling packages; warning cards. (a)(1) Conveyances... secured with Customs seals, bright red cards, 8 by 101/4 inches in size, which shall be attached near such...

  20. Effectiveness of pictorial health warnings on cigarette packs among Lebanese school and university students.

    PubMed

    Alaouie, Hala; Afifi, Rema A; Haddad, Pascale; Mahfoud, Ziyad; Nakkash, Rima

    2015-03-01

    Pictorial health warnings are more effective than text warnings in enhancing motivation to quit and not to start smoking among youth. In Lebanon, packs still have only a very small text warning. The aim of this study was to evaluate the perceived effectiveness of pictorial health warnings on cigarette packs among Lebanese youth. This was a cross-sectional study including school students (n=1412) aged 13-18 years recruited from 28 schools and university students (n=1217) aged 18-25 years recruited from 7 universities. A variety of warnings were adapted from other countries. In all, 4 warnings were tested among school students and 18 among university students. All pictorial warnings were considered more effective than the current text warning on message-related and impact-related variables, including intentions to quit or not to start smoking among school and university students. Selected examples related to the top-ranked pictorial warnings are: among male non-smoking school students, 81% agreed that the 'lung' warning had more impact on their intentions not to start smoking as compared to 57% for the current text warning (p<0.001) with a significant difference compared to the current text warning; among female non-smoking university students, 75% agreed that the 'economic impact' pictorial had more impact on their intentions not to start smoking with significant difference as compared to 43% for the current text warning (p value=0.001); finally, the 'heart attack' pictorial resulted in 52% of male university students smokers stating they intended to quit as opposed to 20% for the current text warning (p value=0.019). The results of the present study add to the general international literature on the impact of pictorial warnings on youth and young adults. This study is also the first to test a non-health pictorial warning about the negative economic consequences of smoking, and to find that such a warning was effective among specific sociodemographic groups

  1. Impact on the Australian Quitline of new graphic cigarette pack warnings including the Quitline number

    PubMed Central

    Miller, C L; Hill, D J; Quester, P G; Hiller, J E

    2009-01-01

    Background: In March 2006, Australia introduced graphic pictorial warnings on cigarette packets. For the first time, packs include the Quitline number. Objective: To measure the combined effect of graphic cigarette pack warnings and printing the Quitline number on packs on calls to the Australian Quitline service. Methods: Calls to the Australian Quitline were monitored over 4 years, 2 years before and after the new packets were introduced. Results: There were twice as many calls to the Quitline in 2006 (the year of introduction), as there were in each of the preceding 2 years. The observed increase in calls exceeds that explained by the accompanying television advertising alone. While call volume tapered back in 2007, it remained at a level higher than before the introduction of new packets. No change was observed in the proportion of first time callers. Conclusion: Introducing graphic cigarette packet warnings and the Quitline number on cigarette packets boosts demand for Quitline services, with likely flow on effects to cessation. PMID:19211613

  2. Effect of Graphic Cigarette Warnings on Smoking Intentions in Young Adults

    PubMed Central

    Blanton, Hart; Snyder, Leslie B.; Strauts, Erin; Larson, Joy G.

    2014-01-01

    Introduction Graphic warnings (GWs) on cigarette packs are widely used internationally and perhaps will be in the US but their impact is not well understood. This study tested support for competing hypotheses in different subgroups of young adults defined by their history of cigarette smoking and individual difference variables (e.g., psychological reactance). One hypothesis predicted adaptive responding (GWs would lower smoking-related intentions) and another predicted defensive responding (GWs would raise smoking-related intentions). Methods Participants were an online sample of 1,169 Americans ages 18–24, who were randomly assigned either to view nine GWs designed by the FDA or to a no-label control. Both the intention to smoke in the future and the intention to quit smoking (among smokers) were assessed before and after message exposure. Results GWs lowered intention to smoke in the future among those with a moderate lifetime smoking history (between 1 and 100 cigarettes), and they increased intention to quit smoking among those with a heavy lifetime smoking history (more than 100 cigarettes). Both effects were limited to individuals who had smoked in some but not all of the prior 30 days (i.e., occasional smokers). No evidence of defensive “boomerang effects” on intention was observed in any subgroup. Conclusion Graphic warnings can reduce interest in smoking among occasional smokers, a finding that supports the adaptive-change hypothesis. GWs that target occasional smokers might be more effective at reducing cigarette smoking in young adults. PMID:24806481

  3. Effect of graphic cigarette warnings on smoking intentions in young adults.

    PubMed

    Blanton, Hart; Snyder, Leslie B; Strauts, Erin; Larson, Joy G

    2014-01-01

    Graphic warnings (GWs) on cigarette packs are widely used internationally and perhaps will be in the US but their impact is not well understood. This study tested support for competing hypotheses in different subgroups of young adults defined by their history of cigarette smoking and individual difference variables (e.g., psychological reactance). One hypothesis predicted adaptive responding (GWs would lower smoking-related intentions) and another predicted defensive responding (GWs would raise smoking-related intentions). Participants were an online sample of 1,169 Americans ages 18-24, who were randomly assigned either to view nine GWs designed by the FDA or to a no-label control. Both the intention to smoke in the future and the intention to quit smoking (among smokers) were assessed before and after message exposure. GWs lowered intention to smoke in the future among those with a moderate lifetime smoking history (between 1 and 100 cigarettes), and they increased intention to quit smoking among those with a heavy lifetime smoking history (more than 100 cigarettes). Both effects were limited to individuals who had smoked in some but not all of the prior 30 days (i.e., occasional smokers). No evidence of defensive "boomerang effects" on intention was observed in any subgroup. Graphic warnings can reduce interest in smoking among occasional smokers, a finding that supports the adaptive-change hypothesis. GWs that target occasional smokers might be more effective at reducing cigarette smoking in young adults.

  4. Framing Pictorial Cigarette Warning Labels to Motivate Young Smokers to Quit.

    PubMed

    Mays, Darren; Turner, Monique M; Zhao, Xiaoquan; Evans, W Douglas; Luta, George; Tercyak, Kenneth P

    2015-07-01

    The Family Smoking Prevention and Tobacco Control Act requires new pictorial warnings for U.S. cigarette packs, but enactment has been delayed by tobacco industry lawsuits. Research can inform implementation of the pictorial warning requirement and identify ways to optimize their public health impact post-implementation. This study investigated the impact of warning label message framing on young smokers' motivation to quit, examining cessation self-efficacy, and perceived risks as moderators of message framing impact. Smokers ages 18-30 (n = 740) completed baseline measures and were randomized to view 4 images of cigarette packs with pictorial health warnings featuring gain- or loss-framed messages. Motivation to quit was assessed after participants viewed the pack images. Linear models accounting for repeated measures and adjusting for baseline covariates examined the impact of message framing and interactions with baseline self-efficacy to quit and perceived risks of smoking. Loss-framed warnings prompted significantly greater motivation to quit among smokers with high self-efficacy compared with smokers with low self-efficacy. Among smokers with low self-efficacy, gain-framed messages were superior to loss-framed messages. Gain-framed warnings generated significantly greater motivation to quit among smokers with high perceived risks compared with smokers with low perceived risks. Among smokers with high perceived risks, gain-framed messages were superior to loss-framed messages. A combination of pictorial warnings featuring risk-based (i.e., loss-framed) and efficacy-enhancing (i.e., gain-framed) information may promote better public health outcomes. Research is needed to investigate how strategically framed warning messages impact smokers' behaviors based on their pre-existing attitudes and beliefs in real-world settings. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved

  5. Framing Pictorial Cigarette Warning Labels to Motivate Young Smokers to Quit

    PubMed Central

    Turner, Monique M.; Zhao, Xiaoquan; Evans, W. Douglas; Luta, George; Tercyak, Kenneth P.

    2015-01-01

    Introduction: The Family Smoking Prevention and Tobacco Control Act requires new pictorial warnings for U.S. cigarette packs, but enactment has been delayed by tobacco industry lawsuits. Research can inform implementation of the pictorial warning requirement and identify ways to optimize their public health impact post-implementation. This study investigated the impact of warning label message framing on young smokers’ motivation to quit, examining cessation self-efficacy, and perceived risks as moderators of message framing impact. Methods: Smokers ages 18–30 (n = 740) completed baseline measures and were randomized to view 4 images of cigarette packs with pictorial health warnings featuring gain- or loss-framed messages. Motivation to quit was assessed after participants viewed the pack images. Linear models accounting for repeated measures and adjusting for baseline covariates examined the impact of message framing and interactions with baseline self-efficacy to quit and perceived risks of smoking. Results: Loss-framed warnings prompted significantly greater motivation to quit among smokers with high self-efficacy compared with smokers with low self-efficacy. Among smokers with low self-efficacy, gain-framed messages were superior to loss-framed messages. Gain-framed warnings generated significantly greater motivation to quit among smokers with high perceived risks compared with smokers with low perceived risks. Among smokers with high perceived risks, gain-framed messages were superior to loss-framed messages. Conclusions: A combination of pictorial warnings featuring risk-based (i.e., loss-framed) and efficacy-enhancing (i.e., gain-framed) information may promote better public health outcomes. Research is needed to investigate how strategically framed warning messages impact smokers’ behaviors based on their pre-existing attitudes and beliefs in real-world settings. PMID:25143295

  6. Does Reactance against Cigarette Warning Labels Matter? Warning Label Responses and Downstream Smoking Cessation amongst Adult Smokers in Australia, Canada, Mexico and the United States

    PubMed Central

    Cho, Yoo Jin; Thrasher, James F.; Swayampakala, Kamala; Yong, Hua-Hie; McKeever, Robert; Hammond, David; Anshari, Dien; Cummings, K. Michael; Borland, Ron

    2016-01-01

    Objective Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts. Methods Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated. Results Interactions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater

  7. Does Reactance against Cigarette Warning Labels Matter? Warning Label Responses and Downstream Smoking Cessation amongst Adult Smokers in Australia, Canada, Mexico and the United States.

    PubMed

    Cho, Yoo Jin; Thrasher, James F; Swayampakala, Kamala; Yong, Hua-Hie; McKeever, Robert; Hammond, David; Anshari, Dien; Cummings, K Michael; Borland, Ron

    2016-01-01

    Some researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts. Survey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated. Interactions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater likelihood of avoiding

  8. The Impact of Cigarette Packaging Design Among Young Females in Canada: Findings From a Discrete Choice Experiment.

    PubMed

    Kotnowski, Kathy; Fong, Geoffrey T; Gallopel-Morvan, Karine; Islam, Towhidul; Hammond, David

    2016-05-01

    The tobacco industry uses various aspects of cigarette packaging design to market to specific groups. The current study examined the relative importance of five cigarette packaging attributes--pack structure (eg, "slims"), brand, branding, warning label size, and price--on perceptions of product taste, harm, and interest in trying, among young females in Canada. A discrete choice experiment was conducted with smoking and nonsmoking females, aged 16 to 24 (N = 448). Respondents were shown 10 choice sets, each containing four packs with different combinations of the attributes: pack structure (slim, lipstick, booklet, traditional); brand ("Vogue," "du Maurier"); branding (branded, plain); warning label size (50%, 75%); and price ($8.45, $10.45). For each choice set, respondents chose the brand that they: (1) would rather try, (2) would taste better, and (3) would be less harmful, or "none." For each outcome, the attributes' impact on consumer choice was analyzed using a multinomial logit model. The multinomial logit analyses revealed that young females weighted pack structure to be most important to their intention to try (46%), judgment of product taste (52%), and judgment of product harm (48%). Price and branding were weighted important in trial intent decisions (23% and 18%, respectively) and product taste judgments (29% and 15%, respectively). Whereas warning label size and brand were weighted important when judging product harm (23% and 17%, respectively). The findings suggest that standardized cigarette packaging may decrease demand and reduce misleading perceptions about product harm among young females. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Pictorial health warnings on cigarette packs and the impact on women

    PubMed Central

    Bittencourt, Lorna; Person, Sharina D; Cruz, Regina Celina; Scarinci, Isabel C

    2013-01-01

    OBJECTIVE To analyze the association between the pictorial graphic health warnings on cigarette packs and their impact on intention to quit smoking among women. METHODS Population-based cross-sectional study among 265 women daily smokers in the State of Paraná in 2010. The sample size was calculated using cluster sampling. Participants were asked whether they had seen any pictorial graphic health warnings in the past 30 days, whether these warnings made them think about quitting, and intensity of these thoughts. The data was analyzed using logistic regression and the independent variables included age, educational attainment, whether they had children, whether they had attempted to quit smoking in the past 12 months, age of smoking initiation, number of cigarettes smoked per day, their town of residence, and how soon after waking do they smoke their first cigarette. RESULTS Participants (91.7%) reported seeing the pictorial graphic health warnings in the past 30 days. Women with elementary education or below and women with some/complete high school education were more likely to think about quitting smoking after seeing the pictorial graphic health warningsthan women with higher education (OR = 4.85; p = 0.0028 and OR = 2.91; p = 0.05), respectively). Women who attempted to quit smoking in the past 12 months were more likely to think about quitting than women who had not (OR = 2.49; p = 0.001). Quit attempts within the last 12 months were associated with intensity of these thoughts (OR = 2.2; p = 0.03). CONCLUSIONS Results show an association between pictorial graphic health warnings and intent to quit smoking among women with warnings having a greater impact among women with less education and who had attempted to quit smoking within the past year. Tobacco control strategies should be implemented across all groups of women regardless of their educational attainment. PMID:24626550

  10. 75 FR 69523 - Required Warnings for Cigarette Packages and Advertisements

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-12

    ... Tax Revenues G. International Effects H. Regulatory Alternatives 1. 24-Month Compliance Period 2. Six-Month Compliance Period 3. Summary of Regulatory Alternatives I. Impact on Small Entities 1. Description... Small Entities 3. Alternatives to Minimize the Burden on Small Entities IX. Comments X. References I...

  11. Cannabis Users' Recommended Warnings for Packages of Legally Sold Cannabis: An Australia-Centered Study.

    PubMed

    Malouff, John M; Johnson, Caitlin E; Rooke, Sally E

    2016-01-01

    Introduction: Although cannabis use creates health risks, governments have recently been legalizing either medical use or leisure use. These governments can mandate health warnings on cannabis packages. Prior research examined recommended warnings of cannabis experts. The aim of this study was to obtain suggested cannabis health and safety warnings from cannabis users. Methods: We used a media release, Facebook postings, and announcements in university classes to seek individuals who had used cannabis at least once according to their own report. Using online data collection software that keeps participants anonymous, we asked the individuals to suggest a warning that governments could mandate on cannabis packages. Results: In total, 288 users suggested warnings. Categorizing the warnings into content categories led to six warning topics: (1) risk of harm to mental health and psychological functioning; (2) risk of operating machinery while under the influence; (3) short-term physical side effects; (4) responsible use; (5) long-term negative physical effects; and (6) dependence, addiction, or abuse. The user-suggested warnings overlapped with six expert-recommended warnings identified in prior survey research and included two content areas that did not feature in expert-recommended warnings: short-term physical side effects and the importance of responsible use. Conclusions: The results are consistent with prior findings that some youths perceive cannabis use as potentially harmful. The current findings provide possible new content for warnings on cannabis packages.

  12. Cannabis Users' Recommended Warnings for Packages of Legally Sold Cannabis: An Australia-Centered Study

    PubMed Central

    Malouff, John M.; Johnson, Caitlin E.; Rooke, Sally E.

    2016-01-01

    Abstract Introduction: Although cannabis use creates health risks, governments have recently been legalizing either medical use or leisure use. These governments can mandate health warnings on cannabis packages. Prior research examined recommended warnings of cannabis experts. The aim of this study was to obtain suggested cannabis health and safety warnings from cannabis users. Methods: We used a media release, Facebook postings, and announcements in university classes to seek individuals who had used cannabis at least once according to their own report. Using online data collection software that keeps participants anonymous, we asked the individuals to suggest a warning that governments could mandate on cannabis packages. Results: In total, 288 users suggested warnings. Categorizing the warnings into content categories led to six warning topics: (1) risk of harm to mental health and psychological functioning; (2) risk of operating machinery while under the influence; (3) short-term physical side effects; (4) responsible use; (5) long-term negative physical effects; and (6) dependence, addiction, or abuse. The user-suggested warnings overlapped with six expert-recommended warnings identified in prior survey research and included two content areas that did not feature in expert-recommended warnings: short-term physical side effects and the importance of responsible use. Conclusions: The results are consistent with prior findings that some youths perceive cannabis use as potentially harmful. The current findings provide possible new content for warnings on cannabis packages. PMID:28861495

  13. Changes in Vietnamese Male Smokers' Reactions Towards New Pictorial Cigarette Pack Warnings Over Time.

    PubMed

    Ngan, Tran Thu; Anh, Le Vu; My, Nguyen Thi Tuyet; Bich, Nguyen Ngoc

    2016-01-01

    Printing of pictorial health warnings (PHWs) on cigarette packages became obligatory by the Vietnam Law on Prevention and Control of Tobacco Harm in May 2013. Literature from high-income countries suggests that PHWs motivate smokers to quit smoking although their long-term effects have been questioned due to reduction of impact over time. This study aimed to assess the salience of PHWs and smokers' reactions towards PHWs over time. In May 2014 and May 2015, a cross-sectional questionnaire-based household survey was administered to respectively 1,462 and 1,509 Vietnamese male smokers aged 18 to 35. The result showed that salience of the PHWs 2 years after the implementation was higher than at the point of 1 year after the implementation. The proportion of respondents who tried to avoid noting the PHWs was reduced from 35% in wave 1 to 23% in wave 2. However, "Tried to avoid looking/thinking about the PHWs" increased 1.5 times the odds of presenting quit intention compared to those respondents who did not try to avoid looking/thinking about the PHWs (OR=1.5; 95%CI: 1.2-2.0). In conclusion, avoidance regarding PHWs may not work as a barrier when aiming at a higher level of quit intention. Salience of the PHWs may increase in the period shortly after their introduction onto packs but can be expected to decrease with time. In other words, it might be advisable to change or renew PHWs after a period of implementation to maintain their beneficial effects.

  14. Reactions to FDA-Proposed Graphic Warning Labels Affixed to U.S. Smokers’ Cigarette Packs

    PubMed Central

    Kreuter, Matthew W.; Boyum, Sonia; Thompson, Vetta S.; Caburnay, Charlene A.; Waters, Erika A.; Kaphingst, Kimberly A.; Rath, Suchitra; Fu, Qiang

    2015-01-01

    Introduction: Graphic warning labels have been shown to be more effective than text-only labels in increasing attention and perceived health risks, but most U.S. studies have involved single exposures in laboratory or Internet settings. Methods: We recruited a convenience sample (N = 202) of U.S. adult smokers from population subgroups with higher rates of smoking and smoking-related deaths who had participated in a larger survey about graphic warning labels. Participants were randomized to get 1 of 9 graphic + text labels or a text-only label. Research staff affixed a warning label sticker to participants’ cigarette pack(s) at enrollment. Color graphic labels covered slightly more than the lower half of packs. Black and white labels of current U.S. text-only warnings covered the existing side warning to prompt attention to the label (i.e., attention control). Participants received extra stickers of the same label for subsequent packs, and completed 3 telephone interviews in 1 week. Results: Participants reported low avoidance (<34%) and consistent use of the stickers (91%). Smokers consistently paid more attention to graphic than text-only labels. Only 5 of the 9 graphic warning labels were significantly associated with greater thoughts of health risks. Thinking about quitting and stopping smoking did not differ by label. Qualitative data illustrated differences in the “stickiness,” self-referencing, and counterarguments of graphic warning labels. Conclusions: U.S. smokers’ reactions to graphic warning labels on their own packs were similar to other, more controlled studies. Qualitative findings underscore the need for warning labels that encourage self-referential processing without increasing defensive reactions. PMID:25589676

  15. The effect of graphic cigarette warning labels on smoking behavior: evidence from the Canadian experience.

    PubMed

    Azagba, Sunday; Sharaf, Mesbah F

    2013-03-01

    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. 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. 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. 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.

  16. Reactions to FDA-Proposed Graphic Warning Labels Affixed to U.S. Smokers' Cigarette Packs.

    PubMed

    McQueen, Amy; Kreuter, Matthew W; Boyum, Sonia; Thompson, Vetta S; Caburnay, Charlene A; Waters, Erika A; Kaphingst, Kimberly A; Rath, Suchitra; Fu, Qiang

    2015-07-01

    Graphic warning labels have been shown to be more effective than text-only labels in increasing attention and perceived health risks, but most U.S. studies have involved single exposures in laboratory or Internet settings. We recruited a convenience sample (N = 202) of U.S. adult smokers from population subgroups with higher rates of smoking and smoking-related deaths who had participated in a larger survey about graphic warning labels. Participants were randomized to get 1 of 9 graphic + text labels or a text-only label. Research staff affixed a warning label sticker to participants' cigarette pack(s) at enrollment. Color graphic labels covered slightly more than the lower half of packs. Black and white labels of current U.S. text-only warnings covered the existing side warning to prompt attention to the label (i.e., attention control). Participants received extra stickers of the same label for subsequent packs, and completed 3 telephone interviews in 1 week. Participants reported low avoidance (<34%) and consistent use of the stickers (91%). Smokers consistently paid more attention to graphic than text-only labels. Only 5 of the 9 graphic warning labels were significantly associated with greater thoughts of health risks. Thinking about quitting and stopping smoking did not differ by label. Qualitative data illustrated differences in the "stickiness," self-referencing, and counterarguments of graphic warning labels. U.S. smokers' reactions to graphic warning labels on their own packs were similar to other, more controlled studies. Qualitative findings underscore the need for warning labels that encourage self-referential processing without increasing defensive reactions. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Do Young Adults Perceive That Cigarette Graphic Warnings Provide New Knowledge About the Harms of Smoking?

    PubMed

    Magnan, Renee E; Cameron, Linda D

    2015-08-01

    Although much research on graphic cigarette warnings has focused on motivational responses, little focus has been given to how much individuals learn from these labels. This study aims to investigate whether graphic warnings provide greater perceived new knowledge of smoking consequences compared to text-only warnings, and to test a mediational model whereby perceived new knowledge promotes discouragement from smoking through its impact on worry. In two studies, young adult smokers and nonsmokers (ages 18-25) evaluated graphic + text and corresponding text-only labels on perceived knowledge, worry about the harms addressed by the warning, and discouragement from smoking. Compared to text-only labels, graphic + text labels were rated as providing better understanding, more new knowledge, and being more worrisome and discouraging. Perceived new knowledge predicted greater discouragement from smoking directly and through worry. Graphic warnings may be more efficacious than text-based warnings in increasing knowledge and worry about harms, and discouragement from smoking.

  18. Tobacco industry argues domestic trademark laws and international treaties preclude cigarette health warning labels, despite consistent legal advice that the argument is invalid

    PubMed Central

    Crosbie, Eric; Glantz, Stanton A

    2013-01-01

    Objectives To analyse the tobacco industry’s use of international trade agreements to oppose policies to strengthen health warning labels (HWLs). Design A review of tobacco industry documents, tobacco control legislation and international treaties. Results During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco’s law firms in Australia and England, Britain’s Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including ‘plain’ packaging, for over a decade. Conclusions Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies’ own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist. PMID:23179728

  19. FDA cigarette warning labels lower craving and elicit frontoinsular activation in adolescent smokers

    PubMed Central

    Do, Kathy T.

    2015-01-01

    Cigarette smoking is an economically and epidemiologically expensive public health concern. Most adult smokers become addicted during adolescence, rendering it a crucial period for prevention and intervention. Although litigation claims have delayed implementation, graphic warning labels proposed by the U.S. Food and Drug Administration (FDA) may be a promising way to achieve this goal. We aimed to determine the efficacy of the labels in reducing in-scanner craving and to characterize the neurobiological responses in adolescent and adult smokers and non-smokers. While undergoing functional magnetic resonance imaging, thirty-nine 13- to 18-year-old adolescent and forty-one 25- to 30-year-old adult smokers and non-smokers rated their desire to smoke when presented with emotionally graphic warning labels and comparison non-graphic labels. Compared with adult smokers, adolescent smokers exhibited greater craving reduction in response to the warning labels. Although smokers evinced overall blunted recruitment of insula and dorsolateral prefrontal cortex (DLPFC) relative to non-smokers, an effect that was stronger in adolescent smokers, parametrically increasing activation of these regions was associated with greater craving reduction. Functional connectivity analyses suggest that greater DLPFC regulation of limbic regions predicted cigarette craving. These data underscore a prominent role of frontoinsular circuitry in predicting the efficacy of FDA graphic warning labels in craving reduction in adult and adolescent smokers. PMID:25887154

  20. 21 CFR 1141.14 - Misbranding of cigarettes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Misbranding of cigarettes. 1141.14 Section 1141.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising...

  1. 21 CFR 1141.14 - Misbranding of cigarettes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Misbranding of cigarettes. 1141.14 Section 1141.14 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising...

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

    PubMed

    Nagelhout, Gera E; Janssen, Eva; Ruiter, Robert A C; de Vries, Hein

    2016-05-01

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

  3. Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy

    PubMed Central

    Omar, Maizurah; Awang, Rahmat; Borland, Ron; Fong, Geoffrey T.; Hammond, David; Zain, Zarihah

    2009-01-01

    Introduction: This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.” Methods: A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses. Results: The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change. Discussion: Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries. PMID:19246625

  4. Do more graphic and aversive cigarette health warning labels affect Brazilian smokers' likelihood of quitting?

    PubMed

    Szklo, André Salem; Volchan, Eliane; Thrasher, James F; Perez, Cristina; Szklo, Moysés; de Almeida, Liz Maria

    2016-09-01

    Between 2008 and 2013, Brazil experienced a large decline in smoking prevalence, with an innovative round of aversive pictorial health warnings implemented on cigarette packs and at points of sale in 2009. The objective of this study was to examine changes over time in the distribution of quitting attempts and self-reported thoughts about quitting due to health warnings among current smokers. We conducted a pre-post study to evaluate data from two nationally-representative surveys conducted in 2008 and 2013. Responses to questions on smokers' quitting attempts in the last year (yes vs. no) and whether health warnings led them to think about quitting in the last month (yes vs. no) were combined into four categories, for which the distribution of the Brazilian smoking population by year was estimated. A multinomial model was used to obtain proportions for each category, adjusted by socio-demographic variables and nicotine dependence. The proportion of smokers who reported making a quitting attempt in the last year and stated that health warnings led them think about quitting smoking statistically increased over time (from 30.0% to 33.1%; p-value=0.010). The percentage of those who answered "no" to these two questions also increased over time (from 23.5% to 32.9%; p-value≤0.001). These findings suggest that innovative warnings introduced in Brazil likely served as a "reminder" for continuing to think about cessation among those who attempted to quit in the last year. These warnings may have also triggered more avoidance of thinking about their contents than the previous warnings, which some studies have found to promote subsequent quitting activity.

  5. Graphic imagery is not sufficient for increased attention to cigarette warnings: the role of text captions.

    PubMed

    Brown, Kyle G; Reidy, John G; Weighall, Anna R; Arden, Madelynne A

    2013-04-01

    The present study aims to assess the extent to which attention to UK cigarette warnings is attributable to the graphic nature of the content. 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. The experiment took place within the laboratories of a UK university. Eighty-six psychology undergraduates (51% smokers, 69% female), predominantly of Caucasian ethnicity took part. Reaction times towards probes replacing graphic images relative to probes replacing neutral images were utilised to create an index of attentional bias. 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. Graphic imagery on cigarette packets increases attentional capture, but only when accompanied by a text message about health risks. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

  6. Perceptions of plain and branded cigarette packaging among Norwegian youth and adults: a focus group study.

    PubMed

    Scheffels, Janne; Sæbø, Gunnar

    2013-02-01

    In Norway, packaging is one of the few remaining ways for tobacco companies to promote their products. Plain packaging of tobacco products could be a means to limit this promotion. Eleven focus group interviews with daily, occasional, and former smokers and nonsmokers (N = 69) aged 16-50 were undertaken to explore perceptions of different cigarette brands, the role of package design in communicating brand images, and how participants perceived cigarette packages when important design elements such as colors, symbols, logos, and branded fonts were removed. Distinct images of brands and user identities associated with these were narrated. Elements of the package design such as colors, images, and fonts were described as configuring brand images. Compared with current, completely branded cigarette packages, packages that displayed progressively fewer branding design elements were perceived increasingly unfavorably and as detracting from the images that packages otherwise communicate. The findings indicate that packaging is vital to consumer identification with and differentiation between cigarette brands and that a policy of plain packaging could be useful in reducing the impact of packaging in promotion of tobacco products.

  7. How does increasingly plainer cigarette packaging influence adult smokers' perceptions about brand image? An experimental study.

    PubMed

    Wakefield, M A; Germain, D; Durkin, S J

    2008-12-01

    Cigarette packaging is a key marketing strategy for promoting brand image. Plain packaging has been proposed to limit brand image, but tobacco companies would resist removal of branding design elements. A 3 (brand types) x 4 (degree of plain packaging) between-subject experimental design was used, using an internet online method, to expose 813 adult Australian smokers to one randomly selected cigarette pack, after which respondents completed ratings of the pack. Compared with current cigarette packs with full branding, cigarette packs that displayed progressively fewer branding design elements were perceived increasingly unfavourably in terms of smokers' appraisals of the packs, the smokers who might smoke such packs, and the inferred experience of smoking a cigarette from these packs. For example, cardboard brown packs with the number of enclosed cigarettes displayed on the front of the pack and featuring only the brand name in small standard font at the bottom of the pack face were rated as significantly less attractive and popular than original branded packs. Smokers of these plain packs were rated as significantly less trendy/stylish, less sociable/outgoing and less mature than smokers of the original pack. Compared with original packs, smokers inferred that cigarettes from these plain packs would be less rich in tobacco, less satisfying and of lower quality tobacco. Plain packaging policies that remove most brand design elements are likely to be most successful in removing cigarette brand image associations.

  8. The Efficacy of Cigarette Warning Labels on Health Beliefs in the United States and Mexico

    PubMed Central

    MUTTI, SEEMA; HAMMOND, DAVID; REID, JESSICA L.; THRASHER, JAMES F.

    2013-01-01

    Concern over health risks is the most common motivation for quitting smoking. Health warnings on tobacco packages are among the most prominent interventions to convey the health risks of smoking. Face-to-face surveys were conducted in Mexico (n=1,072), and a web-based survey was conducted in the US (n=1,449) to examine the efficacy of health warning labels on health beliefs. Respondents were randomly assigned to view two sets of health warnings (each with one text-only warning and 5–6 pictorial warnings) for two different health effects. Respondents were asked whether they believed smoking caused 12 different health effects. Overall, the findings indicate high levels of health knowledge in both countries for some health effects, although significant knowledge gaps remained; for example: less than half of respondents agreed that smoking causes impotence and less than one third agreed that smoking causes gangrene. Mexican respondents endorsed a greater number of correct beliefs about the health impact of smoking than the US sample. In both countries, viewing related health warning labels increased beliefs about the health risks of smoking, particularly for less well-known health effects, such as gangrene, impotence, and stroke. PMID:23905611

  9. Effectiveness of cigarette warning labels: examining the impact of graphics, message framing, and temporal framing.

    PubMed

    Nan, Xiaoli; Zhao, Xiaoquan; Yang, Bo; Iles, Irina

    2015-01-01

    This study examines the effectiveness of cigarette warning labels, with a specific focus on the impact of graphics, message framing (gain vs. loss), and temporal framing (present-oriented vs. future-oriented) among nonsmokers in the United States. A controlled experiment (N = 253) revealed that graphic warning labels were perceived as more effective, stronger in argument strength, and were generally liked more compared to text-only labels. In addition, loss-framed labels, compared to their gain-framed counterparts, were rated higher in perceived effectiveness, argument strength, and liking. No significant difference was observed between the present- and future-oriented frames on any of the dependent variables. Implications of the findings for antismoking communication efforts are discussed.

  10. Smokers’ reactions to the new larger health warning labels on plain cigarette packs in Australia: Findings from the ITC Australia project

    PubMed Central

    Yong, Hua-Hie; Borland, Ron; Hammond, David; Thrasher, James F.; Cummings, K. Michael; Fong, Geoffrey T.

    2015-01-01

    Objectives This study examined whether larger sized Australian cigarette health warning labels (HWLs) with plain packaging (PP) were associated with increased desirable reactions towards the HWLs post-implementation. Methods Data were from the ITC longitudinal cohort survey assessing Australian smokers one wave prior to the policy change in 2011 (n=1104) and another wave after the policy change in 2013 (n=1093). We assessed initial attentional orientation (AO) to or away from warnings, plus other reactions, including cognitive reactions towards the HWLs and quit intentions. Results As expected, AO towards the HWLs and reported frequency of noticing warnings increased significantly after the policy change, but not more reading. Smokers also thought more about the harms of smoking and avoided the HWLs more after the policy change, but frequency of forgoing cigarettes did not change. The subgroup who switched from initially focusing away to focusing on the HWLs following the policy change noticed and read the HWLs more, and also thought more about smoking harmful effects, whereas the subgroup (5.4%) who changed to focusing away from the HWLs showed opposite effects. We tested the mediational model of Yong et al (2014) and confirmed it for predicting quit intentions, with larger effects post-policy. Conclusions Increasing the size of HWLs and introducing them on PP in Australia appears to have led to an overall increase in desired levels and strength of some reactions, but evidence of reactance was among a small minority. PMID:25700365

  11. The cigarette box as an advertising vehicle in the United Kingdom: A case for plain packaging.

    PubMed

    Dewe, Michaela; Ogden, Jane; Coyle, Adrian

    2015-07-01

    This research aimed to study tobacco advertising between 1950-2003 and to evaluate the role of the cigarette box in advertising. Tobacco company advertisements (n = 204) were coded for content and meanings used to promote their product. There was a significant shift from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. It is argued that the cigarette box has absorbed the meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging.

  12. Changes in effectiveness of cigarette health warnings over time in Canada and the United States, 2002-2011.

    PubMed

    Hitchman, Sara C; Driezen, Pete; Logel, Christine; Hammond, David; Fong, Geoffrey T

    2014-05-01

    Article 11 of the World Health Organization's Framework Convention on Tobacco Control (FCTC) requires countries to implement health warnings on tobacco products. The Article 11 guidelines advise countries to periodically rotate warnings to prevent "wearout" of the health warnings. This study investigates potential wearout of cigarette health warnings during a period of 9 years in 2 countries: Canada, where larger pictorial warnings were implemented approximately 1 year prior to the study, and in the United States, where small text-only warnings were in place for 17 years at the beginning of the study. Data were drawn from national samples of smokers from the International Tobacco Control (ITC) Surveys in Canada (N = 5,309), and the United States (N = 6,412) who were originally recruited by telephone with random digit dialing. Changes in 4 measures of health warning effectiveness and in a composite Labels Impact Index were examined over 8 waves of survey data (2002-2011). Analyses were conducted in 2012. The health warning effectiveness measures and the Labels Impact Index indicated that the effectiveness of both the Canadian, and the U.S. warnings declined significantly over time. The Canadian warnings showed greater declines in effectiveness than the U.S. warnings, likely due to the initial novelty of the Canadian warnings. Despite the greater decline in Canada, the Canadian pictorial warnings were significantly more effective than the U.S. text-only warnings throughout the study. Health warnings decline in effectiveness over time. Health warnings on tobacco products should be changed periodically to maintain effectiveness.

  13. Changes in Effectiveness of Cigarette Health Warnings Over Time in Canada and the United States, 2002–2011

    PubMed Central

    2014-01-01

    Introduction: Article 11 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC) requires countries to implement health warnings on tobacco products. The Article 11 guidelines advise countries to periodically rotate warnings to prevent “wearout” of the health warnings. This study investigates potential wearout of cigarette health warnings during a period of 9 years in 2 countries: Canada, where larger pictorial warnings were implemented approximately 1 year prior to the study, and in the United States, where small text-only warnings were in place for 17 years at the beginning of the study. Methods: Data were drawn from national samples of smokers from the International Tobacco Control (ITC) Surveys in Canada (N = 5,309), and the United States (N = 6,412) who were originally recruited by telephone with random digit dialing. Changes in 4 measures of health warning effectiveness and in a composite Labels Impact Index were examined over 8 waves of survey data (2002–2011). Analyses were conducted in 2012. Results: The health warning effectiveness measures and the Labels Impact Index indicated that the effectiveness of both the Canadian, and the U.S. warnings declined significantly over time. The Canadian warnings showed greater declines in effectiveness than the U.S. warnings, likely due to the initial novelty of the Canadian warnings. Despite the greater decline in Canada, the Canadian pictorial warnings were significantly more effective than the U.S. text-only warnings throughout the study. Conclusions: Health warnings decline in effectiveness over time. Health warnings on tobacco products should be changed periodically to maintain effectiveness. PMID:24323572

  14. A difference that makes a difference: young adult smokers' accounts of cigarette brands and package design.

    PubMed

    Scheffels, J

    2008-04-01

    To explore young adult smokers' construction of meaning and identity in accounts of cigarette brands and cigarette package design, and the processes by which positive associations with a brand may be reinforced and sustained. Qualitative in-depth interviews with 21 smokers aged 18-23 in Norway, where advertising for tobacco has been banned since 1975. Cigarette brand and cigarette package design appear as an integrated part of young smokers' constructions of smoker identities, enabling the communication of personal characteristics, social identity and positions in hierarchies of status. Through branding and package design tobacco companies appear to be able to promote their products in a country where advertising is banned, by means of similar principles that make advertising effective: by creating preferences, differentiation and identification.

  15. Analysing compliance of cigarette packaging with the FCTC and national legislation in eight former Soviet countries.

    PubMed

    Mir, Hassan; Roberts, Bayard; Richardson, Erica; Chow, Clara; McKee, Martin

    2013-07-01

    To analyse compliance of cigarette packets with the Framework Convention on Tobacco Control (FCTC) and national legislation and the policy actions that are required in eight former Soviet Union countries. We obtained cigarette packets of each of the 10 most smoked cigarette brands in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia and Ukraine. The packets were then analysed using a standardised data collection instrument. The analysis included the placing, size and content of health warning labels and deceptive labels (eg, 'Lights'). Findings were assessed for compliance with the FCTC and national legislation. Health warnings were on all packets from all countries and met the FCTC minimum recommendations on size and position except Azerbaijan and Georgia. All countries used a variety of warnings except Azerbaijan. No country had pictorial health warnings, despite them being mandatory in Georgia and Moldova. All of the countries had deceptive labels despite being banned in all countries except Russia and Azerbaijan where still no such legislation exists. Despite progress in the use of health warning messages, gaps still remain-particularly with the use of deceptive labels. Stronger surveillance and enforcement mechanisms are required to improve compliance with the FCTC and national legislation.

  16. Tobacco Health Warning Messages on Plain Cigarette Packs and in Television Campaigns: A Qualitative Study with Australian Socioeconomically Disadvantaged Smokers

    ERIC Educational Resources Information Center

    Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

    2015-01-01

    Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health…

  17. Tobacco Health Warning Messages on Plain Cigarette Packs and in Television Campaigns: A Qualitative Study with Australian Socioeconomically Disadvantaged Smokers

    ERIC Educational Resources Information Center

    Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

    2015-01-01

    Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health…

  18. Cigarette Graphic Warning Labels and Smoking Prevalence in Canada: A Critical Examination and Reformulation of the FDA Regulatory Impact Analysis

    PubMed Central

    Huang, Jidong; Chaloupka, Frank J.; Fong, Geoffrey T.

    2014-01-01

    Background The estimated effect of cigarette graphic warning labels (GWLs) on smoking rates is a key input to FDA's regulatory impact analysis (RIA), required by law as part of its rulemaking process. However, evidence on the impact of GWLs on smoking prevalence is scarce. Objective The goal of this paper is to critically analyze FDA's approach to estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path forward to estimating the impact of the adoption of GWLs in Canada on Canadian national adult smoking prevalence. Methods A quasi-experimental methodology was employed to examine the impact of adoption of GWLs in Canada in 2000, using the U.S. as a control. Findings We found a statistically significant reduction in smoking rates after the adoption of GWLs in Canada in comparison to the U.S. Our analyses show that implementation of GWLs in Canada reduced smoking rates by 2.87 to 4.68 percentage points, a relative reduction of 12.1 to 19.6% — 33 to 53 times larger than FDA's estimates of a 0.088 percentage point reduction. We also demonstrated that FDA's estimate of the impact was flawed because it is highly sensitive to the changes in variable selection, model specification, and the time period analyzed. Conclusions Adopting GWLs on cigarette packages reduces smoking prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the U.S. had adopted GWLs in 2012, the number of adult smokers in the U.S. would have decreased by 5.3 to 8.6 million in 2013. Our analysis demonstrates that FDA's approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying these problems before this approach becomes the norm is critical for FDA's effective regulation of tobacco products. PMID:24218057

  19. Cigarette graphic warning labels and smoking prevalence in Canada: a critical examination and reformulation of the FDA regulatory impact analysis.

    PubMed

    Huang, Jidong; Chaloupka, Frank J; Fong, Geoffrey T

    2014-03-01

    The estimated effect of cigarette graphic warning labels (GWL) on smoking rates is a key input to the Food and Drug Administration's (FDA) regulatory impact analysis (RIA), required by law as part of its rule-making process. However, evidence on the impact of GWLs on smoking prevalence is scarce. The goal of this paper is to critically analyse FDA's approach to estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path forward to estimating the impact of the adoption of GWLs in Canada on Canadian national adult smoking prevalence. A quasi-experimental methodology was employed to examine the impact of adoption of GWLs in Canada in 2000, using the USA as a control. We found a statistically significant reduction in smoking rates after the adoption of GWLs in Canada in comparison with the USA. Our analyses show that implementation of GWLs in Canada reduced smoking rates by 2.87-4.68 percentage points, a relative reduction of 12.1-19.6%; 33-53 times larger than FDA's estimates of a 0.088 percentage point reduction. We also demonstrated that FDA's estimate of the impact was flawed because it is highly sensitive to the changes in variable selection, model specification, and the time period analysed. Adopting GWLs on cigarette packages reduces smoking prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the USA had adopted GWLs in 2012, the number of adult smokers in the USA would have decreased by 5.3-8.6 million in 2013. Our analysis demonstrates that FDA's approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying these problems before this approach becomes the norm is critical for FDA's effective regulation of tobacco products.

  20. Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation.

    PubMed

    Levy, David T; Mays, Darren; Yuan, Zhe; Hammond, David; Thrasher, James F

    2016-11-02

    While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts. Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the SimSmoke model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes. Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The SimSmoke model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome. Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. From directive to practice: are pictorial warnings and plain packaging effective to reduce the tobacco addiction?

    PubMed

    Mannocci, Alice; Colamesta, Vittoria; Mipatrini, Daniele; Messina, Gabriele; Gualano, Maria Rosaria; Gianfagna, Francesco; Boccia, G; Langiano, Elisa; Nicolotti, Nicola; Veronesi, Giovanni; Siliquini, Roberta; De Vito, Elisabetta; La Torre, Giuseppe

    2015-12-01

    Tobacco packaging represents an important form of promotion of tobacco products and for this reason plain packaging (PP) can be considered an additional tobacco control measure. In Italy the current tobacco packaging is branded with textual warnings. The study investigated the perception of PP with textual warnings (PPTWs) and pictorial warnings (PPPWs) in Italy. Cross-sectional. The study was conducted on adults who were current, never and former smokers. The participants watched out three types of packages (current packaging, PPTWs and PPPWs) and eight pictorial warnings, and indicated which they considered the most effective ones to motivate smoking cessation or reduction and to prevent the onset. 1065 subjects were recruited. The PPPWs were considered the most effective in motivating to quit, reduce and prevent the smoking habits (ranged 83.4%-96.1%) in all tobacco users and age groups (≤40/>40 years) (P < 0.005). In general PP does not seem to be very effective in quitting for three-quarters of the smokers and 60% declared that they would have still started smoking with PP. The younger group believed less than the older one that PP gives a motivation to quit (29.4% vs 39.1%, P = 0.002). The pictures perceived as most effective in communicating the smoking effects were lung cancer and gangrene (about one-third of the sample). The textual warnings on tobacco products are a measure of control now outdated. Countries still using them should consider the idea of replace them with pictorial warnings that seem to be more effective. It is also desirable in the near future that these countries introduce the PPPWs. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  2. Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship.

    PubMed

    Brennan, Emily; Durkin, Sarah J; Cotter, Trish; Harper, Todd; Wakefield, Melanie A

    2011-11-01

    In Australia, introduction of pictorial health warnings on cigarette packets was supported by a televised media campaign highlighting illnesses featured in two of the warning labels--gangrene and mouth cancer. Two studies examined whether the warnings and the television advertisements complemented one another. Population telephone surveys of two cross-sections of adult smokers measured changes in top-of-mind awareness of smoking-related health effects from before (2005; n=587) to after the pack warnings were introduced (2006; n=583). A second study assessed cognitive and emotional responses and intentions to quit after smokers watched one of the campaign advertisements, comparing outcomes of those with and without prior pack warning exposure. Between 2005 and 2006, the proportion of smokers aware that gangrene is caused by smoking increased by 11.2 percentage points (OR=23.47, p=0.000), and awareness of the link between smoking and mouth cancer increased by 6.6 percentage points (OR=2.00, p=0.006). In contrast, awareness of throat cancer decreased by 4.3 percentage points, and this illness was mentioned in the pack warnings but not the advertisements. In multivariate analyses, smokers who had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions. Television advertisements and pictorial health warnings on cigarette packets may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit. Jurisdictions implementing pictorial warnings should consider the benefits of supportive mass media campaigns to increase the depth, meaning and personal relevance of the warnings.

  3. Evaluation of strategies to communicate harmful and potentially harmful constituent (HPHC) information through cigarette package inserts: a discrete choice experiment.

    PubMed

    Salloum, Ramzi G; Louviere, Jordan J; Getz, Kayla R; Islam, Farahnaz; Anshari, Dien; Cho, Yoojin; O'Connor, Richard J; Hammond, David; Thrasher, James F

    2017-07-13

    The US Food and Drug Administration (FDA) has regulatory authority to use inserts to communicate with consumers about harmful and potentially harmful constituents (HPHCs) in tobacco products; however, little is known about the most effective manner for presenting HPHC information. In a discrete choice experiment, participants evaluated eight choice sets, each of which showed two cigarette packages from four different brands and tar levels (high vs low), accompanied by an insert that included between-subject manipulations (ie, listing of HPHCs vs grouping by disease outcome and numeric values ascribed to HPHCs vs no numbers) and within-subject manipulations (ie, 1 of 4 warning topics; statement linking an HPHC with disease vs statement with no HPHC link). For each choice set, participants were asked: (1) which package is more harmful and (2) which motivates them to not smoke; each with a 'no difference' option. Alternative-specific logit models regressed choice on attribute levels. 1212 participants were recruited from an online consumer panel (725 18-29-year-old smokers and susceptible non-smokers and 487 30-64-year-old smokers). Participants were more likely to endorse high-tar products as more harmful than low-tar products, with a greater effect when numeric HPHC information was present. Compared with a simple warning statement, the statement linking HPHCs with disease encouraged quit motivation. Numeric HPHC information on inserts appears to produce misunderstandings that some cigarettes are less harmful than others. Furthermore, brief narratives that link HPHCs to smoking-related disease may promote cessation versus communications that do not explicitly link HPHCs to disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers.

    PubMed

    Peters, Ellen; Romer, Daniel; Slovic, Paul; Jamieson, Kathleen Hall; Wharfield, Leisha; Mertz, C K; Carpenter, Stephanie M

    2007-04-01

    Cigarette smoking is a major source of mortality and medical costs in the United States. More graphic and salient warning labels on cigarette packs as used in Canada may help to reduce smoking initiation and increase quit attempts. However, the labels also may lead to defensive reactions among smokers. In an experimental setting, smokers and nonsmokers were exposed to Canadian or U.S. warning labels. Compared with current U.S. labels, Canadian labels produced more negative affective reactions to smoking cues and to the smoker image among both smokers and nonsmokers without signs of defensive reactions from smokers. A majority of both smokers and nonsmokers endorsed the use of Canadian labels in the United States. Canadian-style warnings should be adopted in the United States as part of the country's overall tobacco control strategy.

  5. Awareness of FDA-Mandated Cigarette Packaging Changes among Smokers of "Light" Cigarettes

    ERIC Educational Resources Information Center

    Falcone, M.; Bansal-Travers, M.; Sanborn, P. M.; Tang, K. Z.; Strasser, A. A.

    2015-01-01

    Previous research has clearly demonstrated that smokers associate cigarette descriptors such as "light", "ultra-light" and "low tar" with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and…

  6. Awareness of FDA-Mandated Cigarette Packaging Changes among Smokers of "Light" Cigarettes

    ERIC Educational Resources Information Center

    Falcone, M.; Bansal-Travers, M.; Sanborn, P. M.; Tang, K. Z.; Strasser, A. A.

    2015-01-01

    Previous research has clearly demonstrated that smokers associate cigarette descriptors such as "light", "ultra-light" and "low tar" with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and…

  7. Warning labels formulated as questions positively influence smoking-related risk perception.

    PubMed

    Glock, Sabine; Müller, Barbara C N; Ritter, Simone M

    2013-02-01

    Research on warning labels printed on cigarette packages has shown that fear inducing health warnings might provoke defensive responses. This study investigated whether reformulating statements into questions could avoid defensive reactions. Smokers were presented with either warning labels formulated as questions, textual warning labels, graphic warning labels, or no warning labels. Participants' smoking-related risk perception was higher after exposure to warning labels formulated as questions or no warning labels than after exposure to textual or graphic warning labels. These results indicate that reformulating statements into questions can avoid defensive responses elicited by textual- and graphic warning labels.

  8. Emotional graphic cigarette warning labels reduce the electrophysiological brain response to smoking cues.

    PubMed

    Wang, An-Li; Romer, Dan; Elman, Igor; Turetsky, Bruce I; Gur, Ruben C; Langleben, Daniel D

    2015-03-01

    There is an ongoing public debate about the new graphic warning labels (GWLs) that the Food and Drug Administration (FDA) proposes to place on cigarette packs. Tobacco companies argued that the strongly emotional images FDA proposed to include in the GWLs encroached on their constitutional rights. The court ruled that FDA did not provide sufficient scientific evidence of compelling public interest in such encroachment. This study's objectives were to examine the effects of the GWLs on the electrophysiological and behavioral correlates of smoking addiction and to determine whether labels rated higher on the emotional reaction (ER) scale are associated with greater effects. We studied 25 non-treatment-seeking smokers. Event-related potentials (ERPs) were recorded while participants viewed a random sequence of paired images, in which visual smoking (Cues) or non-smoking (non-Cues) images were preceded by GWLs or neutral images. Participants reported their cigarette craving after viewing each pair. Dependent variables were magnitude of P300 ERPs and self-reported cigarette craving in response to Cues. We found that subjective craving response to Cues was significantly reduced by preceding GWLs, whereas the P300 amplitude response to Cues was reduced only by preceding GWLs rated high on the ER scale. In conclusion, our study provides experimental neuroscience evidence that weighs in on the ongoing public and legal debate about how to balance the constitutional and public health aspects of the FDA-proposed GWLs. The high toll of smoking-related illness and death adds urgency to the debate and prompts consideration of our findings while longitudinal studies of GWLs are underway. © 2013 Society for the Study of Addiction.

  9. Emotional graphic cigarette warning labels reduce the electrophysiological brain response to smoking cues

    PubMed Central

    Wang, An-Li; Romer, Dan; Elman, Igor; Turetsky, Bruce I.; Gur, Ruben C.; Langleben, Daniel D.

    2015-01-01

    There is an ongoing public debate about the new graphic warning labels (GWLs) that the Food and Drug Administration (FDA) proposes to place on cigarette packs. Tobacco companies argued that the strongly emotional images FDA proposed to include in the GWLs encroached on their constitutional rights. The court ruled that FDA did not provide sufficient scientific evidence of compelling public interest in such encroachment. This study’s objectives were to examine the effects of the GWLs on the electrophysiological and behavioral correlates of smoking addiction and to determine whether labels rated higher on the emotional reaction (ER) scale are associated with greater effects. We studied 25 non-treatment-seeking smokers. Event-related potentials (ERPs) were recorded while participants viewed a random sequence of paired images, in which visual smoking (Cues) or non-smoking (non-Cues) images were preceded by GWLs or neutral images. Participants reported their cigarette craving after viewing each pair. Dependent variables were magnitude of P300 ERPs and self-reported cigarette craving in response to Cues. We found that subjective craving response to Cues was significantly reduced by preceding GWLs, whereas the P300 amplitude response to Cues was reduced only by preceding GWLs rated high on the ER scale. In conclusion, our study provides experimental neuroscience evidence that weighs in on the ongoing public and legal debate about how to balance the constitutional and public health aspects of the FDA-proposed GWLs. The high toll of smoking-related illness and death adds urgency to the debate and prompts consideration of our findings while longitudinal studies of GWLs are underway. PMID:24330194

  10. Australian adult smokers’ responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey

    PubMed Central

    Wakefield, Melanie; Coomber, Kerri; Zacher, Meghan; Durkin, Sarah; Brennan, Emily; Scollo, Michelle

    2015-01-01

    Background We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms. Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April–September 2012, pre-PP) with n=759 surveyed in the transition period (October–November 2012) and n=4240 during the first year of implementation (December 2012–November 2013, PP year 1), using multivariate logistic regression analyses. Results From pre-PP to PP year 1, more smokers disliked their pack (p<0.001), perceived lower pack appeal (p<0.001), lower cigarette quality (p<0.001), lower satisfaction (p<0.001) and lower value (p<0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p<0.001), attributed much motivation to quit to GHWs (p<0.001), avoided specific GHWs when purchasing (p<0.001), and covered packs (p<0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults. Conclusions The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation. PMID:28407606

  11. Lessons from New Zealand’s introduction of pictorial health warnings on tobacco packaging

    PubMed Central

    Wilson, Nick; Allen, Matthew; Edwards, Richard; Thomson, George; Li, Judy

    2010-01-01

    Abstract While international evidence suggests that featuring pictorial health warnings on tobacco packaging is an effective tobacco control intervention, the process used to introduce these new warnings has not been well documented. We examined relevant documents and interviewed officials responsible for this process in New Zealand. We found that, despite tobacco companies’ opposition to pictorial health warnings and the resource constraints facing health authorities, the implementation process was generally robust and successful. Potential lessons for other countries planning to introduce or refresh existing pictorial health warnings include: (i) strengthening the link between image research and policy; (ii) requiring frequent image development and refreshment; (iii) using larger pictures (e.g. 80% of the front of the packet); (iv) developing themes that recognize concerns held by different smoker sub-groups; and (v) running integrated mass media campaigns when the warnings are introduced. All countries could also support moves by the World Health Organization Framework Convention on Tobacco Control’s Secretariat to develop an international bank of copyright-free warnings. PMID:21076568

  12. Lessons from New Zealand's introduction of pictorial health warnings on tobacco packaging.

    PubMed

    Hoek, Janet; Wilson, Nick; Allen, Matthew; Edwards, Richard; Thomson, George; Li, Judy

    2010-11-01

    While international evidence suggests that featuring pictorial health warnings on tobacco packaging is an effective tobacco control intervention, the process used to introduce these new warnings has not been well documented. We examined relevant documents and interviewed officials responsible for this process in New Zealand. We found that, despite tobacco companies' opposition to pictorial health warnings and the resource constraints facing health authorities, the implementation process was generally robust and successful. Potential lessons for other countries planning to introduce or refresh existing pictorial health warnings include: (i) strengthening the link between image research and policy; (ii) requiring frequent image development and refreshment; (iii) using larger pictures (e.g. 80% of the front of the packet); (iv) developing themes that recognize concerns held by different smoker sub-groups; and (v) running integrated mass media campaigns when the warnings are introduced. All countries could also support moves by the World Health Organization Framework Convention on Tobacco Control's Secretariat to develop an international bank of copyright-free warnings.

  13. Smokers' reactions to the new larger health warning labels on plain cigarette packs in Australia: findings from the ITC Australia project.

    PubMed

    Yong, Hua-Hie; Borland, Ron; Hammond, David; Thrasher, James F; Cummings, K Michael; Fong, Geoffrey T

    2016-03-01

    This study examined whether larger sized Australian cigarette health warning labels (HWLs) with plain packaging (PP) were associated with increased desirable reactions towards the HWLs postimplementation. Data were from the International Tobacco Control (ITC) longitudinal cohort survey assessing Australian smokers one wave prior to the policy change in 2011 (n=1104) and another wave after the policy change in 2013 (n=1093). We assessed initial attentional orientation (AO) to or away from warnings, plus other reactions, including cognitive reactions towards the HWLs and quit intentions. As expected, AO towards the HWLs and reported frequency of noticing warnings increased significantly after the policy change, but not more reading. Smokers also thought more about the harms of smoking and avoided the HWLs more after the policy change, but frequency of forgoing cigarettes did not change. The subgroup that switched from initially focusing away to focusing on the HWLs following the policy change noticed and read the HWLs more, and also thought more about the harmful effects of smoking, whereas the subgroup (5.4%) that changed to focusing away from the HWLs showed opposite effects. We tested the mediational model of Yong et al and confirmed it for predicting quit intentions, with larger effects post-policy. Increasing the size of HWLs and introducing them on PP in Australia appears to have led to an overall increase in desired levels and strength of some reactions, but evidence of reactance was among a small minority. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. The effect of cigarette branding and plain packaging on female youth in the United Kingdom.

    PubMed

    Hammond, David; Daniel, Samantha; White, Christine M

    2013-02-01

    Cigarette packaging is the most prominent form of tobacco marketing remaining in countries such as the United Kingdom. The current study examined perceptions of cigarette packaging among female youth and the potential impact of "plain" cigarette packaging regulations. A national sample of 947 16- to 19-year-old female subjects in the United Kingdom completed an online survey. Participants were randomized to view 10 cigarette packs designed according to one of four experimental conditions: fully branded female packs, the same packs without descriptor words, the same packs without brand imagery or descriptors ("plain" packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk, positive smoker image, and completed a behavioral pack selection task. Plain packs were rated as the least appealing and worse tasting compared with all other conditions. Plain packs were also associated with fewer false beliefs about health risks compared with branded packs. Removing brand descriptors from packs significantly reduced measures of appeal and taste, particularly for brands with flavor descriptors, such as cherry and vanilla. Plain packs were significantly less likely to be associated with positive images, such as glamour, sophistication, and slimness. Most importantly, respondents were significantly less likely to accept a pack of cigarettes when offered only plain versus branded packs (p = .026). Marketing in the form of pack branding remains a potent tool for increasing the appeal of tobacco products to young women. The findings provide empirical support for plain cigarette packaging regulations in Australia to be implemented in 2012. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. The importance of cigarette packaging in a 'dark' market: the 'Silk Cut' experience.

    PubMed

    Moodie, Crawford; Angus, Kathryn; Ford, Allison

    2014-05-01

    In a growing number of countries tobacco companies are severely restricted in how they can legally market their products. In these 'dark' markets the role of packaging as a promotional and communications tool becomes more pronounced. How packaging is used for the most expensive cigarette brands in dark markets has received limited attention however, even though these 'premium' cigarette brands significantly impact upon the profitability of tobacco companies. We outline, using retail trade press journals, how packaging was used for premium brand 'Silk Cut' in the UK from 2004 to 2011, following a comprehensive ban on tobacco advertising, promotions and sponsorship. From 2004 to 2008 packaging was used to help launch two new variants and during this period Silk Cut market share of the premium sector grew by 1.1%. Overall share of the cigarette market for the Silk Cut house (brand family) fell however due to the continuing decline of the premium sector. From 2008 to 2011 changes to the packaging were much more frequent, including the repeated use of limited-edition designs, and modifications to pack shape, texture, style of opening, cellophane, foil and inner frame. Silk Cut's share of the premium sector grew a further 2.9% from 2008 to 2011, and overall cigarette market share increased. That a premium brand can report any level of growth within such a hostile market, where most advertising, promotion and sponsorship is banned, taxation is among the highest in the world, and in the midst of a recession, is testament to the value of packaging.

  16. The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods.

    PubMed

    Droulers, Olivier; Gallopel-Morvan, Karine; Lacoste-Badie, Sophie; Lajante, Mathieu

    2017-01-01

    The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used-for the first time in this context-to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers' emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.).

  17. Tobacco health warning messages on plain cigarette packs and in television campaigns: a qualitative study with Australian socioeconomically disadvantaged smokers.

    PubMed

    Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

    2015-02-01

    Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health risk and cessation benefit messages. Six focus groups were conducted over September 2012-April 2013 with adult clients of welfare organizations in regional New South Wales, Australia who were current smokers (n = 51). Participants discussed HWLs, plain packaging and anti-smoking television advertisements. Discussions were audio-taped, transcribed verbatim and analysed using thematic analysis. Highly emotive warnings delivering messages of negative health effects were most likely to capture the attention of the study participants; however, these warning messages did not prompt quit attempts and participants were sceptical about the effectiveness of cessation programmes such as telephone quitlines. Active avoidance of health warning messages was common, and many expressed false and self-exempting beliefs towards the harms of tobacco. Careful consideration of message content and medium is required to communicate the anti-smoking message to disadvantaged smokers who consider themselves desensitized to warnings. Health communication strategies should continue to address false beliefs about smoking and educate on cessation services that are currently underutilized. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  18. Implementation of graphic health warning labels on tobacco products in India: the interplay between the cigarette and the bidi industries

    PubMed Central

    Sankaran, Sujatha; Hiilamo, Heikki; Glantz, Stanton A

    2014-01-01

    Objectives To understand the competition between and among tobacco companies and health groups that led to graphical health warning labels (GHWL) on all tobacco products in India. Methods Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library, documents obtained through Indias Right to Information ‘ Act, and news reports. Results Implementation of GHWLs in India reflects a complex interplay between the government and the cigarette and bidi industries, who have shared as well as conflicting interests. Joint lobbying by national-level tobacco companies (that are foreign subsidiaries of multinationals) and local producers of other forms of tobacco blocked GHWLs for decades and delayed the implementation of effective GHWLs after they were mandated in 2007. Tobacco control activists used public interest lawsuits and the Right to Information Act to win government implementation of GHWLs on cigarette, bidi and smokeless tobacco packs in May 2009 and rotating GHWLs in December 2011. Conclusions GHWLs in India illustrate how the presence of bidis and cigarettes in the same market creates a complex regulatory environment. The government imposing tobacco control on multinational cigarette companies led to the enforcement of regulation on local forms of tobacco. As other developing countries with high rates of alternate forms of tobacco use establish and enforce GHWL laws, the tobacco control advocacy community can use pressure on the multinational cigarette industry as an indirect tool to force implementation of regulations on other forms of tobacco. PMID:24950697

  19. Impact of Female-Oriented Cigarette Packaging in the United States

    PubMed Central

    Doxey, Juliana; Daniel, Samantha; Bansal-Travers, Maansi

    2011-01-01

    Introduction: Cigarette packaging is among the most prominent forms of tobacco marketing. This study examined the impact of cigarette pack design among young women in the United States. Method: A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010. Participants were randomized to view eight cigarette packs designed according to one of four experimental conditions: fully branded female packs, same packs without descriptors (e.g., “slims”), same packs without brand imagery or descriptors (“plain” packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task. Results: Fully branded female packs were rated significantly more appealing than the same packs without descriptors, “plain” packs, and non–female-branded packs. Female-branded packs were associated with a greater number of positive attributes including glamour, slimness, and attractiveness and were more likely to be perceived as less harmful. Approximately 40% of smokers and nonsmokers requested a pack at the end of the study; female-branded packs were 3 times more likely to be selected than plain packs. Conclusion: Plain packaging and removing descriptors such as “slims” from cigarette packs may reduce smoking susceptibility among young women. PMID:21486994

  20. Impact of female-oriented cigarette packaging in the United States.

    PubMed

    Hammond, David; Doxey, Juliana; Daniel, Samantha; Bansal-Travers, Maansi

    2011-07-01

    Cigarette packaging is among the most prominent forms of tobacco marketing. This study examined the impact of cigarette pack design among young women in the United States. A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010. Participants were randomized to view eight cigarette packs designed according to one of four experimental conditions: fully branded female packs, same packs without descriptors (e.g., "slims"), same packs without brand imagery or descriptors ("plain" packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task. Fully branded female packs were rated significantly more appealing than the same packs without descriptors, "plain" packs, and non-female-branded packs. Female-branded packs were associated with a greater number of positive attributes including glamour, slimness, and attractiveness and were more likely to be perceived as less harmful. Approximately 40% of smokers and nonsmokers requested a pack at the end of the study; female-branded packs were 3 times more likely to be selected than plain packs. Plain packaging and removing descriptors such as "slims" from cigarette packs may reduce smoking susceptibility among young women.

  1. The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers.

    PubMed

    Hammond, David; McDonald, Paul W; Fong, Geoffrey T; Brown, K Stephen; Cameron, Roy

    2004-01-01

    To effectively address the health burden of tobacco use, tobacco control programs must find ways of motivating smokers to quit. The present study examined the extent to which former smokers' motivation to quit was influenced by two tobacco control policies recently introduced in the Waterloo Region: a local smoke-free bylaw and graphic cigarette warning labels. A random digit-dial telephone survey was conducted with 191 former smokers in southwestern Ontario, Canada in October 2001. Former smokers who had quit in the previous three years rated the factors that influenced their decision to quit and helped them to remain abstinent. Thirty-six percent of former smokers cited smoke-free policies as a motivation to quit smoking. Former smokers who quit following the introduction of a total smoke-free bylaw were 3.06 (CI95 = 1.02-9.19) times more likely to cite smoking bylaws as a motivation to quit, compared to former smokers who quit prior to the bylaw. A total of 31% participants also reported that cigarette warning labels had motivated them to quit. Former smokers who quit following the introduction of the new graphic warning labels were 2.78 (CI9 = 1.20-5.94) times more likely to cite the warnings as a quitting influence than former smokers who quit prior to their introduction. Finally, 38% of all former smokers surveyed reported that smoke-free policies helped them remain abstinent and 27% reported that warning labels helped them do so. More stringent smoke-free and labelling policies were associated with a greater impact upon motivations to quit.

  2. Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada.

    PubMed

    Thrasher, James F; Swayampakala, Kamala; Cummings, K Michael; Hammond, David; Anshari, Dien; Krugman, Dean M; Hardin, James W

    2016-07-01

    In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers' attention toward warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up. Data were analyzed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models were estimated to assess associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects. Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11-0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06-0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14-0.47), quit attempts (ORtwice or more vs none=1.68, 95% CI: 1.28-2.19), and sustained quit attempts (ORtwice or more vs none=1.48, 95% CI: 1.01-2.17). More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs. Copyright © 2016. Published by Elsevier Inc.

  3. Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

    PubMed Central

    Thrasher, James F.; Swayampakala, Kamala; Cummings, K. Michael; Hammond, David; Anshari, Dien; Krugman, Dean M.; Hardin, James W.

    2016-01-01

    Background In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers’ attention towards warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up. Methods Data were analysed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models assessed associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30 days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects. Results Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11–0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06–0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14–0.47), quit attempts (ORtwice or more vs none= 1.68, 95% CI: 1.28–2.19), and quit attempts lasting 30 days or longer (ORtwice or more vs none=1.48, 95% CI: 1.01 – 2.17). Conclusions More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs. PMID:26970037

  4. 21 CFR 201.307 - Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 4 2013-04-01 2013-04-01 false Sodium phosphates; package size limitation... Requirements for Specific Drug Products § 201.307 Sodium phosphates; package size limitation, warnings, and... and Drug Administration indicate that multiple container sizes of sodium phosphates oral solution...

  5. 21 CFR 201.307 - Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 4 2012-04-01 2012-04-01 false Sodium phosphates; package size limitation... Requirements for Specific Drug Products § 201.307 Sodium phosphates; package size limitation, warnings, and... and Drug Administration indicate that multiple container sizes of sodium phosphates oral solution...

  6. 21 CFR 201.307 - Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 4 2011-04-01 2011-04-01 false Sodium phosphates; package size limitation... Requirements for Specific Drug Products § 201.307 Sodium phosphates; package size limitation, warnings, and... and Drug Administration indicate that multiple container sizes of sodium phosphates oral solution...

  7. 21 CFR 201.307 - Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 4 2014-04-01 2014-04-01 false Sodium phosphates; package size limitation... Requirements for Specific Drug Products § 201.307 Sodium phosphates; package size limitation, warnings, and... and Drug Administration indicate that multiple container sizes of sodium phosphates oral solution...

  8. 21 CFR 201.307 - Sodium phosphates; package size limitation, warnings, and directions for over-the-counter sale.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Sodium phosphates; package size limitation... Requirements for Specific Drug Products § 201.307 Sodium phosphates; package size limitation, warnings, and... and Drug Administration indicate that multiple container sizes of sodium phosphates oral solution...

  9. The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study.

    PubMed

    White, Christine M; Hammond, David; Thrasher, James F; Fong, Geoffrey T

    2012-09-04

    Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil. A between-subjects experiment was conducted in which 640 Brazilian women aged 16-26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery ("plain packaging"), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal. Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs. Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in Australia.

  10. Adult Smokers’ Reactions to Pictorial Health Warning Labels on Cigarette Packs in Thailand and Moderating Effects of Type of Cigarette Smoked: Findings From the International Tobacco Control Southeast Asia Survey

    PubMed Central

    2013-01-01

    Introduction: In this study, we aimed to examine, in Thailand, the impact on smokers’ reported awareness of and their cognitive and behavioral reactions following the change from text-only to pictorial warnings printed on cigarette packs. We also sought to explore differences by type of cigarette smoked (roll-your-own [RYO] vs. factory-made [FM] cigarettes). Methods: Data came from the International Tobacco Control Southeast Asia Survey, conducted in Thailand and Malaysia, where a representative sample of 2,000 adult smokers from each country were recruited and followed up. We analyzed data from one wave before (Wave 1) and two waves after the implementation of the new pictorial warnings (two sets introduced at Waves 2 and 3, respectively) in Thailand, with Malaysia, having text-only warnings, serving as a control. Results: Following the warning label change in Thailand, smokers’ reported awareness and their cognitive and behavioral reactions increased markedly, with the cognitive and behavioral effects sustained at the next follow-up. By contrast, no significant change was observed in Malaysia over the same period. Compared to smokers who smoke any FM cigarettes, smokers of only RYO cigarettes reported a lower salience but greater cognitive reactions to the new pictorial warnings. Conclusions: The new Thai pictorial health warning labels have led to a greater impact than the text-only warning labels, and refreshing the pictorial images may have helped sustain effects. This finding provides strong support for introducing pictorial warning labels in low- and middle-income countries, where the benefits may be even greater, given the lower literacy rates and generally lower levels of readily available health information on the risks of smoking. PMID:23291637

  11. The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study

    PubMed Central

    2012-01-01

    Background Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil. Methods A between-subjects experiment was conducted in which 640 Brazilian women aged 16–26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery (“plain packaging”), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal. Results Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs. Conclusions Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in

  12. Relative Importance of Different Attributes of Graphic Health Warnings on Tobacco Packages in Viet Nam.

    PubMed

    Giang, Kim Bao; Chung, Le Hong; Minh, Hoang Van; Kien, Vu Duy; Giap, Vu Van; Hinh, Nguyen Duc; Cuong, Nguyen Manh; Manh, Pham Duc; Duc, Ha Anh; Yang, Jui-Chen

    2016-01-01

    Graphic health warnings (GHW) on tobacco packages have proven to be effective in increasing quit attempts among smokers and reducing initial smoking among adolescents. This research aimed to examine the relative importance of different attributes of graphic health warnings on tobacco packages in Viet Nam. A discrete choice experimental (DCE) design was applied with a conditional logit model. In addition, a ranking method was used to list from the least to the most dreadful GHW labels. With the results from DCE model, graphic type was shown to be the most important attribute, followed by cost and coverage area of GHW. The least important attribute was position of the GHW. Among 5 graphic types (internal lung cancer image, external damaged teeth, abstract image, human suffering image and text), the image of lung cancer was found to have the strongest influence on both smokers and non-smokers. With ranking method, the image of throat cancer and heart diseases were considered the most dreadful images. GHWs should be designed with these attributes in mind, to maximise influence on purchase among both smokers and non-smokers.

  13. Plain packaging policy: Preventing industry innovations.

    PubMed

    Al-Hamdani, Mohammed

    2017-04-20

    The pack is a marketing tool for the tobacco industry - its shape, colour, fonts, descriptors and logos attract and mislead smokers. Health warnings on cigarette packs serve as a knowledge reminder for smokers to quit smoking. Plain packaging eliminates brand imagery elements from cigarette packs and has many benefits, including the reduction of intention to smoke and the denormalization of smoking behaviour. The tobacco industry has devised pack and product marketing innovations that thwart the effectiveness of health warnings. Plain packaging policy needs to address these innovations by restricting their use and preventing them from undermining health warnings.

  14. Implementation of graphic health warning labels on tobacco products in India: the interplay between the cigarette and the bidi industries.

    PubMed

    Sankaran, Sujatha; Hiilamo, Heikki; Glantz, Stanton A

    2015-11-01

    To understand the competition between and among tobacco companies and health groups that led to graphical health warning labels (GHWL) on all tobacco products in India. Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library, documents obtained through India's Right to Information Act, and news reports. Implementation of GHWLs in India reflects a complex interplay between the government and the cigarette and bidi industries, who have shared as well as conflicting interests. Joint lobbying by national-level tobacco companies (that are foreign subsidiaries of multinationals) and local producers of other forms of tobacco blocked GHWLs for decades and delayed the implementation of effective GHWLs after they were mandated in 2007. Tobacco control activists used public interest lawsuits and the Right to Information Act to win government implementation of GHWLs on cigarette, bidi and smokeless tobacco packs in May 2009 and rotating GHWLs in December 2011. GHWLs in India illustrate how the presence of bidis and cigarettes in the same market creates a complex regulatory environment. The government imposing tobacco control on multinational cigarette companies led to the enforcement of regulation on local forms of tobacco. As other developing countries with high rates of alternate forms of tobacco use establish and enforce GHWL laws, the tobacco control advocacy community can use pressure on the multinational cigarette industry as an indirect tool to force implementation of regulations on other forms of tobacco. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Effects of plain packaging, warning labels, and taxes on young people's predicted sugar-sweetened beverage preferences: an experimental study.

    PubMed

    Bollard, Tessa; Maubach, Ninya; Walker, Natalie; Ni Mhurchu, Cliona

    2016-09-01

    Consumption of sugar-sweetened beverages (SSBs) is associated with increased risk of obesity, diabetes, heart disease and dental caries. Our aim was to assess the effects of plain packaging, warning labels, and a 20 % tax on predicted SSB preferences, beliefs and purchase probabilities amongst young people. A 2 × 3 × 2 between-group experimental study was conducted over a one-week period in August 2014. Intervention scenarios were delivered, and outcome data collected, via an anonymous online survey. Participants were 604 New Zealand young people aged 13-24 years who consumed soft drinks regularly. Participants were randomly allocated using a computer-generated algorithm to view one of 12 experimental conditions, specifically images of branded versus plain packaged SSBs, with either no warning, a text warning, or a graphic warning, and with or without a 20 % tax. Participant perceptions of the allocated SSB product and of those who might consume the product were measured using seven-point Likert scales. Purchase probabilities were measured using 11-point Juster scales. Six hundred and four young people completed the survey (51 % female, mean age 18 (SD 3.4) years). All three intervention scenarios had a significant negative effect on preferences for SSBs (plain packaging: F (6, 587) = 54.4, p <0.001; warning label: F (6, 588) = 19.8, p <0.001; 20 % tax: F (6, 587) = 11.3, p <0.001). Plain packaging and warning labels also had a significant negative impact on reported likelihood of purchasing SSB's (p = <0.001). A 20 % tax reduced participants' purchase probability but the difference was not statistically significant (p = 0.2). Plain packaging and warning labels significantly reduce young people's predicted preferences for, and reported probability of purchasing, SSBs.

  16. Deadly in pink: the impact of cigarette packaging among young women.

    PubMed

    Doxey, Juliana; Hammond, David

    2011-09-01

    This study sought to examine the impact of cigarette packaging on young women, including the impact of 'plain' packaging. Participants were randomised to view eight cigarette packs designed according to one of four experimental conditions: fully-branded female brands; the same brands without descriptors (eg, 'slims'); the same brands without brand imagery or descriptors (ie, 'plain' packs); and fully branded non-female brands as a control condition. Participants rated packs on perceived appeal, taste, tar, health risks and smoker 'traits'. Fully-branded female packs were rated as significantly more appealing than 'no descriptor' packs, 'plain' packs and non-female branded packs. Female branded packs were associated with a greater number of positive attributes including glamour, slimness and attractiveness, compared to brands without descriptors and 'plain' packs. Women who viewed plain packs were less likely to believe that smoking helps people control their appetite--an important predictor of smoking among young women--compared to women who viewed branded female packs. 'Plain' packaging--removing colours and design elements--and removing descriptors such as 'slims' from packs may reduce brand appeal and thereby susceptibility to smoking among young women.

  17. Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors2

    PubMed Central

    Buettner-Schmidt, Kelly; Miller, Donald R.; Balasubramanian, Narayanaganesh

    2016-01-01

    Purpose To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements. Design and Methods We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis. Results Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred. Conclusions Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states. PMID:27079973

  18. Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors.

    PubMed

    Buettner-Schmidt, Kelly; Miller, Donald R; Balasubramanian, Narayanaganesh

    2016-01-01

    To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements. We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis. Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred. Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Tobacco industry response to a ban on lights descriptors on cigarette packaging and population outcomes.

    PubMed

    Alpert, Hillel R; Carpenter, Daniel; Connolly, Gregory N

    2017-08-04

    The WHO Framework Convention on Tobacco Control and its Guidelines recommend nations ban the use of misleading terms, such as 'light' and 'mild' on tobacco product advertising, packaging and labelling. Many nations, including the USA, have implemented such bans and some have introduced or passed legislation requiring plain packaging on tobacco products. We previously reported that manufacturers in the USA responded by replacing lights terms with colour terms and related colour-coding of packages. This study examines population outcomes and public health impact of the US ban. We examined available data regarding a) per cent filter ventilation strata used to designate lights subbrand categories; b) market share per tar yield; c) initiation and use of cigarettes by lights categories and d) overall cigarette consumption to identify changes from before to after the ban. We used interrupted time series multivariable logistic regression and joinpoint regression models to test for changes in rates and temporal trends associated with the ban. The per cent filter ventilation strata used to designate lights subbrand categories were maintained in the colour named subbrands. No change was observed following the ban in lights market share, relative prevalence of lights versus non-lights smoking or relative smoking initiation on lights versus non-lights among all ages or among youth in particular. The rate of decline in per capita cigarette consumption slowed by 37% from the period 2007-2010 to 2010-2014. This study strongly suggests that manufacturers' circumvention prevented the lights descriptor ban from succeeding as intended, most likely perpetuating the misleading consumer perceptions about relative risks, while failing to increase smoking cessation and reduce initiation. Laws requiring generic (plain) and elimination of subbrand descriptors should prevent evasion of legislation banning the use of specific terms through marketing, regulatory and legal challenges. © Article

  20. Effect of the Framework Convention on Tobacco Control and Voluntary Industry Health Warning Labels on Passage of Mandated Cigarette Warning Labels From 1965 to 2012: Transition Probability and Event History Analyses

    PubMed Central

    Sanders-Jackson, Ashley N.; Song, Anna V.; Hiilamo, Heikki

    2013-01-01

    Objectives. We quantified the pattern and passage rate of cigarette package health warning labels (HWLs), including the effect of the Framework Convention on Tobacco Control (FCTC) and HWLs voluntarily implemented by tobacco companies. Methods. We used transition probability matrices to describe the pattern of HWL passage and change rate in 4 periods. We used event history analysis to estimate the effect of the FCTC on adoption and to compare that effect between countries with voluntary and mandatory HWLs. Results. The number of HWLs passed during each period accelerated, from a transition rate among countries that changed from 2.42 per year in 1965–1977 to 6.71 in 1977–1984, 8.42 in 1984–2003, and 22.33 in 2003–2012. The FCTC significantly accelerated passage of FCTC-compliant HWLs for countries with initially mandatory policies with a hazard of 1.27 per year (95% confidence interval = 1.11, 1.45), but only marginally increased the hazard for countries that had an industry voluntary HWL of 1.68 per year (95% confidence interval = 0.95, 2.97). Conclusions. Passage of HWLs is accelerating, and the FCTC is associated with further acceleration. Industry voluntary HWLs slowed mandated HWLs. PMID:24028248

  1. Influences of Self-Efficacy, Response Efficacy, and Reactance on Responses to Cigarette Health Warnings: A Longitudinal Study of Adult Smokers in Australia and Canada.

    PubMed

    Thrasher, James F; Swayampakala, Kamala; Borland, Ron; Nagelhout, Gera; Yong, Hua-Hie; Hammond, David; Bansal-Travers, Maansi; Thompson, Mary; Hardin, James

    2016-12-01

    Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers' responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior.

  2. Influences of Self-Efficacy, Response Efficacy, and Reactance on Responses to Cigarette Health Warnings: A Longitudinal Study of Adult Smokers in Australia and Canada

    PubMed Central

    Thrasher, James F.; Swayampakala, Kamala; Borland, Ron; Nagelhout, Gera; Yong, Hua-Hie; Hammond, David; Bansal-Travers, Maansi; Thompson, Mary; Hardin, James

    2016-01-01

    ABSTRACT Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers’ responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior. PMID:27135826

  3. The Case for Requiring Graphic Warning Labels on Smokeless Tobacco Product Packages.

    PubMed

    Pakhale, Smita; Samet, Jonathan; Folan, Patricia; Leone, Frank; White, Alexander

    2016-03-01

    On November 10, 2015, the U.S. Food and Drug Administration approved, for the first time, the sale of smokeless tobacco products authorized under the new premarket tobacco application pathway. This Food and Drug Administration regulatory decision draws attention to the growing worldwide use of smokeless tobacco products in general. Use of these tobacco products is particularly popular in low- and middle-income countries of Asia. Due to aggressive and strategic marketing to children, young adults, and current smokers, rates of smokeless tobacco use in men of all ages are on the rise in United States and elsewhere. The tobacco industry also continues to market these products to current cigarette smokers for use in the growing number of "smoke-free environments." Smokeless tobacco products are associated with cancers of the upper aerodigestive tract, particularly the oral cavity, esophagus, and pancreas; cardiovascular diseases; small-for-gestational-age infants; premature births; increased risk of apnea; and stillbirth. There is no convincing evidence regarding the efficacy of smokeless tobacco, including snus, to promote smoking cessation. Rather, studies from Europe and the United States demonstrate that smokeless tobacco use may facilitate regular cigarette smoking by acting as a gateway drug, especially for children. Caution is warranted before proposing smokeless tobacco as a harm-reduction strategy, in part because of the potential for further promoting smokeless tobacco in low- and middle-income countries where use is already widespread. Continued vigilance through comprehensive surveillance is warranted. We strongly recommend the use of graphic warning labels as a "no regrets" strategy for all smokeless tobacco products marketed globally.

  4. Do cigarette graphic warnings encourage smokers to attend a smoking cessation programme: a quasi-experimental study.

    PubMed

    Guydish, Joseph; Tajima, Barbara; Le, Thao; Henderson, Catherine; Yip, Deborah; Gruber, Valerie; Garcia, Wayne; Delucchi, Kevin L

    2016-12-02

    This study assessed whether exposure to cigarette graphic warning labels (GWLs) increased attendance to a smoking cessation programme. From 2014 to 2016, alternating cohorts of smokers in 3 residential drug treatment programmes received either GWLs (experimental) or transparent (control) labels placed on their cigarette packs for 30 days. The primary outcome was the proportion of participants who chose to attend a smoking cessation group after the labelling period. The sample (N=601) was 72.6% male, with a mean age of 41.9 (SD=11.16) and included African-American (37%), White (29.4%) and Hispanic (19.6%) participants. While similar on most measures, controls were more likely to be married, had been in the treatment programme longer and registered higher on expired carbon monoxide (CO). After labelling, the proportion attending at least one cessation group was 26% in the experimental condition and 18.8% among controls. In an intent-to-treat analysis adjusting for group differences at baseline, and for 2 levels of nesting, those who received GWLs were more likely than controls to attend the smoking cessation group (OR=1.58, 95% CI 1.02 to 2.44). Smokers who received GWLs on their cigarette packs were more likely to attend a cessation programme. Thus, this study is one of the first to document a change in a directly observed behavioural outcome as a function of month-long exposure to cigarette pack GWLs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. The Impact of Graphic Cigarette Warning Labels and Smoke-Free Law on Health Awareness and Thoughts of Quitting in Taiwan

    ERIC Educational Resources Information Center

    Chang, Fong-Ching; Chung, Chi-Hui; Yu, Po-Tswen; Chao, Kun-yu

    2011-01-01

    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).…

  6. The Impact of Graphic Cigarette Warning Labels and Smoke-Free Law on Health Awareness and Thoughts of Quitting in Taiwan

    ERIC Educational Resources Information Center

    Chang, Fong-Ching; Chung, Chi-Hui; Yu, Po-Tswen; Chao, Kun-yu

    2011-01-01

    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).…

  7. Assessing the Consequences of Implementing Graphic Warning Labels on Cigarette Packs for Tobacco-Related Health Disparities

    PubMed Central

    Brennan, Emily; Momjian, Ani; Shapiro-Luft, Dina; Seitz, Holli; Cappella, Joseph N.

    2015-01-01

    Introduction: Population-level communication interventions, such as graphic warning labels (GWLs) on cigarette packs, have the potential to reduce or exacerbate tobacco-related health disparities depending on their effectiveness among disadvantaged sub-populations. This study evaluated the likely impact of nine GWLs proposed by the US Food and Drug Administration on (1) African American and (2) Hispanic smokers, who disproportionately bear the burden of tobacco-related illness, and (3) low education smokers, who have higher smoking rates. Methods: Data were collected online from current smokers randomly assigned to see GWLs (treatment) or the current text-only warning labels (control). Participants were stratified by age (18–25; 26+) in each of four groups: general population (n = 1246), African Americans (n = 1200), Hispanics (n = 1200), and low education (n = 1790). We tested the effectiveness of GWLs compared to text-only warning labels using eight outcomes that are predictive of quitting intentions or behaviors including negative emotion, intentions to hold back from smoking, intentions to engage in avoidance behaviors, and intentions to quit. Results: Across all outcomes, GWLs were significantly more effective than text-only warning labels more often than expected by chance. Results suggested that African Americans, Hispanics and smokers with low education did not differ from the general population of smokers in their reactions to any of the nine individual GWLs. Conclusions: The nine GWLs were similarly effective for disadvantaged sub-populations and the general population of smokers. Implementation of GWLs is therefore unlikely to reduce or exacerbate existing tobacco-related health disparities, but will most likely uniformly increase intentions and behaviors predictive of smoking cessation. PMID:26180214

  8. Assessing the Consequences of Implementing Graphic Warning Labels on Cigarette Packs for Tobacco-Related Health Disparities.

    PubMed

    Gibson, Laura; Brennan, Emily; Momjian, Ani; Shapiro-Luft, Dina; Seitz, Holli; Cappella, Joseph N

    2015-08-01

    Population-level communication interventions, such as graphic warning labels (GWLs) on cigarette packs, have the potential to reduce or exacerbate tobacco-related health disparities depending on their effectiveness among disadvantaged sub-populations. This study evaluated the likely impact of nine GWLs proposed by the US Food and Drug Administration on (1) African American and (2) Hispanic smokers, who disproportionately bear the burden of tobacco-related illness, and (3) low education smokers, who have higher smoking rates. Data were collected online from current smokers randomly assigned to see GWLs (treatment) or the current text-only warning labels (control). Participants were stratified by age (18-25; 26+) in each of four groups: general population (n = 1246), African Americans (n = 1200), Hispanics (n = 1200), and low education (n = 1790). We tested the effectiveness of GWLs compared to text-only warning labels using eight outcomes that are predictive of quitting intentions or behaviors including negative emotion, intentions to hold back from smoking, intentions to engage in avoidance behaviors, and intentions to quit. Across all outcomes, GWLs were significantly more effective than text-only warning labels more often than expected by chance. Results suggested that African Americans, Hispanics and smokers with low education did not differ from the general population of smokers in their reactions to any of the nine individual GWLs. The nine GWLs were similarly effective for disadvantaged sub-populations and the general population of smokers. Implementation of GWLs is therefore unlikely to reduce or exacerbate existing tobacco-related health disparities, but will most likely uniformly increase intentions and behaviors predictive of smoking cessation. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Temporal framing and consideration of future consequences: effects on smokers' and at-risk nonsmokers' responses to cigarette health warnings.

    PubMed

    Zhao, Xiaoquan; Nan, Xiaoli; Iles, Irina Alexandra; Yang, Bo

    2015-01-01

    This research examines the influence of temporal framing (long-term vs. short-term) and individual difference in consideration of future consequences (CFC) on the effectiveness of cigarette health warnings among smokers and at-risk nonsmokers in a college population. An online experiment (N = 395) revealed a three-way interaction among temporal framing, CFC, and smoking status. The results among at-risk nonsmokers supported the temporal fit hypothesis--those high in CFC responded more favorably to long-term framing, whereas those low in CFC responded more positively to short-term framing. The findings among smokers revealed a different pattern in which short-term framing was more effective among high-CFC smokers, whereas among low-CFC smokers the framing effect was not distinct. Theoretical and practical implications of the findings are discussed.

  10. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers

    PubMed Central

    Brennan, Emily; Durkin, Sarah; Coomber, Kerri; Zacher, Meghan; Scollo, Michelle; Wakefield, Melanie

    2015-01-01

    Background Implementation of tobacco plain packaging (PP) with larger graphic health warnings (GHWs) in Australia had positive effects on responses reflecting the specific objectives of the PP policy and on follow-up quitting-related cognitions and behaviours. The aim of this study was to examine predictive relationships between these proximal and distal outcomes. Methods A nationally representative sample of Australian adult cigarette smokers completed a baseline survey and a 1-month follow-up survey within the first year of policy implementation (n(weighted)=3125). Logistic regression analyses tested whether baseline measures of cigarette appeal, GHW effectiveness, perceived harm and concern/enjoyment predicted each of seven follow-up measures of quitting-related cognitions and behaviours, adjusting for baseline levels of the outcome and covariates. Results In multivariable models, we found consistent evidence that several baseline measures of GHW effectiveness positively and significantly predicted the likelihood that smokers at follow-up reported thinking about quitting at least daily, intending to quit, having a firm date to quit, stubbing out cigarettes prematurely, stopping oneself from smoking and having attempted to quit. Two of the quitting-related outcomes were also predicted by feeling more smoking-related concern than enjoyment. A smaller number of the appeal variables were prospectively associated with quitting-related outcomes, while believing that brands do not differ in harmfulness did not positively predict any outcomes. Conclusions These findings provide an initial insight into the pathways through which PP with larger GHWs may lead to changes in smoking behaviour. Future research should examine whether the effects are conditional on individual demographic and smoking characteristics. PMID:28407610

  11. Cancer illustrations and warning labels on cigarette packs: perceptions of teenagers from high socioeconomic status in Lahore.

    PubMed

    Zil-E-Ali, Ahsan; Ahsen, Noor Fatima; Iqbal, Humaira

    2015-06-01

    Smoking is linked with adverse health outcomes and multi-organ diseases with six million deaths every year. The smoking population includes both genders and the habit is seen in minors as well. The cross-sectional study was conducted in Lahore among teenagers belonging to high socioeconomic class. A sample of 191 students was recruited by convenience sampling. The teenagers were questioned on their perceptions relating to prohibition labels, factors that led them to smoke, and ideas to make health warnings more effective. Overall, 66(34.55%) teenagers were smokers, and of them, 50(75.75%) were boys and 16(24.24%) were girls. Besides, 25(37.9%) smokers were of the view that smoking is a bad habit; 40(60.6%) said prohibition labels would not change the mindset of the smoker; 35(53%)believed that a smoker is completely uninfluenced by prohibition labels. Results suggest that the warning labels on cigarette packs should be made more comprehensible and alarming for smokers.

  12. "Pictures don't lie, seeing is believing": exploring attitudes to the introduction of pictorial warnings on cigarette packs in Ghana.

    PubMed

    Singh, Arti; Owusu-Dabo, Ellis; Britton, John; Munafò, Marcus R; Jones, Laura L

    2014-12-01

    To compare perceptions of text and pictorial warning labels on cigarette packs among Ghanaian smokers and nonsmokers and to explore their views on the introduction of pictorial warnings in Ghana. Qualitative study involving 12 focus group discussions with 50 smokers and 35 nonsmokers aged 15 years and older in Kumasi, Ghana. Semistructured discussion guides along with visual discussant aids were used to explore the perception, acceptance, and potential use of pictorial warning labels in Ghana. Health warnings combining text and a picture were perceived by both smokers and nonsmokers to communicate health messages more effectively than text-only or picture-only warnings. The effect of text-only warnings was considered limited by low levels of literacy and by the common practice of single stick sales rather than sales of packs. Of the 6 health warnings tested, lung cancer, blindness, stroke, and throat/mouth cancer messages were perceived to have the most impact on smoking behavior, including uptake and quit attempts. Warning labels combining pictures and text have the potential to reduce smoking uptake, increase quit attempts, and reduce smoking appeal among smokers and nonsmokers in Ghana. Measures to prevent single stick sales, or to promote health messages to purchasers of single sticks, are required. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. 76 FR 55923 - Draft Guidance for Industry: Submission of Warning Plans for Cigarettes and Smokeless Tobacco...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-09

    ... HUMAN SERVICES Food and Drug Administration Draft Guidance for Industry: Submission of Warning Plans for... Collection; Comment Request AGENCY: Food and Drug Administration, HHS. ACTION: Notice. SUMMARY: The Food and Drug Administration (FDA) is announcing the availability of a draft guidance for industry entitled...

  14. Implications of Graphic Cigarette Warning Labels on Smoking Behavior: An International Perspective.

    PubMed

    Jung, Minsoo

    2016-03-01

    Graphic warning labels (GWLs) have been developed as a representative non-price policy to block such marketing. This study investigated the current state and effect of the global introduction of GWLs and examines the future tasks related to GWLs. We systematically reviewed literatures on GWL and a tobacco control strategy in the past fifteen years. The policy of enforcing GWLs has spread globally based on the Framework Convention on Tobacco Control. GWLs are more effective than text warnings and are implemented in over 70 countries. The policy has showed the impact of GWLs as a preventive effect on adolescents' smoking, inducement of smoking cessation, reduction in the amount of tobacco smoked, and reduction in smoking rates. The success of an anti-smoking policy can manifests itself as an effect of individual policies, the rise of tobacco prices, and the introduction of GWLs.

  15. Implications of Graphic Cigarette Warning Labels on Smoking Behavior: An International Perspective

    PubMed Central

    Jung, Minsoo

    2016-01-01

    Graphic warning labels (GWLs) have been developed as a representative non-price policy to block such marketing. This study investigated the current state and effect of the global introduction of GWLs and examines the future tasks related to GWLs. We systematically reviewed literatures on GWL and a tobacco control strategy in the past fifteen years. The policy of enforcing GWLs has spread globally based on the Framework Convention on Tobacco Control. GWLs are more effective than text warnings and are implemented in over 70 countries. The policy has showed the impact of GWLs as a preventive effect on adolescents’ smoking, inducement of smoking cessation, reduction in the amount of tobacco smoked, and reduction in smoking rates. The success of an anti-smoking policy can manifests itself as an effect of individual policies, the rise of tobacco prices, and the introduction of GWLs. PMID:27051645

  16. Which Images and Features in Graphic Cigarette Warnings Predict Their Perceived Effectiveness? Findings from an Online Survey of Residents in the UK.

    PubMed

    Cameron, Linda D; Williams, Brian

    2015-10-01

    Many countries are implementing graphic warnings for cigarettes. Which graphic features influence their effectiveness remains unclear. To identify features of graphic warnings predicting their perceived effectiveness in discouraging smoking. Guided by the Common-Sense Model of responses to health threats, we content-analyzed 42 graphic warnings for attributes of illness risk representations and media features (e.g., photographs, metaphors). Using data from 15,536 survey participants, we conducted stratified logistic regressions testing which attributes predict participant selections of warnings as effective. Images of diseased body parts predicted greater perceived effectiveness; OR = 6.53-12.45 across smoking status (smoker, ex-smoker, young non-smoker) groups. Features increasing perceived effectiveness included images of dead or sick persons, children, and medical technology; focus on cancer; and photographs. Attributes decreasing perceived effectiveness included infertility/impotence, addictiveness, cigarette chemicals, cosmetic appearance, quitting self-efficacy, and metaphors. These findings on representational and media attributes predicting perceived effectiveness can inform strategies for generating graphic warnings.

  17. The impact of the 2009/2010 enhancement of cigarette health warning labels in Uruguay: longitudinal findings from the International Tobacco Control (ITC) Uruguay Survey.

    PubMed

    Gravely, Shannon; Fong, Geoffrey T; Driezen, Pete; McNally, Mary; Thrasher, James F; Thompson, Mary E; Boado, Marcelo; Bianco, Eduardo; Borland, Ron; Hammond, David

    2016-01-01

    Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness. Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in five cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (prepolicy: wave 2) and 2010/11 (postpolicy: wave 3). Overall, 1746 smokers participated in the study at wave 2 (n=1379) and wave 3 (n=1411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly (noticing HWLs: OR=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<0.001; and reports that HWLs stopped smokers from having a cigarette 'many times': OR=3.42, p<0.001). The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. The impact of the 2009/2010 enhancement of cigarette health warning labels in Uruguay: longitudinal findings from the International Tobacco Control (ITC) Uruguay Survey

    PubMed Central

    Gravely, Shannon; Fong, Geoffrey T.; Driezen, Pete; McNally, Mary; Thrasher, James F.; Thompson, Mary E.; Boado, Marcelo; Bianco, Eduardo; Borland, Ron; Hammond, David

    2015-01-01

    Background FCTC Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness. Methods Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in 5 cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (pre-policy: Wave 2) and 2010/11 (post-policy: Wave 3). Results Overall, 1746 smokers participated in the study at Wave 2 (n=1,379) and Wave 3 (n=1,411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly [noticing HWLs: odds ratio (OR)=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<.001; and reports that HWLs stopped smokers from having a cigarette “many times”: OR=3.42, p<0.001]. Conclusions The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness. PMID:25512431

  19. Cigarette graphic health warning labels and information avoidance among individuals from low socioeconomic position in the U.S.

    PubMed

    McCloud, Rachel Faulkenberry; Okechukwu, Cassandra; Sorensen, Glorian; Viswanath, K

    2017-04-01

    Although graphic health warning labels (GHWs) on cigarette packs have influenced cessation behaviors in other countries, no U.S. studies have explored the impact of avoidance of GHW content among individuals from low socioeconomic position (SEP). The purpose of this study was to determine the predictors of intention to avoid GHWs, and how avoidance impacts cessation intention, in a low SEP sample in the U.S. Data come from low SEP smokers (n = 541) involved in a field experiment. The participants responded to questions pre- and post viewing of GHWs assessing SEP, intention to avoid them, emotional reactions, and intention to seek health information or quit smoking. Backwards stepwise logistic regression determined the predictors for intention to avoid GHWs. Simple and adjusted logistic regression analyzed the association between avoidance and its main predictors and outcomes of intentions to seek information or quit smoking. Predictors for avoidance included being somewhat addicted to cigarettes (OR 2.3, p = 0.002), younger than 25 (OR 2.6, p = 0.008), and having medium (OR 3.4, p < 0.001) or high (OR 4.7, p < 0.001) levels of negative emotional reaction to the labels. Intention to avoid GHWs was positively associated with the intent to look for health information about smoking (OR 2.2, p = 0.002). Higher levels of negative emotional reaction were positively associated with cessation behaviors, with high negative emotional reaction associated with nine times the odds of quitting (p < 0.001). Results indicate avoidance of GHWs does not detract from the labels' benefit and that GHWs are an effective means of communicating smoking risk information among low SEP groups.

  20. "Avoid health warnings on all tobacco products for just as long as we can": a history of Australian tobacco industry efforts to avoid, delay and dilute health warnings on cigarettes

    PubMed Central

    Chapman, S; Carter, S

    2003-01-01

    Objective: To review critically the history of Australian tobacco industry efforts to avoid, delay, and dilute pack warnings on cigarettes. Design: Systematic keyword and opportunistic website searches of tobacco industry internal documents made available through the Master Settlement Agreement. Results: Four industry strategies and six recurrent arguments used by the industry are described, which were used to thwart the passage of three generations of health warnings (implemented in 1973, 1987, and 1995). These strategies are shown to have been associated with major delays in the implementation of the warnings and in keeping them inconspicuous, unattributed to the industry and non-specific, and particularly in delaying the use of warnings about addiction. The industry today continues to oppose warnings, which might "repel" smokers from tobacco use. Conclusions: Efforts by governments to introduce potent health warnings will be resisted by the tobacco industry. Tobacco control advocates should anticipate and counter the strategies and arguments used by the industry, which are described in this paper if they wish to maximise the use of the pack as a vehicle for raising awareness about the harms of smoking. PMID:14645944

  1. Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging.

    PubMed

    Gallopel-Morvan, Karine; Moodie, Crawford; Hammond, David; Eker, Figen; Beguinot, Emmanuelle; Martinet, Yves

    2012-09-01

    In the face of comprehensive bans on the marketing of tobacco products, packaging has become an increasingly important promotional tool for the tobacco industry. A ban on the use of branding on tobacco packaging, known as 'plain' packaging, has emerged as a promising regulatory strategy. The current study sought to examine perceptions of cigarette packaging among adults in France. Adult smokers and non-smokers (N=836) were surveyed using computer-assisted personal interviewing to assess perceptions of pack design by comparing 'regular' branded packs and 'limited edition' packs (with novel designs or innovations) with 'plain' versions of these packs with all branding, including colour, removed. Plain packs (PP) were less likely than regular packs, and particularly limited edition packs, to be considered attractive, attention grabbing and likely to motivate youth purchase. PPs were also rated as the most effective in convincing non-smokers not to start and smokers to reduce consumption and quit. Logistic regression showed that smokers motivated to quit, in comparison to smokers not motivated to quit, were significantly more likely to consider the PPs as the packs most likely to motivate cessation. Novel cigarette packaging, in the form of limited edition packs, had the highest ratings of consumer appeal, ahead of regular branded packs and also PPs. Interestingly, PPs were perceived to be the packs most likely to promote cessation among those adults with quitting intentions. Plain packaging, therefore, may be a means of helping existing adult smokers motivated to quit to do so.

  2. Ending the cigarette pandemic.

    PubMed

    Richmond, J B

    1983-12-01

    1 year after the issuance of the original Surgeon General's report, Congress passed the Federal Cigarette Labeling Advertising Act, requiring all cigarette packages distributed in the US to carry a Surgeon General's warning that smoking may be hazardous to health. Congress pased the Public Health Cigarette Smoking Act in 1969. This banned cigarette advertising from radio and television. The Surgeon General published the most comprehensive volume on smoking ever issued in the US in 1979, the 15th anniversary of the 1st report. The data on cigarette smoking's adverse effects on health were overwhelming, and the press recognized this. No longer able to rely on journalists to cast doubt on the reliability of the data, the industry changed its strategy by attempting to portray smoking as a civil rights issue. The tobacco industry began to pour millions of dollars into campaigns to prevent the passage of municipal, state, and federal legislation that would ban cigarette advertising or restrict smoking in public places and at the work site. "Healthy People," the Surgeon General's 1st report on health promotion and disease prevention, emphasized the necessary future direction of medicine: prevention. Efforts to end the cigarette pandemic will need to focus on the following in the future: an end to the victimization of women; a greater focus on adolescents; more effective strategies for smoking cessation; more attention to clean indoor air rights; abandonment of recommendations to switch to low-tar, low-nicotine cigarettes; and revelation of chemical additives in cigarettes. The epidemiologists have now documented the devastating nature of the health problems attributable to cigarette smoking, but the minimal budgetary allocations to fight smoking testify to the lack of political will on the part of government.

  3. Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels.

    PubMed

    Harris, Peter R; Mayle, Kathryn; Mabbott, Lucy; Napper, Lucy

    2007-07-01

    Little is known about how smokers respond to graphic images depicting the health consequences of smoking. The authors tested whether smokers respond defensively to such images and whether allowing them to self-affirm reduces their defensiveness. Young smokers (N = 87) were randomly allocated to self-affirm or perform a control task prior to viewing 4 images intended for future use on cigarette packs in the European Union. Measures were taken immediately postexposure and after 1 week. Participants rated each image for threat and personal relevance. Once all 4 images had been viewed, they completed measures of intentions, self-efficacy, and perceived behavioral control for reducing cigarette consumption, negative thoughts and feelings about smoking, personal vulnerability to 6 smoking-related diseases, desire to quit, and plans to quit. At the 1-week follow-up, measures of self-reported smoking and desire to reduce consumption were taken. Relative to controls, self-affirmed participants rated the images as more threatening and personally relevant, and they reported more negative thoughts and feelings and higher levels of control, self-efficacy, and intentions. Risk level moderated the effect of self-affirmation on relevance and intentions: Self-affirmation increased ratings on both measures among those who smoked more. In addition, self-affirmation moderated the threat-intention relationship, which was weaker in the self-affirmed group. At follow-up, motivation to reduce consumption remained higher in self-affirmed participants, but there were no differences in reported consumption. Self-affirmation can promote less defensive responding even to visual material about well-established health risks such as smoking. Copyright 2007 APA.

  4. Measuring the effect of cigarette plain packaging on transaction times and selection errors in a simulation experiment.

    PubMed

    Carter, Owen B J; Mills, Brennen W; Phan, Tina; Bremner, Jonathon R

    2012-11-01

    Australia has introduced legislation to force all cigarette packaging to be generic from 2012 onwards. The tobacco retail industry estimates this will result in transaction times increasing by 15-45 s per pack and is spending at least $A10 million of tobacco industry funds on an advertising campaigns claiming that the increased time and errors associated with plain packaging will ultimately cost small businesses $A 461 million per annum and endanger 15,000 jobs. We undertook an objective experiment to test these claims. Participants (n=52) were randomly assigned to stand in front of a display of either 50 plain or coloured cigarette packets and then were read a randomly ordered list of cigarette brands. The time participants took to locate each packet was recorded and all selection errors were noted. After 50 'transactions', participants repeated the entire experiment with the alternative plain/coloured packs. Afterwards, participants were asked in an open-ended manner whether plain or coloured packaging was easier to locate and why. The average transaction was significantly quicker for plain compared with coloured packs (2.92 vs 3.17 s; p=0.040). One or more mistakes were made by 40.4% of participants when selecting coloured packaging compared with only 17.3% for plain packaging (p=0.011). Qualitative results suggested that the colours and inconsistent location of brand names often served to distract when participants scanned for brands. Rather than plain packaging requiring an additional 45 s per transaction, our results suggest that it will, if anything, modestly decrease transaction times and selection errors.

  5. [Pictorial health warnings on tobacco products packages as a part of tobacco epidemic control].

    PubMed

    Kaleta, Dorota; Kozieł, Anna; Miśkiewicz, Paulina

    2009-01-01

    The use of tobacco products has been described by the World Health Organization as the risk factor responsible for six out of eight causes of death in the world. Informing about the harm of smoking may be presented in many ways like media campaigns, text warnings, or graphic warnings placed on tobacco products. The aim of this article is to describe the role of graphic warnings placed on tobacco products in light of tobacco control. In this work, the available current data, including researches and reports of WHO, have been used. Graphic warnings may be a very valuable source of knowledge about health consequences of smoking. They are also much more visible, draw attention much better compared with text warnings and more clearly communicate the threats of tobacco use. They also have a stronger impact, are better memorized and better motivate to quit smoking. Pictorial warnings are also approved by the society. Smokers themselves perceive them as more effective than text warnings. Moreover, this kind of labeling makes tobacco products less attractive. The introduction of legal regulations enforcing these types of warnings does not cost anybody but the tobacco companies. This kind of solution helps to gain public acceptance for other methods of tobacco control like totally free tobacco smoke places.

  6. Design and Implementation of a C++ Software Package to scan for and parse Tsunami Messages issued by the Tsunami Warning Centers for Operational use at the Pacific Tsunami Warning Center

    NASA Astrophysics Data System (ADS)

    Sardina, V.

    2012-12-01

    The US Tsunami Warning Centers (TWCs) have traditionally generated their tsunami message products primarily as blocks of text then tagged with headers that identify them on each particular communications' (comms) circuit. Each warning center has a primary area of responsibility (AOR) within which it has an authoritative role regarding parameters such as earthquake location and magnitude. This means that when a major tsunamigenic event occurs the other warning centers need to quickly access the earthquake parameters issued by the authoritative warning center before issuing their message products intended for customers in their own AOR. Thus, within the operational context of the TWCs the scientists on duty have an operational need to access the information contained in the message products issued by other warning centers as quickly as possible. As a solution to this operational problem we designed and implemented a C++ software package that allows scanning for and parsing the entire suite of tsunami message products issued by the Pacific Tsunami Warning Center (PTWC), the West Coast and Alaska Tsunami Warning Center (WCATWC), and the Japan Meteorological Agency (JMA). The scanning and parsing classes composing the resulting C++ software package allow parsing both non-official message products(observatory messages) routinely issued by the TWCs, and all official tsunami message products such as tsunami advisories, watches, and warnings. This software package currently allows scientists on duty at the PTWC to automatically retrieve the parameters contained in tsunami messages issued by WCATWC, JMA, or PTWC itself. Extension of the capabilities of the classes composing the software package would make it possible to generate XML and CAP compliant versions of the TWCs' message products until new messaging software natively adds this capabilities. Customers who receive the TWCs' tsunami message products could also use the package to automatically retrieve information from

  7. Effects of plain package branding and graphic health warnings on adolescent smokers in the USA, Spain and France.

    PubMed

    Andrews, J Craig; Netemeyer, Richard G; Burton, Scot; Kees, Jeremy

    2016-12-01

    The purpose of this study is to provide an experimental test of the effects of plain pack branding and graphic health warnings (GHWs) in three different countries for an important and vulnerable population, that is, adolescents who are experimenting with smoking. The effects of plain pack branding (logo present, logo absent), and graphic visual warning level (absent, low, medium, high) are studied experimentally for their impact on adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting in the USA, Spain and France. A total of 1066 adolescents who were experimenting with smoking served as participants in the study. A quota sample produced 375 respondents in the USA, 337 in Spain and 354 in France. Overall findings indicate that the GHWs were effective in impacting adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting. The plain pack effects were not as strong, yet reduced craving, increased fear, and decreased pack feelings for all three samples combined, and for US adolescent smokers individually, irrespective of the GHWs. For French adolescent smokers, plain pack effects for craving were limited to low/moderate GHW levels. For Spanish adolescent smokers, plain pack feeling effects were limited to the absence of the GHWs. The results show that plain packs can independently strengthen the more instantaneous, direct effects (short of quitting thoughts) found with the GHWs. Yet, the plain pack results were attenuated for Spanish and French adolescent smokers, who are currently exposed to GHWs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan.

    PubMed

    Chang, Fong-ching; Chung, Chi-hui; Yu, Po-tswen; Chao, Kun-yu

    2011-04-01

    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.

  9. Awareness of smoking risks and attitudes towards graphic health warning labels on cigarette packs: a cross-cultural study of two populations in Singapore and Scotland.

    PubMed

    Ng, D H L; Roxburgh, S T D; Sanjay, S; Au Eong, K G

    2010-05-01

    Little is known about the level of awareness of blindness as a smoking-related condition, although the relationship has been well established. To compare the awareness of smoking risks and the impact of graphic health warning labels on cigarette packs in discouraging smoking among adults in Singapore and Scotland. A cross-sectional survey using a structured interview of adults in ophthalmic, general medical, and general surgical outpatient clinics in Singapore and Scotland. One hundred and fifteen out of 163 (70.6%) outpatients in Singapore and 105 out of 112 (93.8%) outpatients in Scotland responded to the study. In both samples, awareness levels for smoking-related diseases such as lung cancer, mouth and throat cancer, heart disease, and stroke were all greater than 85%. These were found to be significantly higher than the level of awareness of blindness as a smoking-related condition (chi (2)-test, P<0.001). Although the awareness of blindness as a smoking-related condition was greater in Singapore (36.5%) than in Scotland (30.5%), this difference was not statistically significant. More than half of the respondents indicated that graphic health warning labels would be effective in discouraging them from smoking. Graphic health warning labels reading 'Smoking causes blindness' printed on cigarette packs may be useful in raising public awareness of blindness as a smoking-related condition and discouraging the habit of smoking in Singapore and Scotland.

  10. Divergence between strength indicators in packaging and cigarette engineering: a case study of Marlboro varieties in Australia and the USA.

    PubMed

    King, Bill; Borland, Ron; Abdul-Salaam, Shadeed; Polzin, Gregory; Ashley, David; Watson, Clifford; O'Connor, Richard J

    2010-10-01

    To investigate how the tobacco industry is adapting to regulatory action in accordance with provisions of the Framework Convention on Tobacco Control that targets misleading packaging and labelling. To relate the packaging and labelling of new cigarette varieties to their construction and performance. The principal design features and tar, nicotine and carbon monoxide yields of the Marlboro 'brand family' in Australia were measured and compared with those of the US equivalents. Marlboro Red and Blue/Medium, could not be differentiated in preliminary tests in Australia, but were different in the USA. However, yield testing showed Marlboro Blue/Medium did not have lower tar and nicotine yields in either country, indeed being higher in Australia. Colour can be used to market cigarettes as 'milder', independently of ISO yields and 'Light'/'Mild' descriptors. Banning of 'Light' and 'Mild' brand descriptors may be inadequate to end belief in less harmful cigarettes so long as the tobacco industry remains free to engineer 'mildness' and to use colours, other descriptors and design features to characterise varieties it wants to market as 'milder'.

  11. 19 CFR 18.4 - Sealing conveyances and compartments; labeling packages; warning cards.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... commercial shipper seals, Customs red in-bond seals, or other accepted seals. High-security Customs seals... bright red paper, not less than 5 by 8 inches in size, containing the following legend in black or white... warning label, whether as a continuous series in tape form or otherwise, but not less than 11/2 by...

  12. 16 CFR 307.11 - Rotation, display, and distribution of warning statements on smokeless tobacco packages.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Rotation, display, and distribution of... COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS REGULATIONS UNDER THE COMPREHENSIVE SMOKELESS TOBACCO HEALTH EDUCATION ACT OF 1986 Plans § 307.11 Rotation, display, and distribution of warning statements on...

  13. Avoidance of smoking: the impact of warning labels in Brazil.

    PubMed

    Nascimento, B E M; Oliveira, L; Vieira, A S; Joffily, M; Gleiser, S; Pereira, M G; Cavalcante, T; Volchan, E

    2008-12-01

    Research on human emotion shows that pictures drive the activity of specialised brain networks affecting attitude and behaviour. Pictorial warnings on cigarette packages are considered one of the most effective ways to convey information on the health consequences of smoking. However, few studies have evaluated the effectiveness of warning labels to elicit avoidance of smoking. To investigate the impact of pictorial health warnings conveyed by the Brazilian tobacco control programme through a well-established psychometric tool designed for studies on emotion and behaviour. Graphic Brazilian cigarette warnings labels were evaluated. They consisted of the two sets of warning pictures displayed in 2002-4 (n = 9) and 2004-8 (n = 10). Pleasant, unpleasant and neutral pictures selected from a standard catalogue were used as controls. Undergraduate students (n = 212, 18% smokers) evaluated the emotional content of each picture in two affective dimensions: hedonic valence and arousal. Participants were not provided with the sources of distinction between control and warning pictures. The judgements of hedonic content of the warning pictures ranged from neutral to very unpleasant. None was classified as highly arousing. Smokers judged warning pictures representing people smoking significantly more pleasant than pictures without smoking scenes, and significantly more so than non-smokers. No significant differences between smokers and non-smokers were found for warning pictures without these smoking scenes. Previous studies have shown that the most threatening and arousing pictures prompt the greatest evidence of defensive activation. Emotional ratings of Brazilian warning pictures described them as unpleasant but moderately arousing. To intensify avoidance of the packages, future graphic warnings should therefore generate more arousal. The ratings for the Brazilian warning pictures indicated that, except for those depicting people smoking, judgements by smokers and non

  14. 19 CFR 18.4 - Sealing conveyances and compartments; labeling packages; warning cards.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... transported is waived under paragraph (a) or (b) of this section. When the packages are shipped in a railroad... or compartments in which carload lots of bonded merchandise are transported shall be sealed with... conveyances or compartments in which bonded merchandise is transported in other cases when in his opinion...

  15. A study comparing the effectiveness of three warning labels on the package of driving-impairing medicines.

    PubMed

    Emich, Bas; van Dijk, Liset; Monteiro, Susana P; de Gier, Johan J

    2014-12-01

    Several medicines are known to potentially impair patients' driving fitness. Appropriate communication towards patients about this risk can be supported by the use of package warning labels. To compare the effectiveness of a standing practice yellow/black label-with written warning-with a newly developed rating model in communicating risk on driving-impairing medicines (DIMs). Furthermore, the added value of a side-text in the rating model was determined. Community pharmacies in the Netherlands. In a cross-sectional study, patients with a first dispensing of a DIM were asked by their community pharmacists (n = 38) to fill out a written questionnaire to compare each of the three warning labels. A 2 [yellow/black label vs. rating model (pair 1) and rating model with side-text vs. rating model without side-text (pair 2)] × 3 [category of driving-impairment: I = minor risk, II = moderate risk, III = severe risk] design was used. The category of driving-impairment varied per respondent, depending on the DIM the patient collected. (1) estimated level of driving risk valued by patients (2) intention to change driving behaviour after seeing the warning label. An estimated number of 992 patients were approached. As 298 questionnaires were analysed, the net response rate was 30%. With the yellow/black label, respondents considered DIMs of all three categories of driving-impairment to equally impair driving fitness, while with the rating model the estimated risk was higher when the category referred to a higher level of driving-impairment. Addition of a side-text to the rating model resulted in a significantly higher estimated level of driving risk and a significant increase in intention to change driving behaviour. Only 8.0% of the patients using a category III DIM estimated the level of driving risk correctly when seeing the yellow/black label, while this was 26.7% for the rating model and 43.0% for the rating model with side-text. The yellow/black label, which is standing

  16. The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey.

    PubMed

    Scheffels, Janne; Lund, Ingeborg

    2013-12-04

    This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. Norway. 1010 youths and adults aged 15-22. Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, 'would rather try' and 'easier to quit' for pairs of packages. Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (β -0.77, 95% CI -0.97 to -0.56), would rather try (β -0.32, 95% CI -0.50 to -0.14) and easier to quit (β -0.58, 95% CI -0.76 to -0.39). The results indicate that a shift from branded to plain cigarette packaging could lead to a reduction in positive perceptions of cigarettes among young people.

  17. The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey

    PubMed Central

    Scheffels, Janne; Lund, Ingeborg

    2013-01-01

    Objectives This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. Design Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. Setting Norway. Participants 1010 youths and adults aged 15–22. Primary outcome measures Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, ‘would rather try’ and ‘easier to quit’ for pairs of packages. Results Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (β −0.77, 95% CI −0.97 to −0.56), would rather try (β −0.32, 95% CI −0.50 to −0.14) and easier to quit (β −0.58, 95% CI −0.76 to −0.39). Conclusions The results indicate that a shift from branded to plain cigarette

  18. Assessing tobacco marketing receptivity among youth: integrating point of sale marketing, cigarette package branding and branded merchandise.

    PubMed

    Braun, Sandra; Kollath-Cattano, Christy; Barrientos, Inti; Mejía, Raúl; Morello, Paola; Sargent, James D; Thrasher, James F

    2016-11-01

    As countries prohibit tobacco marketing through traditional channels, marketing at point of sale (PoS) and through tobacco packaging is increasingly important for promoting tobacco consumption. Assess the validity of a novel marketing receptivity index that considers frequency of PoS exposures, tobacco brand recall and ownership of branded merchandise. Data come from a cross-sectional survey of 3172 secondary school students in Argentina. Questions assessed frequency of going to stores where tobacco is often sold; cued recall of brand names for 3 cigarette packages with brand name removed and ownership of branded merchandise. A four-level marketing receptivity index was derived: low PoS exposure only; high PoS exposure or recall of 1 brand; recall of 2 or more brands; and ownership of branded merchandise. Indicators of marketing receptivity and smoking involvement were regressed on the index, including in adjusted models that controlled for sociodemographics, social influences and sensation seeking. Among never-smokers, the index had independent positive associations with smoking susceptibility (ie, adjusted OR (AOR)2v1=1.66; AOR3v1=1.64; AOR4v1=2.95), willingness to try a specific brand (ie, AOR2v1=1.45; AOR3v1=2.38; AOR4v1=2.20) and positive smoking expectancies (ie, Badj 2v1=0.09; Badj 3v1=0.18; Badj 4v1=0.34). A more marked dose-response independent association was found with current smoking behaviour (ie, AOR2v1=2.47; AOR3v1=3.16; AOR4v1=3.62). The marketing receptivity index was associated with important variation in smoking-related perceptions, intentions and behaviour among Argentine adolescents. Future research should determine the predictive validity and generalisability of this measure to other contexts, including the explanatory power gained by integrating cigarette package brand recognition tasks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Noticing cigarette health warnings and support for new health warnings among non-smokers in China: findings from the International Tobacco Control project (ITC) China survey.

    PubMed

    Li, Zejun; Elton-Marshall, Tara; Fong, Geoffrey T; Quah, Anne Chiew Kin; Feng, Guoze; Jiang, Yuan; Hitchman, Sara C

    2017-05-19

    Health warnings labels (HWLs) have the potential to effectively communicate the health risks of smoking to smokers and non-smokers, and encourage smokers to quit. This study sought to examine whether non-smokers in China notice the current text-only HWLs and whether they support adding more health information and including pictures on HWLs. Adult non-smokers (n = 1324) were drawn from Wave 4 (September 2011-November 2012) of the International Tobacco Control (ITC) China Survey. The proportion of non-smokers who noticed the HWLs, and supported adding more health information and pictures to the HWLs was examined. Additionally, the relation between non-smokers' demographic characteristics, including whether they had a smoking partner, their number of smoking friends, and noticing the HWLs and support for adding health information and pictures was examined. Because the HWLs changed during the survey period (April 2012), differences between non-smokers who completed the survey before and after the change were examined. 12.2% reported they noticed the HWLs often in the last month. The multivariate model, adjusting for demographics showed that respondents with a smoking partner (OR = 2.41, 95% CI 1.42-4.13, p = 0.001) noticed the HWLs more often. 64.8% of respondents agreed that the HWLs should have more information, and 80.2% supported including pictures. The multivariate model showed that non-smokers who completed the survey after the HWLs were implemented (OR = 0.63, 95% CI 0.40-0.99, p = 0.04) were less likely to support adding more health information. The multivariate model showed a significant relation between having a smoking partner and supporting pictorial HWLs (OR = 2.03, 95% CI 1.24-3.33, p = 0.005). The findings indicate that the Chinese HWLs are noticed by a minority of non-smokers and that non-smokers strongly support strengthening the Chinese warning labels with more health information and pictures. Additionally, because the HWLs are noticed

  20. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers

    PubMed Central

    Durkin, Sarah; Brennan, Emily; Coomber, Kerri; Zacher, Meghan; Scollo, Michelle; Wakefield, Melanie

    2015-01-01

    Background Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours. Methods We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates. Results Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed significantly greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed-up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)). Conclusions These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers.

  1. Factors affecting failure to quit smoking after exposure to pictorial cigarette pack warnings among employees in Thailand.

    PubMed

    Sujirarat, Dusit; Silpasuwan, Pimpan; Viwatwongkasem, Chukiat; Sirichothiratana, Nithat

    2011-07-01

    This study was carried out to determine whether health warning pictures(HWP) affect smoking cessation using a structured equation model for intending-to-quit smokers in work places. Data from a 1-year longitudinal followup of attempt-to-quit employees was obtained to determine if pack warnings affect tobacco cessation rates. Stratified simple random sampling, and Structured Equation Modeling (SEM) were employed. Approximately 20% of intending-to-quit smokers were successful. The integrated model, combining internal, interpersonal factors and health warning pictures as external factors, fit the fail to quit pattern of the model. Having a smoking father was the most significant proximate indicator linked with failure to quit. Although HWL pictures were an external factor in the decision to stop smoking, the direct and indirect causes of failure to quit smoking were the influence of the family members. Fathers contributed to the success or failure of smoking cessation in their children by having an influence on the decision making process. Future HWP should include information about factors that stimulate smokers to quit successfully. The role model of a father on quitting is also important.

  2. Transnational tobacco industry promotion of the cigarette gifting custom in China.

    PubMed

    Chu, Alexandria; Jiang, Nan; Glantz, Stanton A

    2011-07-01

    To understand how British American Tobacco (BAT) and Philip Morris (PM) researched the role and popularity of cigarette gifting in forming relationships among Chinese customs and how they exploited the practice to promote their brands State Express 555 and Marlboro. Searches and analysis of industry documents from the Legacy Tobacco Documents Library complemented by searches on LexisNexis Academic news, online search engines and information from the tobacco industry trade press. From 1980-1999, BAT and PM employed Chinese market research firms to gather consumer information about perceptions of foreign cigarettes and the companies discovered that cigarettes, especially prestigious ones, were gifted and smoked purposely for building relationships and social status in China. BAT and PM promoted their brands as gifts by enhancing cigarette cartons and promoting culturally themed packages, particularly during the gifting festivals of Chinese New Year and Mid-Autumn Festival to tie their brands in to festival values such as warmth, friendship and celebration. They used similar marketing in Chinese communities outside China. BAT and PM tied their brands to Chinese cigarette gifting customs by appealing to social and cultural values of respect and personal honour. Decoupling cigarettes from their social significance in China and removing their appeal would probably reduce cigarette gifting and promote a decline in smoking. Tobacco control efforts in countermarketing, large graphic warnings and plain packaging to make cigarette packages less attractive as gifts could contribute to denormalising cigarette gifting.

  3. Transnational tobacco industry promotion of the cigarette gifting custom in China

    PubMed Central

    Chu, Alexandria; Jiang, Nan; Glantz, Stanton A

    2011-01-01

    Objective To understand how British American Tobacco (BAT) and Philip Morris (PM) researched the role and popularity of cigarette gifting in forming relationships among Chinese customs and how they exploited the practice to promote their brands State Express 555 and Marlboro. Methods Searches and analysis of industry documents from the Legacy Tobacco Documents Library complemented by searches on LexisNexis Academic news, online search engines and information from the tobacco industry trade press. Results From 1980–1999, BAT and PM employed Chinese market research firms to gather consumer information about perceptions of foreign cigarettes and the companies discovered that cigarettes, especially prestigious ones, were gifted and smoked purposely for building relationships and social status in China. BAT and PM promoted their brands as gifts by enhancing cigarette cartons and promoting culturally themed packages, particularly during the gifting festivals of Chinese New Year and Mid-Autumn Festival to tie their brands in to festival values such as warmth, friendship and celebration. They used similar marketing in Chinese communities outside China. Conclusions BAT and PM tied their brands to Chinese cigarette gifting customs by appealing to social and cultural values of respect and personal honour. Decoupling cigarettes from their social significance in China and removing their appeal would probably reduce cigarette gifting and promote a decline in smoking. Tobacco control efforts in countermarketing, large graphic warnings and plain packaging to make cigarette packages less attractive as gifts could contribute to denormalising cigarette gifting. PMID:21282136

  4. Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia—legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011

    PubMed Central

    Scollo, Michelle; Lindorff, Kylie; Coomber, Kerri; Bayly, Megan; Wakefield, Melanie

    2015-01-01

    This paper describes the development, content and implementation of two pieces of Australian tobacco control legislation: one to standardise the packaging of tobacco products and the other to introduce new, enlarged graphic health warnings. It describes the process of legislative drafting, public consultation and parliamentary consideration. It summarises exactly how tobacco products have been required to look since late 2012. Finally, it describes implementation, most particularly, the extent to which packs compliant with the legislation became available to consumers over time. PMID:28407605

  5. Implementation of effective cigarette health warning labels among low and middle income countries: State capacity, path-dependency and tobacco industry activity

    PubMed Central

    Hiilamo, Heikki; Glantz, Stanton A.

    2014-01-01

    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. PMID:25462428

  6. Labelling of electronic cigarettes: regulations and current practice

    PubMed Central

    Buonocore, Federico; Marques Gomes, Ana C N; Nabhani-Gebara, Shereen; Barton, Stephen J; Calabrese, Gianpiero

    2017-01-01

    Background Over the past decade e-cigarettes have established themselves in the global market. E-cigarettes triggered much interest in relation to their content and efficacy as smoking cessation tools, but less attention has been paid to users and environmental safety warnings and guidance. Several regulations have been introduced to promote their safe handling and disposal. From May 2016, liquids and cartridges will be regulated by European Community Directives (ECDs) 2001/83/EC and 93/42/EEC, or 2014/40/EU if marketed as tobacco-related products. Currently, manufacturers and distributors must abide by the Chemical (Hazard Information and Packaging for Supply) Regulations 2009 (CHIP) or Classification, Labelling and Packaging Regulations (CLP), the latter replacing CHIP in June 2015. Objective In this work, the compliance of marketed e-liquids and e-cigarettes with current European Union and UK legislations is assessed. Results E-liquids and e-cigarettes (21 and 9 brands, respectively) were evaluated. Evidence of non-compliance was found in relation to the CHIP/CLP toxic (13%) and environmental (37%) pictograms, tactile warning (23%), nominal amount of solution (30%), supplier contact telephone number and address (40%). None of the evaluated e-cigarettes displayed information on the correct disposal/recycling of batteries in line with the ECD 2006/66/EC. Conclusions More stringent enforcement of regulations is needed to ensure not only the user's safety and awareness, but also the safeguarding of the environment. PMID:26790924

  7. Patterns of combustible tobacco use in U.S. young adults and potential response to graphic cigarette health warning labels.

    PubMed

    Villanti, Andrea C; Pearson, Jennifer L; Cantrell, Jennifer; Vallone, Donna M; Rath, Jessica M

    2015-03-01

    In the evolving landscape of tobacco use, it remains unclear how tobacco control efforts should be designed and promoted for maximum impact. The current study links the identification of latent classes of young adult combustible tobacco users with anticipated responses to graphic health warning labels (HWLs). Data were collected in January 2012 using an online address-based panel as part of the Legacy Young Adult Cohort Study, and analyses were conducted in 2013. Latent class analyses identified five groups of tobacco users in a national sample of 4,236 young adults aged 18-34years: (1) little cigar/cigarillo/bidi (LCC) and hookah users (4%); (2) nonusers, open to smoking (3%); (3) daily smokers who self-identify as "smokers" (11%); (4) nondaily, light smokers who self-identify as "social or occasional smokers" (9%); and (5) nonusers closed to smoking (73%). Of the nonusers closed to smoking, 23% may be better characterized as at risk for tobacco initiation. Results indicate differences in the potential effectiveness of HWLs across classes. Compared to the daily "smokers," LCC and hookah users (RRR=2.35) and nonusers closed to smoking (RRR=2.33) were more than twice as likely to report that new graphic HWLs would make them think about not smoking. This study supports the potential of graphic HWLs to prevent young nonusers from using tobacco products. It suggests that the extension of prominent HWLs to other tobacco products, including LCCs and hookah tobacco, may also serve a prevention function.

  8. Implementation of effective cigarette health warning labels among low and middle income countries: state capacity, path-dependency and tobacco industry activity.

    PubMed

    Hiilamo, Heikki; Glantz, Stanton A

    2015-01-01

    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. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Influence of point-of-sale tobacco displays and plain black and white cigarette packaging and advertisements on adults: Evidence from a virtual store experimental study.

    PubMed

    Nonnemaker, James; Kim, Annice; Shafer, Paul; Loomis, Brett; Hill, Edward; Holloway, John; Farrelly, Matthew

    2016-05-01

    We examined the potential impact of banning tobacco displays and mandating plain packaging and cigarette advertisements at the point of sale (POS) on adult outcomes. A virtual convenience store was created with scenarios in which the tobacco product display was either fully visible (status quo) or enclosed behind a cabinet (display ban), and cigarette packs and advertisements were either in full color (status quo) or black and white, text only (plain). A national convenience sample of 1313 adult current smokers and recent quitters was randomized to 1 of 4 conditions and given a shopping task to complete in the virtual store. Main outcomes were participants' self-reported urge to smoke and tobacco purchase attempts in the virtual store. Compared with recent quitters in the status quo conditions, recent quitters in the display ban condition had lower urges to smoke (β=-4.82, 95% CI=-8.16--1.49, p<0.01). Compared with current smokers in the status quo conditions, smokers in the display ban conditions were less likely to attempt to purchase cigarettes in the virtual store (OR=0.05, 95% CI=0.03-0.08, P<0.01). Smokers exposed to plain packs and ads were significantly less likely to attempt to purchase cigarettes (OR=0.31, 95% CI=0.20-0.47, P<0.01) than those exposed to color packs and ads. Policies that ban the display of tobacco products or require plain packaging and advertising at the POS may help reduce adult smoking. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. The impact of structural packaging design on young adult smokers' perceptions of tobacco products.

    PubMed

    Borland, Ron; Savvas, Steven; Sharkie, Fiona; Moore, Karen

    2013-03-01

    To examine the extent that novel cigarette pack shapes and openings have on smokers' perceptions of those packs and the cigarettes contained within. Using a web-based survey, 160 young adult ever-smokers (18-29 years) were shown computer images of plain packaged cigarette packs in five different shapes. This was followed by packs illustrating five different methods of opening. Brand (prestige or budget) and size of the health warnings (30% or 70% warning size) were between-subject conditions. Respondents ranked packs on attractiveness, perceived quality of the cigarettes contained within and extent that the pack distracted from health warnings. Ratings of attractiveness and perceived quality were significantly associated in both substudies, but tendency to distract from warnings was more independent. Significant differences were found between the pack shapes on attractiveness, perceived quality and distraction from warnings. Standard, 2×10 and 4×5 packs were ranked less attractive than Bevelled and Rounded packs. 2×10 and 4×5 packs were also perceived as lower quality than Bevelled and Rounded packs. The Standard pack was less distracting to health warnings than all other shapes except the 2×10 pack. Pack openings were perceived as different on quality of cigarettes contained and extent of distraction to warnings. The Standard Flip-top was rated significantly lower in distracting from warnings than all other openings. Pack shape and pack opening affect ever-smokers' perceptions of the packs and the cigarettes they contain. This means that they have the potential to create appeal and differentiate products and thus should be regulated.

  11. Perceived effectiveness of pictorial health warnings among Mexican youth and adults: a population-level intervention with potential to reduce tobacco-related inequities.

    PubMed

    Hammond, David; Thrasher, James; Reid, Jessica L; Driezen, Pete; Boudreau, Christian; Santillán, Edna Arillo

    2012-03-01

    Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message content and socio-demographic effects. This study tested message themes and content of pictorial warnings in Mexico. Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5-7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: "graphic" health effects, "lived experience", symbolic images, and testimonials. Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring "graphic" depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme. Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups.

  12. Perceived effectiveness of pictorial health warnings among Mexican youth and adults: a population-level intervention to reduce tobacco related inequities

    PubMed Central

    Hammond, David; Thrasher, James; Reid, Jessica L.; Driezen, Pete; Boudreau, Christian; Santillan, Edna Arillo

    2015-01-01

    Purpose Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message content and socio-demographic effects. This study tested message themes and content of pictorial warnings in Mexico. Methods Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5–7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: “graphic” health effects, “lived experience”, symbolic images, and testimonials. Results Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring “graphic” depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme. Conclusions Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups. PMID:22362058

  13. Health warnings on tobacco products - worldwide, 2007.

    PubMed

    2009-05-22

    Many countries require that tobacco product packaging includes health warnings about the risks associated with tobacco use. Health warnings on tobacco product packages are effective in highlighting the perception of health risk, supporting the intention to quit tobacco use, discouraging the intention to begin tobacco use, and increasing cessation rates. Prominent displays of health warnings increase their effectiveness; larger warnings, with pictures, are more likely to be noticed, better communicate health risks, provoke greater emotional response, and further motivate tobacco users to quit. This report assesses the current status of tobacco packaging health warning requirements worldwide. Governments could further discourage tobacco use by requiring prominent health warnings on tobacco packaging.

  14. Impact of the removal of light and mild descriptors from cigarette packages in Ontario, Canada: switching to "light replacement" brand variants.

    PubMed

    Cohen, Joanna E; Yang, Jingyan; Donaldson, Elisabeth A

    2014-12-01

    This study assessed cessation and brand switching among smokers in Ontario, Canada after tobacco companies' voluntary removal of 'light' and 'mild' descriptors from cigarette packages. We analyzed longitudinal data on brand preference and cessation from a cohort of smokers (n=632) in the Ontario Tobacco Survey in Canada from 2006 to 2008 with a longitudinal regression model. While cessation differed by brand variant prior to the ban (7% light vs. 3% regular; P<0.05), it did not differ by brand variant after the ban was implemented. In 2008, when light cigarette brand variants were no longer available, 33% of the sample still reported smoking lights and 31% smoked light replacement brand variants. During each subsequent follow-up, light brand smokers had 2 times the odds of smoking regular brand variants (Adjusted OR: 2.03, 95% CI 1.80,2.29), and almost 5 times the odds of using light replacement brand variants (Adjusted OR: 4.87, 95% CI 4.07,5.84), respectively, compared to continuing to smoke lights. Even after removing misleading descriptors from cigarette packs, smokers continued to report using light brand variants, and many switched to newly introduced light replacement brand variants. After full implementation of the ban, cessation did not vary by brand variant. Copyright © 2014. Published by Elsevier Inc.

  15. Impact of the removal of light and mild descriptors from cigarette packages in Ontario, Canada: Switching to “light replacement” brand variants☆,☆☆

    PubMed Central

    Cohen, Joanna E.; Yang, Jingyan; Donaldson, Elisabeth A.

    2015-01-01

    Objective This study assessed cessation and brand switching among smokers in Ontario, Canada after tobacco companies’ voluntary removal of ‘light’ and ‘mild’ descriptors from cigarette packages. Method We analyzed longitudinal data on brand preference and cessation from a cohort of smokers (n = 632) in the Ontario Tobacco Survey in Canada from 2006 to 2008 with a longitudinal regression model. Results While cessation differed by brand variant prior to the ban (7% light vs. 3% regular; P < 0.05), it did not differ by brand variant after the ban was implemented. In 2008, when light cigarette brand variants were no longer available, 33% of the sample still reported smoking lights and 31% smoked light replacement brand variants. During each subsequent follow-up, light brand smokers had 2 times the odds of smoking regular brand variants (Adjusted OR: 2.03, 95% CI 1.80,2.29), and almost 5 times the odds of using light replacement brand variants (Adjusted OR: 4.87, 95% CI 4.07,5.84), respectively, compared to continuing to smoke lights. Conclusions Even after removing misleading descriptors from cigarette packs, smokers continued to report using light brand variants, and many switched to newly introduced light replacement brand variants. After full implementation of the ban, cessation did not vary by brand variant. PMID:25224153

  16. The advertised price of cigarette packs in retail outlets across Australia before and after the implementation of plain packaging: a repeated measures observational study.

    PubMed

    Scollo, Michelle; Bayly, Megan; Wakefield, Melanie

    2015-04-01

    This study monitored the advertised price of the most prominently promoted and the cheapest single packs of cigarettes in Australian retail outlets before and after the implementation of plain packaging. A panel of 421 outlets in four large Australian cities was visited monthly from May 2012 to August 2013 and the brand, pack size and price of the most-prominently listed and lowest-priced single cigarette pack were recorded from each store's tobacco price board. Changes in the inflation-adjusted stick price were examined using linear mixed models, controlling for fixed effects of city, store type, area socioeconomic status and random effects of time. The adjusted stick price was also examined over time by tobacco manufacturer and pack size. The inflation-adjusted stick price of the most-prominently advertised single packs was significantly higher than in May-July 2012 from August-October 2012 for mainstream and premium brands and from February-April 2013 for value brands. Adjusted average stick prices of lowest-priced packs in August 2013 were $0.02 (95% CI $0.02 to $0.03, p<0.001) higher than in May-July 2012 ($Aug13). A large real increase in stick price was seen in February-April 2013 across all major manufacturers, market segments and pack size categories. The price of cigarettes most prominently promoted on price boards did not decrease in the months following implementation of Australia's plain packaging legislation. Retail prices continued to increase above the level resulting from automatic indexation of excise/customs duty even at the lowest-priced end of the Australian market. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. The advertised price of cigarette packs in retail outlets across Australia before and after the implementation of plain packaging: a repeated measures observational study

    PubMed Central

    Scollo, Michelle; Bayly, Megan; Wakefield, Melanie

    2015-01-01

    Objective This study monitored the advertised price of the most prominently promoted and the cheapest single packs of cigarettes in Australian retail outlets before and after the implementation of plain packaging. Methods A panel of 421 outlets in four large Australian cities was visited monthly from May 2012 to August 2013 and the brand, pack size and price of the most-prominently listed and lowest-priced single cigarette pack were recorded from each store's tobacco price board. Changes in the inflation-adjusted stick price were examined using linear mixed models, controlling for fixed effects of city, store type, area socioeconomic status and random effects of time. The adjusted stick price was also examined over time by tobacco manufacturer and pack size. Results The inflation-adjusted stick price of the most-prominently advertised single packs was significantly higher than in May–July 2012 from August–October 2012 for mainstream and premium brands and from February–April 2013 for value brands. Adjusted average stick prices of lowest-priced packs in August 2013 were $0.02 (95% CI $0.02 to $0.03, p<0.001) higher than in May–July 2012 ($Aug13). A large real increase in stick price was seen in February–April 2013 across all major manufacturers, market segments and pack size categories. Discussion The price of cigarettes most prominently promoted on price boards did not decrease in the months following implementation of Australia's plain packaging legislation. Retail prices continued to increase above the level resulting from automatic indexation of excise/customs duty even at the lowest-priced end of the Australian market. PMID:28407616

  18. Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns.

    PubMed

    Cai, Hua; Wang, Chen

    2017-10-01

    Since the initial marketing in 2005, the use of e-cigarettes has increased exponentially. Nonetheless, accumulating evidence has demonstrated the ineffectiveness of e-cigarettes in leading to smoking cessation, and decreasing the adverse health impacts of cigarette smoking. The number of adolescents adapted to e-cigarettes has been increasing substantially each year, and this adaptation has promoted openness to tobacco smoking. The present review discusses controversies regarding the smoking cessation effects of e-cigarettes, recent governmental policies and regulations of e-cigarette use, toxic components and vaporization products of e-cigarettes, and the novel molecular mechanisms underlying the adverse health impacts of e-cigarettes leading to oxidative stress in target tissues, and consequent development of cardiopulmonary diseases (i.e. COPD), neurodegenerative disorders (i.e. Alzheimer's' disease), and cancer. Health warning signs on the packaging and professional consultation to avoid adaptation in risk groups might be helpful solutions to control negative impacts of e-cigarettes. It is also recommended to further expand basic and clinical investigations to reveal more detailed oxidative stress mechanisms of e-cigarette induced damages, which would ultimately result in more effective protective strategies. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  19. Electronic Cigarettes

    MedlinePlus

    ... New FDA Regulations Text Size: A A A Electronic Cigarettes Electronic cigarettes (e-cigarettes) are battery operated products designed to ... more about: The latest news and events about electronic cigarettes on this FDA page Electronic cigarette basics on ...

  20. Survey of descriptors on cigarette packs: still misleading consumers?

    PubMed

    Peace, Jo; Wilson, Nick; Hoek, Janet; Edwards, Richard; Thomson, George

    2009-09-25

    In September 2008, the New Zealand (NZ) Commerce Commission issued a warning to the major tobacco companies to remove "light" and "mild" descriptors from cigarette packaging. Despite published evidence that suggested tobacco companies had started colour-coding their packs in anticipation of the Commission's decision, the investigation did not consider more general misleading packaging. This study explored changes in tobacco packaging that had been introduced to the New Zealand market, by surveying descriptors used on cigarette packs after the Commerce Commission's warning. A convenience sample of discarded cigarette packs were collected in four cities and six towns/rural areas between November 2008 and January 2009. The majority of packs (93%) were collected in the capital city (Wellington). Information on the descriptors and pack colours was analysed. Four percent of the 1208 packs collected still included the terms "light" and "mild". Almost half the packs (42%) used a colour word (e.g. red, blue, gold) as a descriptor to indicate mildness or strength. A further 18% used other words that suggested mildness/strength (e.g. "subtle", "mellow"). A quarter of packs used a descriptor that did not connote either mildness or strength; however, the majority of these packs still appeared to be colour-coded. Although the words "light" and "mild" have been largely removed from tobacco packaging in the New Zealand market, these words have been replaced with associated colours or other words that may continue to communicate "reduced harm" messages to consumers. Further research to test how smokers interpret the new words and colours, and how these influence their behaviour, is desirable. However, government-mandated generic (plain) packaging would remove the opportunity to communicate misleading claims and so would afford the highest level of consumer protection.

  1. Perceptions and acceptability of pictorial health warning labels vs text only--a cross-sectional study in Lao PDR.

    PubMed

    Sychareun, Vanphanom; Hansana, Visanou; Phengsavanh, Alongkone; Chaleunvong, Kongmany; Tomson, Tanja

    2015-10-28

    In Lao PDR, health warnings were first introduced with printed warning messages on the side of the cigarette package in 1993 and again in 2004. Lao PDR same year ratified the Framework Convention on Tobacco Control (WHO FCTC) but has not yet implemented pictorial health warnings. This paper aims to examine the perception and opinion of policymakers on "text-only" and "pictorial" health warnings and to understand lay people's perceptions on current health warnings and their opinions on the recommended types of health warnings. A combination of quantitative and qualitative methods were used in this cross-sectional study conducted in 2008. A purposive sample of 15 policymakers, and a representative sample of 1360 smokers and non-smokers were recruited. A range of different areas were covered including consumer attitudes towards current and proposed cigarette package design, views on health warning messages on the flip/slide and inserts, and views on the relative importance of the size, content and pictures of health warning messages. Descriptive statistics and content analysis were used. Policy makers and survey respondents said that the current health warning messages were inappropriate, ineffective, and too small in size. All respondents perceived pictorial health warnings as a potentially powerful element that could be added to the messages that can communicate quickly, and dramatically. The majority of policymakers and survey respondents strongly supported the implementation of pictorial health warnings. The non-smokers agreed that the graphic pictorial health warnings were generally more likely than written health warnings to stimulate thinking about the health risks of smoking, by conveying potential health effects, increasing and reinforcing awareness of the negative health effect of smoking, aiding memorability of the health effects and arousing fear of smoking among smokers. The study suggested that current warnings are too small and that content is

  2. 27 CFR 41.74 - Notice for cigarettes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Notice for cigarettes. 41..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Packages § 41.74 Notice for cigarettes. Every package of cigarettes, except as...

  3. 27 CFR 41.74 - Notice for cigarettes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Notice for cigarettes. 41..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Packages § 41.74 Notice for cigarettes. Every package of cigarettes, except as...

  4. 27 CFR 41.74 - Notice for cigarettes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Notice for cigarettes. 41..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Packages § 41.74 Notice for cigarettes. Every package of cigarettes, except...

  5. 27 CFR 41.74 - Notice for cigarettes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Notice for cigarettes. 41..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Packages § 41.74 Notice for cigarettes. Every package of cigarettes, except...

  6. 27 CFR 41.74 - Notice for cigarettes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Notice for cigarettes. 41..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO IMPORTATION OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Packages § 41.74 Notice for cigarettes. Every package of cigarettes, except...

  7. Does Adding Information on Toxic Constituents to Cigarette Pack Warnings Increase Smokers' Perceptions About the Health Risks of Smoking? A Longitudinal Study in Australia, Canada, Mexico, and the United States.

    PubMed

    Cho, Yoo Jin; Thrasher, James F; Swayampakala, Kamala; Lipkus, Isaac; Hammond, David; Cummings, Kenneth Michael; Borland, Ron; Yong, Hua-Hie; Hardin, James W

    2017-06-01

    Health warning labels (HWLs) on cigarette packs in Australia, Canada, Mexico, and the United States include varying information about toxic cigarette smoke constituents and smoking-related health risks. HWL information changed more recently in Australia, Canada, and Mexico than in the United States. To investigate whether smokers' knowledge of toxic constituents and perceived smoking-related risks increased after adding this information to HWLs and how knowledge of toxic constituents is associated with perceptions of smoking-related risks. Data come from a longitudinal, online cohort of 4,621 adult smokers surveyed every 4 months from September 2012 (Wave 1) to January 2014 (Wave 5) in Australia, Canada, and Mexico, with the United States being surveyed from Waves 2 to 5. Generalized estimating equation models estimated the association between perceived smoking-related risk at follow-up and prior wave knowledge of toxic constituents, adjusting for attention to HWLs, sociodemographics, and smoking-related characteristics. Between 2012 and 2014, knowledge of toxic constituents increased in Australia, Canada, and Mexico ( p < .001), but not in the United States. Higher levels of both attention to HWLs and knowledge of toxic constituents were associated with a higher perceived risk of smoking-related conditions at follow-up across all countries except for the United States. Our results suggest that information about toxic constituents on prominent HWLs not only increases smoker's knowledge of toxic constituents, but that it may also reinforce the effects of HWL messages about specific, smoking-related health outcomes.

  8. Tobacco Packaging and Labeling Policies Under the U.S. Tobacco Control Act: Research Needs and Priorities

    PubMed Central

    2012-01-01

    Introduction: The Family Smoking Prevention and Tobacco Control Act (the “Act”), enacted in June 2009, gave the U.S. Food and Drug Administration authority to regulate tobacco products. The current paper reviews the provisions for packaging and labeling, including the existing evidence and research priorities. Methods: Narrative review using electronic literature search of published and unpublished sources in 3 primary areas: health warnings, constituent labeling, and prohibitions on the promotional elements of packaging. Results: The Act requires 9 pictorial health warnings covering half of cigarette packages and 4 text warnings covering 30% of smokeless tobacco packages. The Act also prohibits potentially misleading information on packaging, including the terms “light” and “mild,” and provides a mandate to require disclosure of chemical constituents on packages. Many of the specific regulatory provisions are based on the extent to which they promote “greater public understanding of the risks of tobacco.” As a result, research on consumer perceptions has the potential to shape the design and renewal of health warnings and to determine what, if any, information on product constituents should appear on packages. Research on consumer perceptions of existing and novel tobacco products will also be critical to help identify potentially misleading information that should be restricted under the Act. Conclusion: Packaging and labeling regulations required under the Act will bring the United States in line with international standards. There is an immediate need for research to evaluate these measures to guide future regulatory action. PMID:22039072

  9. Tobacco packaging and labeling policies under the U.S. Tobacco Control Act: research needs and priorities.

    PubMed

    Hammond, David

    2012-01-01

    The Family Smoking Prevention and Tobacco Control Act (the "Act"), enacted in June 2009, gave the U.S. Food and Drug Administration authority to regulate tobacco products. The current paper reviews the provisions for packaging and labeling, including the existing evidence and research priorities. Narrative review using electronic literature search of published and unpublished sources in 3 primary areas: health warnings, constituent labeling, and prohibitions on the promotional elements of packaging. The Act requires 9 pictorial health warnings covering half of cigarette packages and 4 text warnings covering 30% of smokeless tobacco packages. The Act also prohibits potentially misleading information on packaging, including the terms "light" and "mild," and provides a mandate to require disclosure of chemical constituents on packages. Many of the specific regulatory provisions are based on the extent to which they promote "greater public understanding of the risks of tobacco." As a result, research on consumer perceptions has the potential to shape the design and renewal of health warnings and to determine what, if any, information on product constituents should appear on packages. Research on consumer perceptions of existing and novel tobacco products will also be critical to help identify potentially misleading information that should be restricted under the Act. Packaging and labeling regulations required under the Act will bring the United States in line with international standards. There is an immediate need for research to evaluate these measures to guide future regulatory action.

  10. Flavoured cigarettes, sensation seeking and adolescents' perceptions of cigarette brands.

    PubMed

    Manning, K C; Kelly, K J; Comello, M L

    2009-12-01

    This study examined the interactive effects of cigarette package flavour descriptors and sensation seeking on adolescents' brand perceptions. High school students (n = 253) were randomly assigned to one of two experimental conditions and sequentially exposed to cigarette package illustrations for three different brands. In the flavour descriptor condition, the packages included a description of the cigarettes as "cherry", while in the traditional descriptor condition the cigarette brands were described with common phrases found on tobacco packages such as "domestic blend." Following exposure to each package participants' hedonic beliefs, brand attitudes and trial intentions were assessed. Sensation seeking was also measured, and participants were categorised as lower or higher sensation seekers. Across hedonic belief, brand attitude and trial intention measures, there were interactions between package descriptor condition and sensation seeking. These interactions revealed that among high (but not low) sensation seekers, exposure to cigarette packages including sweet flavour descriptors led to more favourable brand impressions than did exposure to packages with traditional descriptors. Among high sensation seeking youths, the appeal of cigarette brands is enhanced through the use of flavours and associated descriptions on product packaging.

  11. Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States.

    PubMed

    Kamboj, Alisha; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thiphalak; Smith, Gary A

    2016-06-01

    To investigate the epidemiologic characteristics and outcomes of exposures to electronic cigarettes (e-cigarettes), nicotine, and tobacco products among young children in the United States. A retrospective analysis of exposures associated with nicotine and tobacco products among children younger than 6 years old was conducted by using National Poison Data System data. From January 2012 through April 2015, the National Poison Data System received 29 141 calls for nicotine and tobacco product exposures among children younger than 6 years, averaging 729 child exposures per month. Cigarettes accounted for 60.1% of exposures, followed by other tobacco products (16.4%) and e-cigarettes (14.2%). The monthly number of exposures associated with e-cigarettes increased by 1492.9% during the study period. Children <2 years old accounted for 44.1% of e-cigarette exposures, 91.6% of cigarette exposures, and 75.4% of other tobacco exposures. Children exposed to e-cigarettes had 5.2 times higher odds of a health care facility admission and 2.6 times higher odds of having a severe outcome than children exposed to cigarettes. One death occurred in association with a nicotine liquid exposure. The frequency of exposures to e-cigarettes and nicotine liquid among young children is increasing rapidly and severe outcomes are being reported. Swift government action is needed to regulate these products to help prevent child poisoning. Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children. Copyright © 2016 by the American Academy of Pediatrics.

  12. Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies

    PubMed Central

    Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I.; Bryce, Stuart L.

    2013-01-01

    Background and Objectives Standardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Methods Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Results Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. Conclusions The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way

  13. Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies.

    PubMed

    Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I; Bryce, Stuart L

    2013-01-01

    Standardised or 'plain' tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm

  14. Public support for graphic health warning labels in the U.S.

    PubMed

    Kamyab, Kian; Nonnemaker, James M; Farrelly, Matthew C

    2015-01-01

    In 2009, the U.S. Food and Drug Administration was required to mandate that graphic health warning labels be placed on cigarette packages and advertisements. To assess public support in the U.S. for graphic health warning labels from 2007 to 2012. Data from 17,498 respondents from 13 waves of the National Adult Tobacco Survey, a list-assisted random-digit-dial survey, were used. Overall support for graphic health warning labels, as well as support by smoking status, and by sociodemographics and smoker characteristics are estimated. Analyses were conducted in 2014. Since 2007, a majority of the public overall has been in favor of labels. Support increased significantly among the public overall and among non-smokers from 2007 through 2009 (p<0.001), after which it remained flat. Among smokers, support levels increased from 2007 through 2011 (p<0.001), but decreased significantly from 2011 through 2012 (p<0.001). Support was high regardless of smoking status, although among smokers, support varied by level of smoking, interest in quitting, and whether labels were seen as an important reason to quit. Support varied by sociodemographic characteristics, particularly among smokers. Younger, less-affluent, and less-educated smokers supported labels at higher levels than their counterparts. A majority of U.S. residents support graphic health warning labels for cigarette packs, though support among smokers declined after 2011. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Impact of graphic pack warnings on adult smokers’ quitting activities: Findings from the ITC Southeast Asia Survey (2005–2014)

    PubMed Central

    Li, Lin; Fathelrahman, Ahmed I.; Borland, Ron; Omar, Maizurah; Fong, Geoffrey T.; Quah, Anne C.K.; Sirirassamee, Buppha; Yong, Hua-Hie

    2016-01-01

    Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50–55% in 2010. Data came from six waves (2005–2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts. PMID:27525045

  16. Impact of graphic pack warnings on adult smokers' quitting activities: Findings from the ITC Southeast Asia Survey (2005-2014).

    PubMed

    Li, Lin; Fathelrahman, Ahmed I; Borland, Ron; Omar, Maizurah; Fong, Geoffrey T; Quah, Anne C K; Sirirassamee, Buppha; Yong, Hua-Hie

    2016-06-01

    Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50-55% in 2010. Data came from six waves (2005-2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts.

  17. 27 CFR 40.215 - Notice for cigarettes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

  18. 27 CFR 40.215 - Notice for cigarettes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

  19. 19 CFR 10.65 - Cigars and cigarettes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

  20. 19 CFR 10.65 - Cigars and cigarettes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 1 2011-04-01 2011-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

  1. 19 CFR 10.65 - Cigars and cigarettes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 1 2012-04-01 2012-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be...

  2. 27 CFR 40.215 - Notice for cigarettes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately...

  3. 27 CFR 40.215 - Notice for cigarettes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately...

  4. 19 CFR 10.65 - Cigars and cigarettes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 1 2013-04-01 2013-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be...

  5. 27 CFR 40.215 - Notice for cigarettes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately...

  6. 19 CFR 10.65 - Cigars and cigarettes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 1 2014-04-01 2014-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be...

  7. Considerations and Future Research Directions for E-Cigarette Warnings—Findings from Expert Interviews

    PubMed Central

    Wackowski, Olivia A.; Hammond, David; O’Connor, Richard J.; Strasser, Andrew A.; Delnevo, Cristine D.

    2017-01-01

    Tobacco warning labels are important sources of risk information but research historically has been cigarette-centric. This qualitative study aimed to inform future direction and research on warnings for e-cigarettes. Between June and August 2016, we conducted interviews with 10 researchers with expertise in tobacco warning label research. Interviewees were registrants of a 2016 National Cancer Institute grantee meeting on tobacco warnings. Several participants agreed that the Food and Drug Administration’s new nicotine addiction warning for e-cigarettes could be informative but that it might not resonate with young people. Many agreed that more than one warning would be important as e-cigarette science evolves and that research on additional warning themes (e.g., nicotine exposure, harmful constituents) and execution styles (including use of pictorials) was important. Participants were somewhat mixed about the use of reduced-risk messages within e-cigarette warnings, but agreed that research on how to communicate about cigarette/e-cigarette relative risks was needed. Overall, more research is needed on tobacco warnings for non-cigarette products, including on the message content, placement, execution and potential impact on audiences’ product knowledge, risk perceptions and use intentions. This is particularly needed for products such as e-cigarettes which may have harm-reduction potential relative to cigarettes and require unique considerations. PMID:28708124

  8. Demographic Characteristics, Nicotine Dependence, and Motivation to Quit as Possible Determinants of Smoking Behaviors and Acceptability of Shocking Warnings in Italy

    PubMed Central

    Mannocci, Alice; Colamesta, Vittoria; Conti, Vittoria; Cattaruzza, Maria Sofia; Paone, Gregorino; Cafolla, Maria; Saulle, Rosella; Bulzomì, Vincenzo; Antici, Daniele; Cuccurullo, Pasquale; Boccia, Antonio; La Torre, Giuseppe; Terzano, Claudio

    2014-01-01

    Introduction. This paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use. Methods. The study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit. Results. 666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor's score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with P < 0.05. Conclusions. This study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior. PMID:24900980

  9. Demographic characteristics, nicotine dependence, and motivation to quit as possible determinants of smoking behaviors and acceptability of shocking warnings in Italy.

    PubMed

    Mannocci, Alice; Colamesta, Vittoria; Conti, Vittoria; Cattaruzza, Maria Sofia; Paone, Gregorino; Cafolla, Maria; Saulle, Rosella; Bulzomì, Vincenzo; Antici, Daniele; Cuccurullo, Pasquale; Boccia, Antonio; La Torre, Giuseppe; Terzano, Claudio

    2014-01-01

    This paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use. The study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit. 666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor's score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with P < 0.05. This study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior.

  10. Young adult smokers' perceptions of illicit tobacco and the possible impact of plain packaging on purchase behaviour.

    PubMed

    Moodie, Crawford; Hastings, Gerard; Joossens, Luk

    2012-04-01

    Plain (unbranded) packaging for cigarettes is at the top of the tobacco control agenda in both Australia and Europe. The evidence suggests that it will benefit public health by decreasing the appeal of tobacco products and increasing the power of the health warning. The tobacco industry instead argues that plain packaging would make it easier to counterfeit cigarettes, which would both confuse consumers and reduce price; thereby increasing consumption. Using focus group research we examined young adult smokers (N = 54) perceptions of, and ability to recognize, illicit tobacco and the possible impact of plain packaging on illicit tobacco purchasing behaviour. We found that the pack has no impact on the decision to buy illicit tobacco. Smokers were easily able to identify counterfeit cigarettes, not least by the pack, and buy it knowingly and in the full expectation that it will be inferior in quality. Illicit tobacco purchase, including that for counterfeit tobacco, was instead driven by availability and price. Given the extremely low manufacturing cost, per pack, of certain types of illicit cigarettes, it is difficult to envisage how plain packaging would alter the price of illicit tobacco in any meaningful way. The findings therefore suggest that a move to plain packaging would have no impact on young adult smokers' purchase behaviour.

  11. [Excise taxes on tobacco and the problem of smuggling - concerning the credibility of the tobacco industry's "Discarded-Cigarette-Packages-Study"].

    PubMed

    Adams, M; Effertz, T

    2011-10-01

    The consumption of tobacco products is one of the main causes of illnesses. An often neglected but highly effective instrument for fiscal and preventive purposes is higher taxes on tobacco products. The tobacco industry however claims that higher taxes have tremendous effects on smuggling activity with additional costs with regard to law enforcement. The claim appears to be substantiated by a study which collects and documents the amounts of discarded empty cigarette packs, and which is used to estimate the fraction of illegally imported cigarettes. We show that this study makes use of systematic misspecifications and impreciseness and thus seems to pursue the aim of showing an exaggerated high amount of illegally imported cigarettes. The industry's claim that two thirds of non-taxed cigarettes in Germany are imported illegally, thus lacks any sound, well-grounded empirical corroboration. © Georg Thieme Verlag KG Stuttgart · New York.

  12. 21 CFR 740.2 - Conspicuousness of warning statements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS General § 740.2 Conspicuousness of warning... exemption pursuant to paragraph (b) of this section is established. (b) If the label of any cosmetic package...

  13. 21 CFR 740.2 - Conspicuousness of warning statements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS General § 740.2 Conspicuousness of warning... exemption pursuant to paragraph (b) of this section is established. (b) If the label of any cosmetic package...

  14. 21 CFR 740.2 - Conspicuousness of warning statements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS General § 740.2 Conspicuousness of warning... exemption pursuant to paragraph (b) of this section is established. (b) If the label of any cosmetic package...

  15. 21 CFR 740.2 - Conspicuousness of warning statements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS General § 740.2 Conspicuousness of warning... exemption pursuant to paragraph (b) of this section is established. (b) If the label of any cosmetic package...

  16. 21 CFR 740.2 - Conspicuousness of warning statements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) COSMETICS COSMETIC PRODUCT WARNING STATEMENTS General § 740.2 Conspicuousness of warning... exemption pursuant to paragraph (b) of this section is established. (b) If the label of any cosmetic package...

  17. Short and Sweet: The Persuasive Effects of Message Framing and Temporal Context in Antismoking Warning Labels.

    PubMed

    Mollen, Saar; Engelen, Susanne; Kessels, Loes T E; van den Putte, Bas

    2017-01-01

    Current warning labels on cigarette packages are generally focused on long-term losses that can be incurred if one continues smoking. This study compares the effects of these labels against warning labels that stress short-term losses of smoking as well as labels that stress short- and long-term benefits that can be obtained when one quits smoking. A 2 (message frame: gain vs. loss) × 2 (temporal context: short vs. long term) between-subjects experiment was conducted among 132 smokers, with attitude toward quitting smoking and intention to quit smoking, as well as information-seeking behavior and message recall, as the dependent variables. Findings were in line with theory regarding message framing and temporal discounting, showing enhanced effects of gain over loss frames and short-term over long-term consequences on warning labels for attitudes and intentions. In addition, an interaction between message frame and temporal context was found. Especially, gain-framed messages showed stronger effects on intentions to quit smoking than loss-framed messages when warning labels concerned short-term outcomes. Findings suggest that current warning labels, with an emphasis on long-term negative health outcomes, should be reconsidered.

  18. Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours?

    PubMed

    White, Victoria; Webster, Bernice; Wakefield, Melanie

    2008-09-01

    To assess the impact of the introduction of graphic health warning labels on cigarette packets on adolescents at different smoking uptake stages. School-based surveys conducted in the year prior to (2005) and approximately 6 months after (2006) the introduction of the graphic health warnings. The 2006 survey was conducted after a TV advertising campaign promoting two new health warnings. Secondary schools in greater metropolitan Melbourne, Australia. Students in year levels 8-12: 2432 students in 2005, and 2050 in 2006, participated. Smoking uptake stage, intention to smoke, reported exposure to cigarette packs, knowledge of health effects of smoking, cognitive processing of warning labels and perceptions of cigarette pack image. At baseline, 72% of students had seen cigarette packs in the previous 6 months, while at follow-up 77% had seen packs and 88% of these had seen the new warning labels. Cognitive processing of warning labels increased, with students more frequently reading, attending to, thinking and talking about warning labels at follow-up. Experimental and established smokers thought about quitting and forgoing cigarettes more at follow-up. At follow-up intention to smoke was lower among those students who had talked about the warning labels and had forgone cigarettes. Graphic warning labels on cigarette packs are noticed by the majority of adolescents, increase adolescents' cognitive processing of these messages and have the potential to lower smoking intentions. Our findings suggest that the introduction of graphic warning labels may help to reduce smoking among adolescents.

  19. Adolescent perceptions of cigarette appearance.

    PubMed

    Ford, Allison; Moodie, Crawford; MacKintosh, Anne M; Hastings, Gerard

    2014-06-01

    To reduce the possibility of cigarette appearance misleading consumers about harm caused by the product, the European Commission's draft Tobacco Products Directive proposed banning cigarettes <7.5 mm in diameter. It appears however, following a plenary vote in the European Parliament, that this will not be part of the final Tobacco Products Directive. To reduce the appeal of cigarettes, the Australian Government banned the use of branding on cigarettes and stipulated a maximum cigarette length as part of the Tobacco Plain Packaging Act. We explored the role, if any, of cigarette appearance on perceptions of appeal and harm among adolescents. Focus group research with 15-year-olds (N = 48) was conducted in Glasgow (Scotland) to explore young people's perceptions of eight cigarettes differing in length, diameter, colour and decorative design. Slim and superslim cigarettes with white filter tips and decorative features were viewed most favourably and rated most attractive across gender and socio-economic groups. The slimmer diameters of these cigarettes communicated weaker tasting and less harmful looking cigarettes. This was closely linked to appeal as thinness implied a more pleasant and palatable smoke for young smokers. A long brown cigarette was viewed as particularly unattractive and communicated a stronger and more harmful product. This exploratory study provides some support that standardising cigarette appearance could reduce the appeal of cigarettes in adolescents and reduce the opportunity for stick design to mislead young smokers in terms of harm. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  20. Compelled commercial speech: the Food and Drug Administration's effort to smoke out the tobacco industry through graphic warning labels.

    PubMed

    Haynes, Bryan M; Andrews, Anne Hampton; Jacob, C Reade

    2013-01-01

    FDA's proposed graphic warning labels for cigarette packages have been scrutinized for potentially violating the First Amendment's free speech clause. This article addresses the distinction between the commercial speech and compelled speech doctrines and their applicability in analyzing the constitutionality of the labels. The government's position is that the labels evoke an emotional response and educate consumers, while tobacco companies argue that the labels forcibly promote the government's message. Two federal appellate courts, applying different legal standards, have arrived at different conclusions. This article advocates that the Supreme Court, if faced with review of the labels, should apply strict scrutiny and declare the labels unconstitutional.

  1. The lower effectiveness of text-only health warnings in China compared to pictorial health warnings in Malaysia.

    PubMed

    Elton-Marshall, Tara; Xu, Steve Shaowei; Meng, Gang; Quah, Anne C K; Sansone, Genevieve C; Feng, Guoze; Jiang, Yuan; Driezen, Pete; Omar, Maizurah; Awang, Rahmat; Fong, Geoffrey T

    2015-11-01

    In 2009, China changed its health warnings on cigarette packs from side-only text warnings to two text-only warnings on 30% of the bottom of the front and back of the pack. Also in 2009, Malaysia changed from similar text warnings to pictorial health warnings consistent with Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines. To measure the impact of the change in health warnings in China and to compare the text-only health warnings to the impact of the pictorial health warnings introduced in Malaysia. We measured changes in key indicators of warning effectiveness among a longitudinal cohort sample of smokers from Waves 1 to 3 (2006-2009) of the International Tobacco Control (ITC) China Survey and from Waves 3 to 4 (2008-2009) of the ITC Malaysia Survey. Each cohort consisted of representative samples of adult (≥18 years) smokers from six cities in China (n=6575) and from a national sample in Malaysia (n=2883). Generalised Estimating Equations (GEE) were used to examine the impact of the health warnings on subsequent changes in salience of warnings, cognitive and behavioural outcomes. Compared to Malaysia, the weak text-only warning labels in China led to a significant change in only two of six key indicators of health warning effectiveness: forgoing cigarettes and reading the warning labels. The change to pictorial health warnings in Malaysia led to significant and substantial increases in five of six indicators (noticing, reading, forgoing, avoiding, thinking about quitting). The delay in implementing pictorial health warnings in China constitutes a lost opportunity for increasing knowledge and awareness of the harms of cigarettes, and for motivating smokers to quit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Reactance to Health Warnings Scale: Development and Validation

    PubMed Central

    Hall, Marissa G.; Sheeran, Paschal; Noar, Seth M.; Ribisl, Kurt M.; Bach, Laura E.; Brewer, Noel T.

    2016-01-01

    Background Health warnings may be less effective if they elicit reactance, a motivation to resist a threat to freedom, yet we lack a standard measure of reactance. Purpose We sought to validate a new health warning reactance scale in the context of pictorial cigarette pack warnings. Methods A national sample of adults (n=1,413) responded to reactance survey questions while viewing randomly assigned pictorial or text warnings on images of cigarette packs. A separate longitudinal sample of adult smokers received the warnings on their own cigarette packs (n=46). Results Factor analyses identified a reliable and valid 27-item Reactance to Health Warnings Scale. In our experimental study, smokers rated pictorial warnings as being able to motivate quitting more than text warnings. However, five reactance scale factors weakened the warnings’ impact (anger, exaggeration, government, manipulation, and personal attack; all p<.05). Conclusions The Reactance to Health Warnings Scale had good psychometric properties. Reactance weakened the impact of pictorial warnings on smokers’ evaluation of the warning’s ability to motivate quitting. PMID:27333895

  3. Cigarette smokers' classification of tobacco products.

    PubMed

    Casseus, M; Garmon, J; Hrywna, M; Delnevo, C D

    2016-11-01

    Cigarette consumption has declined in the USA. However, cigar consumption has increased. This may be due in part to some cigarette smokers switching to filtered cigars as a less expensive substitute for cigarettes. Additionally, some cigarette smokers may perceive and consume little filtered cigars as cigarettes. The purpose of this study was to determine how cigarette smokers classify tobacco products when presented with photographs of those products. An online survey was conducted with a sample of 344 self-identified cigarette smokers. Respondents were presented with pictures of various types of tobacco products, both with and without packaging, and then asked to categorise them as either a cigarette, little cigar, cigarillo, cigar or machine-injected roll-your-own cigarette (RYO). Respondents were also asked about their tobacco use and purchasing behaviour. Overall, respondents had difficulty distinguishing between cigarettes, little cigars, cigarillos and RYO. When presented with images of the products without packaging, 93% of respondents identified RYO as a cigarette, while 42% identified a little cigar as a cigarette. Additionally, respondents stated that they would consider purchasing little cigars as substitutes for cigarettes because of the price advantage. The results of this survey suggest that when presented with photographs of tobacco products, large proportions of current smokers were unable to differentiate between cigarettes, little cigars, cigarillos, RYO and cigars. Findings have implications for existing public health efforts targeting cigarette smokers, and underscore the need to review current definitions of tobacco products and federal excise taxes on such products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis.

    PubMed

    Young, Jane M; Stacey, Ingrid; Dobbins, Timothy A; Dunlop, Sally; Dessaix, Anita L; Currow, David C

    2014-01-20

    To investigate whether the introduction of tobacco plain packaging in Australia from 1 October 2012 was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1 March 2006. Whole-of-population interrupted time-series analysis in New South Wales and the Australian Capital Territory between 1 March 2005 and October 2006 for the comparator, graphic health warnings, and October 2011 and April 2013 for the intervention of interest, tobacco plain packaging. Weekly number of calls to the Quitline, after adjusting for seasonal trends, anti-tobacco advertising, cigarette costliness and the number of smokers in the community. There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging (baseline, 363/week; peak, 651/week [95% CI, 523-780/week; P < 0.001]). This peak occurred 4 weeks after the initial appearance of plain packaging and has been prolonged. The 2006 introduction of graphic health warnings had the same relative increase in calls (84%; baseline, 910/week; peak, 1673/week [95% CI, 1383-1963/week; P < 0.001]) but the impact of plain packaging has continued for longer. There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control.

  5. 27 CFR 45.45 - Notice for cigarettes.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

  6. 27 CFR 45.45 - Notice for cigarettes.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

  7. Believability of Cigar Warning Labels Among Adolescents.

    PubMed

    Kowitt, Sarah D; Jarman, Kristen; Ranney, Leah M; Goldstein, Adam O

    2017-03-01

    Despite high rates of cigar use among youth, little information exists about how cigar warnings are received by youth. We examined believability of different cigar warning messages with different sources among adolescents in a national phone survey. Adolescents (aged 13-17 years) in the US (N = 1,125; total response rate, 66%) were randomized to receive one of three health messages ("cigar smoking can cause cancers of the mouth and throat, even if you do not inhale," "cigar smoking can cause lung cancer and heart disease," and "cigars are not a safe alternative to cigarettes") and one of four warning sources (Food and Drug Administration, Surgeon General, Centers for Disease Control and Prevention, and no source). Believability was assessed with "how believable is this warning," and responses were dichotomized for "not at all or somewhat" versus "very." Weighted logistic regression results indicated that most youth found the cigar warnings very believable (60.5%). Messages about mouth and throat cancer (regardless of inhalation) and the safety of cigars in comparison to cigarettes were rated as significantly less believable than messages about lung cancer and heart disease related to cigars. There were no significant differences by source or other demographics. However, youth susceptible to using cigarettes were less likely to report the cigar warnings to be very believable. The messages of cigar warning labels are not viewed as equally believable among adolescents. Future studies should examine how youth process messages about health effects of cigars and the impact of different cigar warnings on youth experimentation with and use of cigars. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  8. Cigarette labeling policies in Latin America and the Caribbean: progress and obstacles

    PubMed Central

    Sebrié, Ernesto M; Blanco, Adriana; Glantz, Stanton A

    2011-01-01

    Objetive To describe cigarette labeling policies in Latin America and the Caribbean as of August 2010. Material and Methods Review of tobacco control legislation of all 33 countries of the region; analysis of British American Tobacco (BAT)’s corporate social reports; analysis of information from cigarette packages collected in 27 countries. Results In 2002, Brazil became the first country in the region to implement pictorial health warning labels on cigarette packages. Since then, six more countries adopted pictorial labels. The message content and the picture style vary across countries. Thirteen countries have banned brand descriptors and nine require a qualitative label with information on constituents and emissions. Tobacco companies are using strategies commonly used around the world to block the effective implementation of WHO Framework Convention on Tobacco Control (FCTC)’s Article 11. Conclusions Since 2002, important progress has been achieved in the region. However, countries that have ratified the FCTC have not yet implemented all the recommendations of Article 11 Guidelines. PMID:21243194

  9. Impact of tobacco health warnings on smokers in Pakistan.

    PubMed

    Ahsan, Muhammad; Saad, Muhammad; Jawed, Memoona; Akhtar, Sohail; Haseeb, Abdul; Bilal, Muhammad; Ahmed, Afia

    2016-01-01

    To see the impact of health warnings cigarette packets on the smoking habits of smokers. The cross-sectional study was conducted in Karachi from July to October 2014, and comprised adult male cigarettes smokers. A self-administered questionnaire was presented to the participants who were selected through non-probability convenience sampling irrespective of their educational background. Data was analyzed using SPSS 17. Out of the 1500 subjects, 1330(88.7%) noticed warning on cigarette packets; 730(54.8%) considered the picture to have significant impact; 630(47.3%) tried to decrease smoking; and 430(32.4%) actually attempted to quit. Of the 430 who tried to quit, 300(69.7%) considered the picture as having had an impact. The current health warnings on cigarette packets sold in Pakistan do not carry a significant deterrent impact.

  10. Global approaches to regulating electronic cigarettes.

    PubMed

    Kennedy, Ryan David; Awopegba, Ayodeji; De León, Elaine; Cohen, Joanna E

    2017-07-01

    Classify and describe the policy approaches used by countries to regulate e-cigarettes. National policies regulating e-cigarettes were identified by (1) conducting web searches on Ministry of Health websites, and (2) broad web searches. The mechanisms used to regulate e-cigarettes were classified as new/amended laws, or existing laws. The policy domains identified include restrictions or prohibitions on product: sale, manufacturing, importation, distribution, use, product design including e-liquid ingredients, advertising/promotion/sponsorship, trademarks, and regulation requiring: taxation, health warning labels and child-safety standards. The classification of the policy was reviewed by a country expert. The search identified 68 countries that regulate e-cigarettes: 22 countries regulate e-cigarettes using existing regulations; 25 countries enacted new policies to regulate e-cigarettes; 7 countries made amendments to existing legislation; 14 countries use a combination of new/amended and existing regulation. Common policies include a minimum-age-of-purchase, indoor-use (vape-free public places) bans and marketing restrictions. Few countries are applying a tax to e-cigarettes. A range of regulatory approaches are being applied to e-cigarettes globally; many countries regulate e-cigarettes using legislation not written for e-cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Nicotine and the Developing Human: A Neglected Element in the Electronic Cigarette Debate.

    PubMed

    England, Lucinda J; Bunnell, Rebecca E; Pechacek, Terry F; Tong, Van T; McAfee, Tim A

    2015-08-01

    The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. Published by Elsevier Inc.

  12. Expert-recommended warnings for medical marijuana.

    PubMed

    Malouff, John M; Rooke, Sally E

    2013-01-01

    Medical marijuana is legal in some countries, including in many US states. At present, there are no government-mandated warnings on packages of marijuana, even though the substance has dangers similar to those of alcohol, tobacco, and various prescribed drugs. This article reports the results of an effort to collect marijuana warnings recommended by scientific experts on marijuana. The recommended warnings, the first ever from marijuana experts, come from 13 experts. The expert-recommended warnings pertain to risks relating to (1) safety, (2) physical health, (3) fetal harm, (4) mental health, (5) withdrawal and dependence, and (6) adolescent development. The results provide initial expert recommendations for warnings to be required on packages of medical marijuana.

  13. The appeal of smokeless tobacco products among young Canadian smokers: the impact of pictorial health warnings and relative risk messages.

    PubMed

    Callery, William E; Hammond, David; O'Connor, Richard J; Fong, Geoffrey T

    2011-05-01

    Although the health risks from smokeless tobacco (ST) are lower than cigarettes, it remains unclear how smokers might use ST products, including as a substitute, a cessation aid, or concurrently with cigarette use, if at all. Additionally, there is little evidence examining the impact of health warning labels (HWL) on ST use and perceptions. The current study investigated perceptions of ST products with and without HWL and a relative health risk (RHR) message. The study consisted of a full-factorial "between-subjects" experiment in which 3 HWL and a RHR message were systematically varied. Canadian smokers aged 18-30 years (N = 611) completed an online survey where they viewed four brands of ST packages altered according to the experimental conditions. Approximately half of the smokers indicated that they were willing to try ST as a substitute and to help quit smoking. More than one quarter (28%) of smokers were unaware that using ST is less harmful than smoking. Pictorial HWL increased false beliefs about the RHR of ST and decreased smokers' willingness to try ST, whereas text warnings did not. Adding a RHR message communicating the lower risk of ST compared with cigarettes increased willingness to try ST when added to text HWL but decreased willingness to try ST even further when added to pictorial HWL. The findings indicate relatively high levels of appeal for ST among young adult Canadian cigarette smokers. Pictorial HWL reduced the appeal of ST products and increased perceived risks, including the false belief that ST is equally harmful as cigarettes. Further research could consider evaluating designs of HWL on ST products that better balance absolute and RHR.

  14. 19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

  15. 19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 1 2011-04-01 2011-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

  16. Low-Yield Cigarettes

    MedlinePlus

    ... smoking, cigarette manufacturers began heavily marketing cigarettes labeled "light," "low," and "mild" (or similar descriptors). 1 Cigarettes with "light/low/mild" labels delivered less tar or nicotine ...

  17. Tobacco packaging design for reducing tobacco use.

    PubMed

    McNeill, Ann; Gravely, Shannon; Hitchman, Sara C; Bauld, Linda; Hammond, David; Hartmann-Boyce, Jamie

    2017-04-27

    participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post-implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye-tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. We found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse-tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack. The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect

  18. Menthol Content in U.S. Marketed Cigarettes

    PubMed Central

    Ai, Jiu; Taylor, Kenneth M.; Lisko, Joseph G.; Tran, Hang; Watson, Clifford H.; Holman, Matthew R.

    2015-01-01

    Introduction In 2011 menthol cigarettes accounted for 32 percent of the market in the United States, but there are few literature reports that provide measured menthol data for commercial cigarettes. To assess current menthol application levels in the U.S. cigarette market, menthol levels in cigarettes labeled or not labeled to contain menthol was determined for a variety of contemporary domestic cigarette products. Method We measured the menthol content of 45whole cigarettes using a validated gas chromatography/mass spectrometry method (GC/MS). Results In 23 cigarette brands labeled as menthol products, the menthol levels of the whole cigarette ranged from 2.9 to 19.6 mg/cigarette, with three products having higher levels of menthol relative to the other menthol products. The menthol levels for 22 cigarette products not labeled to contain menthol ranged from 0.002 to 0.07 mg/cigarette. The type of packaging (soft vs. hard pack) for a given cigarette product does not appear to affect menthol levels based on the current limited data. Conclusion Menthol levels in cigarette products labeled as containing menthol are approximately 50 to 5,000-fold higher than those in cigarette products not labeled as containing menthol. In general, menthol content appears to occur within discrete ranges for both mentholated and non-mentholated cigarettes. PMID:26259988

  19. Self-reported exposure to tobacco warning labels among U.S. middle and high school students.

    PubMed

    Johnson, Sarah E; Wu, Charles C; Coleman, Blair N; Choiniere, Conrad J

    2014-08-01

    Warning labels on tobacco products are a means to communicate information about the negative health effects of tobacco use to current and potential users. Most tobacco use begins in early adolescence, making it particularly important to understand the degree to which warning labels reach adolescents. To examine the extent to which youth report (1) seeing the current warnings on cigarettes and smokeless tobacco (SLT) products in the U.S. and (2) that seeing warnings makes them think about the health risks associated with tobacco use. Exposure to warning labels on cigarettes and SLT, as well as the degree to which adolescents report thinking about health risks in response to warnings, was examined among U.S. middle and high school students using data from the 2012 National Youth Tobacco Survey (NYTS) and analyzed in 2013. Current data suggest that less than half of adolescents who saw a cigarette pack (46.9%) or SLT product (40.3%) reported seeing the warning label "most of the time" or "always." Among adolescents who reported seeing a warning, less than one third reported that cigarette (30.4%) or SLT (25.2%) warning labels made them think about health risks "a lot." These rates were even lower among current tobacco users (<14%). Current warning labels for cigarettes and SLT could be improved by implementing warnings that incorporate features that make them salient and more likely to evoke thoughts about health risks. Published by Elsevier Inc.

  20. The effects of natural cigarette claims on adolescents' brand-related beliefs, attitudes, and intentions.

    PubMed

    Kelly, Kathleen J; Manning, Kenneth

    2014-09-01

    The marketing of natural cigarettes has been widely criticized by consumer advocates and public policymakers. The present research is designed to inform the ongoing policy debate by examining the effects of natural cigarette claims on adolescents' brand impressions. The authors report the results of an experiment in which high school students viewed images of cigarette packages for three different brands. Findings indicate that including natural claims on cigarette packages can weaken beliefs that the cigarettes cause diseases. Results also reveal that skepticism toward marketing claims may play an important role in undermining brand attitudes and trial intentions toward cigarette brands promoted with natural claims. Policy implications and suggestions for further research are provided.

  1. An examination of the effectiveness of health warning labels on smokeless tobacco products in four states in India: findings from the TCP India cohort survey.

    PubMed

    Gravely, Shannon; Fong, Geoffrey T; Driezen, Pete; Xu, Steve; Quah, Anne C K; Sansone, Genevieve; Gupta, Prakash C; Pednekar, Mangesh S

    2016-12-13

    In 2009, after many delays and changes, India introduced a single pictorial health warning label (HWL) on smokeless tobacco (SLT) packing-a symbolic image of a scorpion covering 40% of the front surface. In 2011, the scorpion was replaced with 4 graphic images. This paper tested the effectiveness of SLT HWLs in India and whether the 2011 change from symbolic to graphic images increased their effectiveness. Data were from a cohort of 4733 adult SLT users (age15+) of the Tobacco Control Project (TCP) India Survey from 4 states. The surveys included key indicators of health warning effectiveness, including warning salience, and cognitive, emotional, and behavioral responses to the warnings. The HWL change from symbolic to graphic did not result in significant increases on any of the HWL outcome indicators. A substantial minority of SLT users were unaware that SLT packages contained HWLs (27% at both waves). Noticing the warnings was also remarkably low at both waves (W1 = 34.3%, W2 = 28.1%). These effects carried over to the cognitive and behavioural measures, where among those who noticed HWLs, about one-third reported forgoing SLT at least once because of the HWLs, and fewer than 20% reported that HWLs made them think about SLT risks or about quitting SLT. Even fewer reported avoiding HWLs (8.1 to 11.6%). Among those who quit using SLT by post-policy, awareness that SLT packaging contained HWLs was significantly greater at post-policy (86.8%) compared to pre-policy (77.8%, p = 0.02). Quitters were also significantly more aware of the post-policy HWLs compared to those who continued to use SLT (p < 0.001). Health warnings on SLT packages in India are low in effectiveness, and the change from the symbolic warning (pre-policy) to graphic HWLs (post-policy) did not lead to significant increases of effectiveness on any of the HWL indicators among those who continued to use SLT products, thus suggesting that changing an image alone is not enough to have an

  2. Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey.

    PubMed

    Chiosi, John J; Andes, Linda; Asma, Samira; Palipudi, Krishna; McAfee, Tim

    2016-07-01

    Knowledge about the harms of tobacco use deters initiation and is associated with cessation. Most studies on this knowledge in the general population have been in high-income countries, but the tobacco use burden is increasing in low-income and middle-income countries. We sought to estimate levels of knowledge about tobacco-related diseases in 22 countries and determine the factors associated with differences in knowledge. We used data from the Global Adult Tobacco Survey (GATS), a nationally representative survey of persons aged ≥15 years. GATSs were conducted from 2008 to 2013 in 22 low-income and middle-income countries. Information was gathered on tobacco-related knowledge and noticing of antismoking mass media messages and health warning labels on cigarette packages. We constructed a four-point knowledge scale and performed multivariate regression analyses. Median country values for the proportion of adults who believed smoking causes a specific illness were 95.9% for lung cancer, 82.5% for heart attack and 74.0% for stroke. Knowledge scores ranged from 2.1 to 3.8. In multivariate regressions, adults scored significantly higher on the knowledge scale if they noticed antismoking media messages (22 countries) or health warning labels (17 countries). Significantly higher knowledge scores occurred in all 9 countries with pictorial health warning labels compared with only 8 out of 13 countries with text-only warning labels. Antismoking media messages appear effective for warning the public about the harms from tobacco use in all 22 countries, while warning labels are effective in the majority of these countries. Our findings suggest opportunities to motivate smoking cessation globally. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Warning Signs After Birth

    MedlinePlus

    ... Home > Pregnancy > Postpartum care > Warning signs after birth Warning signs after birth E-mail to a friend ... breast infection Postpartum bleeding Postpartum depression (PPD) What warning signs should you look for? Call your provider ...

  4. Single Cigarette Sales: State Differences in FDA Advertising and Labeling Violations, 2014, United States.

    PubMed

    Baker, Hannah M; Lee, Joseph G L; Ranney, Leah M; Goldstein, Adam O

    2016-02-01

    Single cigarettes, which are sold without warning labels and often evade taxes, can serve as a gateway for youth smoking. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration (FDA) authority to regulate the manufacture, distribution, and marketing of tobacco products, including prohibiting the sale of single cigarettes. To enforce these regulations, the FDA conducted over 335,661 inspections between 2010 and September 30, 2014, and allocated over $115 million toward state inspections contracts. To examine differences in single cigarette violations across states and determine if likely correlates of single cigarette sales predict single cigarette violations at the state level. Cross-sectional study of publicly available FDA warning letters from January 1 to July 31, 2014. All 50 states and the District of Columbia. Tobacco retailer inspections conducted by FDA (n = 33 543). State cigarette tax, youth smoking prevalence, poverty, and tobacco production. State proportion of FDA warning letters issued for single cigarette violations. There are striking differences in the number of single cigarette violations found by state, with 38 states producing no warning letters for selling single cigarettes even as state policymakers developed legislation to address retailer sales of single cigarettes. The state proportion of warning letters issued for single cigarettes is not predicted by state cigarette tax, youth smoking, poverty, or tobacco production, P = .12. Substantial, unexplained variation exists in violations of single cigarette sales among states. These data suggest the possibility of differences in implementation of FDA inspections and the need for stronger quality monitoring processes across states implementing FDA inspections. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Mobilizing for policy: using community-based participatory research to impose minimum packaging requirements on small cigars.

    PubMed

    Milam, Adam J; Bone, Lee; Furr-Holden, Debra; Coylewright, Megan; Dachille, Kathleen; Owings, Kerry; Clay, Eric; Holmes, William; Lambropoulos, Soula; Stillman, Frances

    2012-01-01

    Cigarette sales have declined in the United States over the past decade; however, small cigar sales have been rapidly increasing. In most urban areas, small cigars are inexpensive and are sold as singles without health warnings. This paper describes a community- academic-practice partnership's (CAPP) efforts to decrease small cigar use in young adults living in Baltimore, Maryland, through legislative strategies. Survey data among young adults not in school indicated that 20% of individuals reported current small cigar use, often in combination with cigarettes. The community- academic partnership engaged the community in discussion about small cigar use in the fall of 2007. In collaboration with partners, bills were submitted to the legislative bodies for the city and state to impose minimum packaging requirements on small cigars. Collaborative partnerships between community-based organizations, public health agencies, and academic institutions can lead to policy initiatives with the potential to improve public health.

  6. Regulations and policies regarding e-cigarettes.

    PubMed

    Barraza, Leila F; Weidenaar, Kim E; Cook, Livia T; Logue, Andrea R; Halpern, Michael T

    2017-08-15

    Electronic cigarettes (e-cigarettes) are a growing public health concern because of a dramatic increase in use by adolescents and the uncertainty of potential health impacts. These health concerns and lack of an established federal regulatory scheme have led many local and state governments to address the regulatory void for e-cigarettes by incorporating them into the statutory definition of tobacco or by passing laws specific to the use of e-cigarettes. In August 2016, the US Food and Drug Administration issued a final rule deeming e-cigarettes within their authority; providing uniform requirements like premarket approval applications, Harmful and Potentially Harmful Constituents reporting, and warning labels; and establishing 18 years as a minimum age of purchase. Although the impact on the public's health remains uncertain, regulations and laws governing e-cigarettes continue to develop. This review highlights the available data regarding safety and public health impacts of e-cigarettes and details the status of US regulations and policies affecting their sale and use. Cancer 2017;123:3007-14. © 2017 American Cancer Society. © 2017 American Cancer Society.

  7. An evaluation of the FDA's analysis of the costs and benefits of the graphic warning label regulation

    PubMed Central

    Chaloupka, Frank J; Warner, Kenneth E; Acemoğlu, Daron; Gruber, Jonathan; Laux, Fritz; Max, Wendy; Newhouse, Joseph; Schelling, Thomas; Sindelar, Jody

    2015-01-01

    The Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration (FDA) regulatory authority over cigarettes and smokeless tobacco products and authorised it to assert jurisdiction over other tobacco products. As with other Federal agencies, FDA is required to assess the costs and benefits of its significant regulatory actions. To date, FDA has issued economic impact analyses of one proposed and one final rule requiring graphic warning labels (GWLs) on cigarette packaging and, most recently, of a proposed rule that would assert FDA’s authority over tobacco products other than cigarettes and smokeless tobacco. Given the controversy over the FDA's approach to assessing net economic benefits in its proposed and final rules on GWLs and the importance of having economic impact analyses prepared in accordance with sound economic analysis, a group of prominent economists met in early 2014 to review that approach and, where indicated, to offer suggestions for an improved analysis. We concluded that the analysis of the impact of GWLs on smoking substantially underestimated the benefits and overestimated the costs, leading the FDA to substantially underestimate the net benefits of the GWLs. We hope that the FDA will find our evaluation useful in subsequent analyses, not only of GWLs but also of other regulations regarding tobacco products. Most of what we discuss applies to all instances of evaluating the costs and benefits of tobacco product regulation and, we believe, should be considered in FDA's future analyses of proposed rules. PMID:25550419

  8. 27 CFR 45.45 - Notice for cigarettes.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for...

  9. 27 CFR 45.45 - Notice for cigarettes.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for...

  10. 27 CFR 45.45 - Notice for cigarettes.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for...

  11. Higher cigarette prices influence cigarette purchase patterns

    PubMed Central

    Hyland, A; Bauer, J; Li, Q; Abrams, S; Higbee, C; Peppone, L; Cummings, K

    2005-01-01

    Objective: To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Background: Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Methods: Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. Results: 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Conclusion: Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts. PMID:15791017

  12. Higher cigarette prices influence cigarette purchase patterns.

    PubMed

    Hyland, A; Bauer, J E; Li, Q; Abrams, S M; Higbee, C; Peppone, L; Cummings, K M

    2005-04-01

    To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.

  13. E-cigarettes: Considerations for the otolaryngologist.

    PubMed

    Biyani, Sneh; Derkay, Craig S

    2015-08-01

    To review the literature regarding electronic cigarettes and discuss potential implications and need for advocacy for the pediatric otolaryngologist. Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine-containing vapors via inhalation. Research on the health related consequences of e-cigarettes is ongoing and safety has yet to be established. E-cigarettes are not presently under the regulation of any national governing body with wide accessibility to minors. Use of these products has substantially increased since arrival to the market, particularly within the adolescent population. These products are marketed via various platforms including television, Internet and social media. Hundreds of flavors are offered and e-cigarettes are packaged in various colors. Not only are the ill health effects and addictive quality of nicotine concerning, these products have the potential to serve as a gateway for minors to tobacco use. The relationship between tobacco use, secondhand smoke exposure and otolaryngology specific diseases has well been defined. As use of electronic cigarettes increases, pediatric otolaryngologists should be aware of the ongoing literature regarding these products and to be prepared to counsel families accordingly. The use of e-cigarettes among teenagers, potential implications of secondhand vapor exposure from parents and friends, and concerns this may encourage adolescents to utilize conventional tobacco products needs to be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. 19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 1 2012-04-01 2012-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and...

  15. 19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 1 2014-04-01 2014-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and...

  16. 19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 1 2013-04-01 2013-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and...

  17. The electronic cigarette: a wolf in sheep's clothing.

    PubMed

    Neuberger, Manfred

    2015-05-01

    The American Heart Association warned from the potential of electronic cigarettes to renormalize smoking in public and the International Respiratory Societies demanded regulation of all nicotine products as medicines or tobacco products. This review summarizes the results of studies on hazards of e-cigarette use, which has increased dramatically and may be the real threat for the achievements in tobacco control of the past 20 years.

  18. Reactions to Graphic Health Warnings in the United States

    ERIC Educational Resources Information Center

    Nonnemaker, James M.; Choiniere, Conrad J.; Farrelly, Matthew C.; Kamyab, Kian; Davis, Kevin C.

    2015-01-01

    This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States. We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample: (i) current smokers aged 25 or older, (ii) young adult smokers aged 18-24…

  19. Reactions to Graphic Health Warnings in the United States

    ERIC Educational Resources Information Center

    Nonnemaker, James M.; Choiniere, Conrad J.; Farrelly, Matthew C.; Kamyab, Kian; Davis, Kevin C.

    2015-01-01

    This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States. We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample: (i) current smokers aged 25 or older, (ii) young adult smokers aged 18-24…

  20. Perceived effectiveness of graphic health warnings as a deterrent for smoking initiation among adolescents in selected schools in southwest Nigeria.

    PubMed

    Adebiyi, A O; Uchendu, O C; Bamgboye, E; Ibitoye, O; Omotola, B

    2016-01-01

    There has been a sustained increment in young people initiating smoking in low middle income countries like Nigeria. Health warnings on cigarette packages are a prominent source of health information and an effective means of communicating specific disease risks to adolescents and young adults alike. This study evaluated the perceived effectiveness of selected graphic warnings on smoking initiation amongst in-school adolescents. This was a cross-sectional study conducted amongst secondary school students aged 13-17years in Igbo-Ora, Nigeria. A two-stage sampling technique with the school classes as the final sampling unit was used to select the students. An interviewer assisted questionnaire was used to obtain information on students demographic characteristics and their perception of graphic warnings using four images from the pictorial health warning galleries of the World Health Organization showing: 'cigarette smoking causes cancer of the airways, harms children, causes stroke and causes impotence respectively'. A total of 544 senior secondary students were included in this study with a male female ratio of 0.8:1. Of those interviewed, 40 (7.4 %) indicated that they had ever considered smoking, nine (1.7 %) responded that they had ever smoked and two students indicated that they were current smokers. With all the images, fear was the dominant emotion expressed by the respondents. This was expressed by 307 (56.4), 215 (39.5), 203 (37.3) and 228 (41.9 %) respondents to images 1, 2, 3, and 4 respectively. Furthermore, 76.7, 44.7, 58.5 and 62.1 % of respondents felt Images 1, 2, 3 and 4 respectively will to a large extent prevent people from initiating smoking. There was no association between perceived effectiveness and gender. However, those younger than 15 years rated images on cancer of the airway and impotence as probably effective to a larger extent than did those who were 15 years and older (p = 0.032). Introduction of graphic health warnings

  1. Teens and E-cigarettes

    MedlinePlus

    ... Statistics » Infographics » Teens and E-cigarettes Teens and E-cigarettes Email Facebook Twitter Figure 1: Teens are more likely to use e-cigarettes than cigarettes. Past-month use of cigarettes was ...

  2. Warning systems and public warning response

    SciTech Connect

    Sorensen, J.H.

    1993-09-01

    This background paper reviews current knowledge on warning systems and human response to warnings. It expands on an earlier paper prepared for a workshop on the Second Assessment on Natural Hazards, held in Estes Park, Colorado in July 1992. Although it has a North American perspective, many of the lessons learned are universally applicable. The paper addresses warning systems in terms of dissemination and does not cover physical science issues associated with prediction and forecast. Finally, it covers hazards with relatively short lead times -- 48 hours or less. It does not address topics such as long-term forecasts of earthquakes or volcanic eruptions or early famine warning systems.

  3. A brief measure of reactance to health warnings.

    PubMed

    Hall, Marissa G; Sheeran, Paschal; Noar, Seth M; Ribisl, Kurt M; Boynton, Marcella H; Brewer, Noel T

    2017-01-24

    Reactance to persuasive messages involves perceived threat to freedom, anger, and counterarguing that may undermine the impact of health warnings. To understand reactance's effects, reliable and valid assessment is critical. We sought to develop and validate a brief Reactance to Health Warnings Scale (RHWS). Two independent samples of US adults completed the brief RHWS in studies that presented warnings on cigarette packs that smokers carried with them for 4 weeks (Study 1; n = 2149) or as digital images of cigarette packs that participants viewed briefly (Study 2; n = 1413). The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance and exposure to pictorial warnings, supporting its convergent validity. With respect to predictive validity, the Brief RHWS predicted perceived message effectiveness, quit intentions, avoidance of the warnings, and number of cigarettes smoked per day. The Brief RHWS can serve as an efficient adjunct to the development of persuasive messages.

  4. Gender, depressive symptoms, and daily cigarette use.

    PubMed

    Bares, Cristina B

    2014-01-01

    and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific to females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms.

  5. Gender, Depressive Symptoms and Daily Cigarette Use

    PubMed Central

    Bares, Cristina B.

    2014-01-01

    follows similar patterns for males and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific for females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms. PMID:25391276

  6. Wind gust warning verification

    NASA Astrophysics Data System (ADS)

    Primo, Cristina

    2016-07-01

    Operational meteorological centres around the world increasingly include warnings as one of their regular forecast products. Warnings are issued to warn the public about extreme weather situations that might occur leading to damages and losses. In forecasting these extreme events, meteorological centres help their potential users in preventing the damage or losses they might suffer. However, verifying these warnings requires specific methods. This is due not only to the fact that they happen rarely, but also because a new temporal dimension is added when defining a warning, namely the time window of the forecasted event. This paper analyses the issues that might appear when dealing with warning verification. It also proposes some new verification approaches that can be applied to wind warnings. These new techniques are later applied to a real life example, the verification of wind gust warnings at the German Meteorological Centre ("Deutscher Wetterdienst"). Finally, the results obtained from the latter are discussed.

  7. Warning Signs of Bullying

    MedlinePlus

    ... to talk to kids about bullying. Respond to Bullying Learn how to respond to bullying . From stopping ... Text Size: A A A Warning Signs for Bullying There are many warning signs that may indicate ...

  8. Analysis of Polish internet retail sites offering electronic cigarettes.

    PubMed

    Zarobkiewicz, Michał Konrad; Woźniakowski, Mateusz Mariusz; Sławiński, Mirosław Aleksander; Samborski, Patryk Michał; Wawryk-Gawda, Ewelina; Jodłowska-Jędrych, Barbara

    Electronic cigarettes as possibly healthier alternative to conventional cigarettes are gaining popularity worldwide, although they are still hazardous to human health. Partly it is caused by unregulated advertising and online sales. Unfortunately it is more and more popular for youth to try electronic cigarettes. The aim of the study was to assess the marketing claims used by Polish websites offering electronic cigarettes. A search using Google search engine was performed in July 2015 for two keywords: e-papierosy [e-cigarettes] and elektroniczne papierosy [electronic cigarettes]. First 150 websites (15 pages) were listed. After initial review 86 pages met all inclusion criteria and were included in the study. Pages were searched for presence of 13 selected marketing claims as well as age-related warning and any social websites connections. Age-related warning was present on only 33.72% (n=29) websites. Two thirds has its own Facebook fan-page with average 1922.09 ± 3634.86 likes. Articles about health are available on 10.46% (n=9) websites, 53.49% (n=46) states that e-cigarettes are healthier than conventional ones, 39.53% (n=34) emphasized that during usage of e-cigarettes no tarry substances are produced. Two pages had special article in which conventional and electronic cigarettes were compared. Almost half (44.19%) remarked that e-cigarettes are cheaper in usage than conventional, one third pointed out the simplicity of usage. 32.56% advertised e-cigarettes as aid in quitting smoking. One fourth stated that e-cigarettes are harmless for surroundings. 33.72% marketed them as a way of bypassing public smoking act. 56.98% remarked the variety of liquid tastes offered. Electronic cigarettes and their rising popularity create another new possible threat for public health as the widely available information emphasize safety of e-cigarettes usage and as their availability and usage is not limited or restricted by law. electronic cigarettes, e-cigarettes, internet

  9. Young adult smokers' perceptions of plain packaging: a pilot naturalistic study.

    PubMed

    Moodie, Crawford; Mackintosh, Anne Marie; Hastings, Gerard; Ford, Allison

    2011-09-01

    To explore the impact, if any, that using plain (non-branded) cigarette packs in real-life settings has on young adult smokers. Naturalistic-type research was employed, where smokers used brown 'plain' packs for 2 weeks and their regular packs for 2 weeks, in real-life settings. Participants were recruited in Glasgow, Scotland. Of the 140 smokers aged 18-35 years who participated in the naturalistic study, 48 correctly completed and returned all questionnaires. Over the 4-week study period, participants completed a questionnaire twice a week assessing pack perceptions and feelings, feelings about smoking, salience of health warnings and smoking-related behaviours. A subsample of 18 participated in a post-study interview, which employed a semistructured topic guide to assess perceptions and experiences of using plain packs. Trends in the data show that in comparison with branded packaging, plain packaging increased negative perceptions and feelings about the pack and about smoking. Plain packaging also increased avoidant behaviour (hiding the pack, covering the pack), certain smoking cessation behaviours, such as smoking less around others and forgoing cigarettes, and thinking about quitting. Almost half (n=8) of those in the post-study interview, predominantly women (n=6), reported that the use of plain packs had either increased avoidant behaviour or reduced consumption. This pilot naturalistic study suggests that plain packaging could potentially help reduce tobacco consumption among some young adult smokers, and women in particular. Employing an innovative research methodology, the findings of this study are consistent with, and indeed support, past plain packaging research.

  10. The role of negative affect and message credibility in perceived effectiveness of smokeless tobacco health warning labels in Navi Mumbai, India and Dhaka, Bangladesh: A moderated-mediation analysis.

    PubMed

    Mutti-Packer, Seema; Reid, Jessica L; Thrasher, James F; Romer, Daniel; Fong, Geoffrey T; Gupta, Prakash C; Pednekar, Mangesh S; Nargis, Nigar; Hammond, David

    2017-10-01

    There is strong evidence showing that pictorial health warnings are more effective than text-only warnings. However, much of this evidence comes from high-income countries and is limited to cigarette packaging. Moreover, few studies have identified mechanisms that might explain the impact of warnings. The current study examined the potential mediating role of negative affect and the moderating influence of message credibility in perceived effectiveness of smokeless tobacco warnings in two low- and middle-income countries (LMICs). Field interviews were conducted in India and Bangladesh, with adult (19+ years) smokeless tobacco users (n=1053), and youth (16-18years) users (n=304) and non-users (n=687). Respondents were randomly assigned to view warnings in one of four conditions: (1) Text-only, (2) pictorial with symbolic imagery, (3) pictorial with graphic images of health effects, or (4) pictorial with personalized graphic images plus a personal testimonial. The findings provide support for the mediating influence of negative affect in perceived effectiveness, for adult and youth smokeless tobacco users who viewed pictorial warnings (vs. text-only), and graphic health warnings (vs. personal testimonials). Among adults, message credibility moderated the indirect effect; the association was stronger when credibility was high and weaker when it was low. Among youth users and non-users, message credibility did not moderate the indirect effect. Consistent with research from high-income countries, these findings highlight the importance of selecting imagery that will elicit negative emotional reactions and be perceived as credible. Differential effects among adults and youth highlight the importance of pre-testing images. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Perceptions of plain packaging among young adult roll-your-own smokers in France: a naturalistic approach.

    PubMed

    Gallopel-Morvan, Karine; Moodie, Crawford; Eker, Figen; Beguinot, Emmanuelle; Martinet, Yves

    2015-03-01

    We explored, for the first time, young adult roll-your-own smokers' response to using plain packaging in real-world settings. Naturalistic research was employed, where 133 French young adult smokers (18-25 years of age) used plain roll-your-own packs for 10 days; the plain packs they were provided with contained their usual brand of rolling tobacco and displayed the name of their usual brand. Participants were recruited in five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) and completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, brand attachment, product perceptions (eg, taste, quality, natural), feelings about smoking (satisfying, pleasurable), feelings when using the pack in front of others (embarrassment, image), warning response (credibility, awareness of risks) and smoking-related behaviour (eg, consumption, quitting). Compared to their own fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment and less positive feelings about smoking and feelings when using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like missing out on rolling a cigarette. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. The study suggests that the impacts of plain packaging for roll-your-own cigarette smokers are the same as for smokers of factory-made cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. 21 CFR 1141.1 - Scope.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... requirements for the display of health warnings on cigarette packages and in advertisements for cigarettes. FDA... part as it applies to the display of health warnings on a cigarette package if the package: (1... violation of this part as it applies to the display of health warnings in an advertisement for cigarettes...

  13. Positive impact of Australian ‘blindness’ tobacco warning labels: findings from the ITC four country survey

    PubMed Central

    Kennedy, Ryan David; Spafford, Marlee M; Behm, Ilan; Hammond, David; Fong, Geoffrey T; Borland, Ron

    2013-01-01

    Background Smokers with greater knowledge of the health effects of smoking are more likely to quit and remain abstinent. Australia has communicated the causal association of smoking and blindness since the late 1990s. In March 2007, Australia became the first country to include a pictorial warning label on cigarette packages with the message that smoking causes blindness. The current study tested the hypothesis that the introduction of this warning label increased smokers’ knowledge of this important health effect. Methods Six waves of the International Tobacco Control Four Country Survey were conducted, as a telephone survey of 17,472 adult smokers in Australia, Canada, United Kingdom and the United States, with three waves before and three waves after the blindness health warning was introduced in Australia. The survey measured adult smokers’ knowledge that smoking causes blindness. Results Australian smokers were significantly more likely to report that smoking causes blindness, compared to Canadian, UK and US smokers, where there were neither health campaigns nor health warnings labels about blindness. After the introduction of the blindness warning, Australian smokers were more likely than before the blindness warning to report that they know that smoking causes blindness (62 versus 49 per cent; OR = 1.68, 95% CI: 1.03, 2.76, p = 0.04). In Australia, smokers aged over 55 years were less likely than those aged 18 to 24 to report that smoking causes blindness (OR = 0.43; 95% CI: 0.29, 0.62, p < 0.001). Conclusion While more smokers report that smoking causes blindness in Australia compared to other countries, which have not had national social marketing campaigns, further gains in knowledge were found after pictorial warning labels were introduced in Australia. Findings suggest there is still a need to educate the public about the causal association of smoking and blindness. More education may be needed to redress the knowledge gap in older Australian

  14. Analysis of legal and scientific issues in court challenges to graphic tobacco warnings.

    PubMed

    Kraemer, John D; Baig, Sabeeh A

    2013-09-01

    Smoking is the leading preventable cause of death in the U.S., yet cigarette health warnings in the U.S. are among the weakest in the world. In 2011, the FDA issued regulations mandating that graphic warnings be displayed on every cigarette pack sold in the U.S. Almost immediately, the tobacco industry challenged the warnings on First Amendment grounds. In March 2013, the FDA withdrew the graphic warning mandate, choosing instead to pursue additional research and then issue requirements for a new set of warnings. These warnings almost certainly will be challenged by the tobacco industry. The current paper describes the legal standards that will be used to assess the warnings, and the empirical questions that must be answered in order to determine whether each standard has been met. The paper also identifies errors the FDA could make in choosing images to be evaluated that would cause the images to be unable to meet the standards, regardless of the scientific evidence the FDA can establish. To be on safest ground, the FDA should adopt images that depict factual health consequences of smoking and should avoid images that could be interpreted as opinions. The FDA will have a high likelihood of prevailing in legal challenges to the warnings if there is evidence demonstrating that graphic warnings are necessary to counter past industry deception or that graphic warnings affect smoking behavior better than textual warnings. Even without evidence of the impact of graphic warnings on behavior, strong evidence that they affect behavioral intent, and that intent predicts behavior, should be sufficient for the warnings to be upheld. Alternatively, evidence that graphic warnings lead to more accurate consumer assessment of smoking risks should also be sufficient. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Does Size Impact Attention and Recall of Graphic Health Warnings?

    PubMed

    Klein, Elizabeth G; Shoben, Abigail B; Krygowski, Sarah; Ferketich, Amy; Berman, Micah; Peters, Ellen; Rao, Unnava; Wewers, Mary Ellen

    2015-07-01

    To evaluate the attention paid to larger sizes of graphic health warnings (GHWs) embedded within cigarette advertisements so as to assess their impacts on rural smokers. Daily smokers (N = 298) were randomly assigned to view a cigarette advertisement with 3 conditions: 2 intervention conditions with GHW comprising 20% or 33% of the ad area, or a text-only control. Eye-tracking software measured attention in milliseconds. Binary outcome mediation was conducted. Intervention participants spent 24% of their time viewing the GHWs, compared to 10% for control (p < .01). The odds of GHW recall in the combined (20% and 33%) intervention group were 3.3 times higher than controls. Total dwell time mediated 33% of the effect of the graphic condition on any recall. GHWs in 20% of cigarette advertisement space attracted significantly more attention than text-only warnings; larger GHWs did not increase attention. Attention was significantly associated with warning recall; total time viewing mediated warning recall. Tobacco ads should include GHWs to attract the attention of smokers.

  16. Does Size Impact Attention and Recall of Graphic Health Warnings?

    PubMed Central

    Klein, Elizabeth G.; Shoben, Abigail B.; Krygowski, Sarah; Ferketich, Amy; Berman, Micah; Peters, Ellen; Rao, Unnava; Wewers, Mary Ellen

    2015-01-01

    Objective To evaluate the attention paid to larger sizes of graphic health warnings (GHWs) embedded within cigarette advertisements so as to assess their impacts on rural smokers. Methods Daily smokers (N = 298) were randomly assigned to view a cigarette advertisement with 3 conditions: 2 intervention conditions with GHW comprising 20% or 33% of the ad area, or a text-only control. Eye-tracking software measured attention in milliseconds. Binary outcome mediation was conducted. Results Intervention participants spent 24% of their time viewing the GHWs, compared to 10% for control (p < .01). The odds of GHW recall in the combined (20% and 33%) intervention group were 3.3 times higher than controls. Total dwell time mediated 33% of the effect of the graphic condition on any recall. Conclusions GHWs in 20% of cigarette advertisement space attracted significantly more attention than text-only warnings; larger GHWs did not increase attention. Attention was significantly associated with warning recall; total time viewing mediated warning recall. Tobacco ads should include GHWs to attract the attention of smokers. PMID:26550583

  17. DrugFacts: Electronic Cigarettes (e-Cigarettes)

    MedlinePlus

    ... Print Home » Publications » DrugFacts » Electronic Cigarettes (e-Cigarettes) Electronic Cigarettes (e-Cigarettes) Email Facebook Twitter Revised May 2016 ... by ©iStock.com/kitiara65/ http://istockpho.to/1SWVugO Electronic cigarettes (also called e-cigarettes or electronic nicotine delivery ...

  18. Examining the conspicuousness and prominence of two required warnings on OTC pain relievers

    PubMed Central

    Bix, Laura; Bello, Nora M.; Auras, Rafael; Ranger, Jon; Lapinski, Maria K.

    2009-01-01

    The labeling of over-the-counter (OTC) drugs is critical to their safe and effective use, and certain warnings are meant to be read at the point of purchase (POP). Examples include (i) warnings that alert consumers to the fact that the package is not child-resistant and (ii) warnings that alert consumers to potential product tampering. U.S. law mandates these warnings be “conspicuous” and “prominent” so that it is likely that consumers will read them before leaving the store. Our objective was to quantify the relative prominence and conspicuousness of these warnings. Sixty-one participants reviewed the packages of 5 commercially available analgesics to evaluate the prominence and conspicuousness of these warnings. Evaluated data included (i) the time spent examining the warnings compared with other areas of the label (using a bright pupil eye tracker), (ii) the ability to recall information from the OTCs viewed, and (iii) the legibility of the warnings relative to other elements of the labels (as measured by ASTM D7298-06). Eye-tracking data indicated that warnings were viewed by fewer participants and for less time than other elements of the packages. Recall and legibility data also indicated that the warning statements compared unfavorably with other elements of the labels tested. Evidence presented in this study suggests that 2 required warnings on 5 different OTCs are not prominent or conspicuous when compared with other elements of tested labels. PMID:19332798

  19. Driver Adaptive Warning Systems

    DTIC Science & Technology

    1998-03-01

    this threshold, an alarm is triggered. Since TLC based systems can have user defined thresholds, a warning can be given as early as desired. However, the...Driver Adaptive Warning Systems Thesis Proposal Parag H. Batavia CMU-RI-TR-98-07 The Robotics Institute Carnegie Mellon University Pittsburgh...control number. 1. REPORT DATE MAR 1998 2. REPORT TYPE 3. DATES COVERED 00-00-1998 to 00-00-1998 4. TITLE AND SUBTITLE Driver Adaptive Warning

  20. Exploring the e-cigarette e-commerce marketplace: Identifying Internet e-cigarette marketing characteristics and regulatory gaps.

    PubMed

    Mackey, Tim K; Miner, Angela; Cuomo, Raphael E

    2015-11-01

    The electronic cigarette (e-cigarette) market is maturing into a billion-dollar industry. Expansion includes new channels of access not sufficiently assessed, including Internet sales of e-cigarettes. This study identifies unique e-cigarette Internet vendor characteristics, including geographic location, promotional strategies, use of social networking, presence/absence of age verification, and consumer warning representation. We performed structured Internet search engine queries and used inclusion/exclusion criteria to identify e-cigarette vendors. We then conducted content analysis of characteristics of interest. Our examination yielded 57 e-cigarette Internet vendors including 54.4% (n=31) that sold exclusively online. The vast majority of websites (96.5%, n=55) were located in the U.S. Vendors used a variety of sales promotion strategies to market e-cigarettes including 70.2% (n=40) that used more than one social network service (SNS) and 42.1% (n=24) that used more than one promotional sales strategies. Most vendors (68.4%, n=39) displayed one or more health warnings on their website, but often displayed them in smaller font or in their terms and conditions. Additionally, 35.1% (n=20) of vendors did not have any detectable age verification process. E-cigarette Internet vendors are actively engaged in various promotional activities to increase the appeal and presence of their products online. In the absence of FDA regulations specific to the Internet, the e-cigarette e-commerce marketplace is likely to grow. This digital environment poses unique challenges requiring targeted policy-making including robust online age verification, monitoring of SNS marketing, and greater scrutiny of certain forms of marketing promotional practices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use.

    PubMed

    Barrington-Trimis, Jessica L; Berhane, Kiros; Unger, Jennifer B; Cruz, Tess Boley; Huh, Jimi; Leventhal, Adam M; Urman, Robert; Wang, Kejia; Howland, Steve; Gilreath, Tamika D; Chou, Chih-Ping; Pentz, Mary Ann; McConnell, Rob

    2015-08-01

    Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence. Information on e-cigarette and cigarette psychosocial factors (use and attitudes about use in the home and among friends) was collected from 11th- and 12th-grade participants in the Southern California Children's Health Study during the spring of 2014. Of 2084 participants, 499 (24.0%) had used an e-cigarette, including 200 (9.6%) current users (past 30 days); 390 participants (18.7%) had smoked a combustible cigarette, and 119 (5.7%) were current cigarette smokers. Cigarette and e-cigarette use were correlated. Nevertheless, 40.5% (n = 81) of current e-cigarette users had never smoked a cigarette. Psychosocial factors (home use of each product, friends' use of and positive attitudes toward e-cigarettes and cigarettes) and participant perception of the harm of e-cigarettes were strongly positively associated both with e-cigarette and cigarette use. Most youth who reported e-cigarette use had friends who used e-cigarettes, and almost half of current users reported that they did not believe there were health risks associated with e-cigarette use. Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use. Copyright © 2015 by the American Academy of Pediatrics.

  2. Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use

    PubMed Central

    Berhane, Kiros; Unger, Jennifer B.; Cruz, Tess Boley; Huh, Jimi; Leventhal, Adam M.; Urman, Robert; Wang, Kejia; Howland, Steve; Gilreath, Tamika D.; Chou, Chih-Ping; Pentz, Mary Ann; McConnell, Rob

    2015-01-01

    BACKGROUND: Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence. METHODS: Information on e-cigarette and cigarette psychosocial factors (use and attitudes about use in the home and among friends) was collected from 11th- and 12th-grade participants in the Southern California Children’s Health Study during the spring of 2014. RESULTS: Of 2084 participants, 499 (24.0%) had used an e-cigarette, including 200 (9.6%) current users (past 30 days); 390 participants (18.7%) had smoked a combustible cigarette, and 119 (5.7%) were current cigarette smokers. Cigarette and e-cigarette use were correlated. Nevertheless, 40.5% (n = 81) of current e-cigarette users had never smoked a cigarette. Psychosocial factors (home use of each product, friends’ use of and positive attitudes toward e-cigarettes and cigarettes) and participant perception of the harm of e-cigarettes were strongly positively associated both with e-cigarette and cigarette use. Most youth who reported e-cigarette use had friends who used e-cigarettes, and almost half of current users reported that they did not believe there were health risks associated with e-cigarette use. CONCLUSIONS: Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use. PMID:26216326

  3. Reactions to graphic health warnings in the United States.

    PubMed

    Nonnemaker, James M; Choiniere, Conrad J; Farrelly, Matthew C; Kamyab, Kian; Davis, Kevin C

    2015-02-01

    This study reports consumer reactions to the graphic health warnings selected by the Food and Drug Administration to be placed on cigarette packs in the United States. We recruited three sets of respondents for an experimental study from a national opt-in e-mail list sample: (i) current smokers aged 25 or older, (ii) young adult smokers aged 18-24 and (iii) youth aged 13-17 who are current smokers or who may be susceptible to initiation of smoking. Participants were randomly assigned to be exposed to a pack of cigarettes with one of nine graphic health warnings or with a text-only warning statement. All three age groups had overall strong negative emotional (ß = 4.7, P < 0.001 for adults; ß = 4.6, P < 0.001 for young adults and ß = 4.0, P < 0.001 for youth) and cognitive (ß = 2.4, P < 0.001 for adults; ß = 3.0, P < 0.001 for young adults and ß = 4.6, P < 0.001 for youth) reactions to the proposed labels. The strong negative emotional and cognitive reactions following a single exposure to the graphic health warnings suggest that, with repeated exposures over time, graphic health warnings may influence smokers' beliefs, intentions and behaviors. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  4. RADAR WARNING SYSTEM,

    DTIC Science & Technology

    RADAR TRACKING, *AIRCRAFT DEFENSE SYSTEMS, RADAR EQUIPMENT, AIR TO AIR, SEARCH RADAR, GUIDED MISSILES, HIGH SPEED BOMBING, EARLY WARNING SYSTEMS, FIRE CONTROL SYSTEM COMPONENTS, AIRCRAFT, TIME, CHINA.

  5. What's in a Cigarette?

    MedlinePlus

    ... Toluene - used to manufacture paint What's in an e-cigarette? Get the facts about nicotine, flavorings, colorings and other chemicals found in e-cigarettes. Find out more » Learn about the American Lung ...

  6. Cigars, Cigarettes, and Adolescents

    ERIC Educational Resources Information Center

    Brooks, Ashley; Larkin, Elizabeth M. Gaier; Kishore, Sonal; Frank, Scott

    2008-01-01

    Objective: To examine public health implications of adolescent use of cigars only, cigarettes only, and both cigarettes and cigars. Methods: A cross-sectional health risk survey was administered to a random sample of 4486 high school students in a Midwestern county. Results: More adolescents reported using both cigarettes and cigars (10.6%) than…

  7. Cigars, Cigarettes, and Adolescents

    ERIC Educational Resources Information Center

    Brooks, Ashley; Larkin, Elizabeth M. Gaier; Kishore, Sonal; Frank, Scott

    2008-01-01

    Objective: To examine public health implications of adolescent use of cigars only, cigarettes only, and both cigarettes and cigars. Methods: A cross-sectional health risk survey was administered to a random sample of 4486 high school students in a Midwestern county. Results: More adolescents reported using both cigarettes and cigars (10.6%) than…

  8. Electronic Cigarette Sales to Minors via the Internet

    PubMed Central

    Williams, Rebecca S.; Derrick, Jason; Ribisl, Kurt M.

    2015-01-01

    Importance Electronic cigarettes (e-cigarettes) entered the US market in 2007 and, with little regulatory oversight, grew into a $2-billion-a-year industry by 2013. The Centers for Disease Control and Prevention has reported a trend of increasing e-cigarette use among teens, with use rates doubling from 2011 to 2012. While several studies have documented that teens can and do buy cigarettes online, to our knowledge, no studies have yet examined age verification among Internet tobacco vendors selling e-cigarettes. Objective To estimate the extent to which minors can successfully purchase e-cigarettes online and assess compliance with North Carolina's 2013 e-cigarette age-verification law. Design, Setting, and Participants In this cross-sectional study conducted from February 2014 to June 2014, 11 nonsmoking minors aged 14 to 17 years made supervised e-cigarette purchase attempts from 98 Internet e-cigarette vendors. Purchase attempts were made at the University of North Carolina Internet Tobacco Vendors Study project offices using credit cards. Main Outcome and Measure Rate at which minors can successfully purchase e-cigarettes on the Internet. Results Minors successfully received deliveries of e-cigarettes from 76.5% of purchase attempts, with no attempts by delivery companies to verify their ages at delivery and 95% of delivered orders simply left at the door. All delivered packages came from shipping companies that, according to company policy or federal regulation, do not ship cigarettes to consumers. Of the total orders, 18 failed for reasons unrelated to age verification. Only 5 of the remaining 80 youth purchase attempts were rejected owing to age verification, resulting in a youth buy rate of 93.7%. None of the vendors complied with North Carolina's e-cigarette age-verification law. Conclusions and Relevance Minors are easily able to purchase e-cigarettes from the Internet because of an absence of age-verification measures used by Internet e-cigarette

  9. Electronic cigarette sales to minors via the internet.

    PubMed

    Williams, Rebecca S; Derrick, Jason; Ribisl, Kurt M

    2015-03-01

    Electronic cigarettes (e-cigarettes) entered the US market in 2007 and, with little regulatory oversight, grew into a $2-billion-a-year industry by 2013. The Centers for Disease Control and Prevention has reported a trend of increasing e-cigarette use among teens, with use rates doubling from 2011 to 2012. While several studies have documented that teens can and do buy cigarettes online, to our knowledge, no studies have yet examined age verification among Internet tobacco vendors selling e-cigarettes. To estimate the extent to which minors can successfully purchase e-cigarettes online and assess compliance with North Carolina's 2013 e-cigarette age-verification law. In this cross-sectional study conducted from February 2014 to June 2014, 11 nonsmoking minors aged 14 to 17 years made supervised e-cigarette purchase attempts from 98 Internet e-cigarette vendors. Purchase attempts were made at the University of North Carolina Internet Tobacco Vendors Study project offices using credit cards. Rate at which minors can successfully purchase e-cigarettes on the Internet. Minors successfully received deliveries of e-cigarettes from 76.5% of purchase attempts, with no attempts by delivery companies to verify their ages at delivery and 95% of delivered orders simply left at the door. All delivered packages came from shipping companies that, according to company policy or federal regulation, do not ship cigarettes to consumers. Of the total orders, 18 failed for reasons unrelated to age verification. Only 5 of the remaining 80 youth purchase attempts were rejected owing to age verification, resulting in a youth buy rate of 93.7%. None of the vendors complied with North Carolina's e-cigarette age-verification law. Minors are easily able to purchase e-cigarettes from the Internet because of an absence of age-verification measures used by Internet e-cigarette vendors. Federal law should require and enforce rigorous age verification for all e-cigarette sales as with the federal

  10. Airlock caution and warning system

    NASA Technical Reports Server (NTRS)

    Mayfield, W. J.; Cork, L. Z.; Malchow, R. G.; Hornback, G. L.

    1972-01-01

    Caution and warning system, used to monitor performance and warn of hazards or out-of-limit conditions on space vehicles, may have application to aircraft and railway transit systems. System consists of caution and warning subsystem and emergency subsystem.

  11. Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial.

    PubMed

    Evans, Abigail T; Peters, Ellen; Strasser, Andrew A; Emery, Lydia F; Sheerin, Kaitlin M; Romer, Daniel

    2015-01-01

    Observational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates, but field studies lack experimental control. Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a randomized clinical trial involving exposure to modified cigarette packs over a 4-week period. Theories of graphic-warning impact were tested by examining affect toward smoking, credibility of warning information, risk perceptions, quit intentions, warning label memory, and smoking risk knowledge. Adults who smoked between 5 and 40 cigarettes daily (N = 293; mean age = 33.7), did not have a contra-indicated medical condition, and did not intend to quit were recruited from Philadelphia, PA and Columbus, OH. Smokers were randomly assigned to receive their own brand of cigarettes for four weeks in one of three warning conditions: text only, graphic images plus text, or graphic images with elaborated text. Data from 244 participants who completed the trial were analyzed in structural-equation models. The presence of graphic images (compared to text-only) caused more negative affect toward smoking, a process that indirectly influenced risk perceptions and quit intentions (e.g., image->negative affect->risk perception->quit intention). Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings, a process that also indirectly affected risk perceptions and quit intentions (e.g., image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention). Unexpectedly, elaborated text reduced warning credibility. Finally, graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later. In the first naturalistic clinical trial conducted, graphic warning labels are more effective than text-only warnings in encouraging

  12. Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial

    PubMed Central

    Evans, Abigail T.; Peters, Ellen; Strasser, Andrew A.; Emery, Lydia F.; Sheerin, Kaitlin M.; Romer, Daniel

    2015-01-01

    Objective Observational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates, but field studies lack experimental control. Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a randomized clinical trial involving exposure to modified cigarette packs over a 4-week period. Theories of graphic-warning impact were tested by examining affect toward smoking, credibility of warning information, risk perceptions, quit intentions, warning label memory, and smoking risk knowledge. Methods Adults who smoked between 5 and 40 cigarettes daily (N = 293; mean age = 33.7), did not have a contra-indicated medical condition, and did not intend to quit were recruited from Philadelphia, PA and Columbus, OH. Smokers were randomly assigned to receive their own brand of cigarettes for four weeks in one of three warning conditions: text only, graphic images plus text, or graphic images with elaborated text. Results Data from 244 participants who completed the trial were analyzed in structural-equation models. The presence of graphic images (compared to text-only) caused more negative affect toward smoking, a process that indirectly influenced risk perceptions and quit intentions (e.g., image->negative affect->risk perception->quit intention). Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings, a process that also indirectly affected risk perceptions and quit intentions (e.g., image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention). Unexpectedly, elaborated text reduced warning credibility. Finally, graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later. Conclusions In the first naturalistic clinical trial conducted, graphic warning labels are more effective

  13. Timely Warning Update

    ERIC Educational Resources Information Center

    Stafford, Dolores

    2011-01-01

    A complaint received by the Department of Education alleged that Virginia Tech violated the "timely warning" requirements of the Clery Act on April 16, 2007, by not issuing specific campus-wide alerts once senior officials knew of the immediate threat to health and safety. The complaint also alleged that the University's timely warning policy, as…

  14. Are current tobacco pictorial warnings in India effective?

    PubMed

    Oswal, Kunal C; Raute, Lalit J; Pednekar, Mangesh S; Gupta, Prakash C

    2011-01-01

    Warning labels on tobacco products provide an effective way of communicating the consequences of tobacco use. Research has shown that larger and colorful warnings placed on packaging are more effective for informing consumers and general public. However, primarily due to powerful lobbying by the industry, pictorial health warnings in India experienced constant delay in introduction and dilution of content. The current warnings appearing on tobacco products consist of drawing of a scorpion on smokeless forms of tobacco and pictures and X- rays of diseased lungs for smoking forms. To understand people's attitude towards the pictorial warning and their understanding of the pictures, a study was planned in two phases. The first phase was qualitative with focus group discussion and second, a population based survey for validating the findings. The findings of the study suggested that the mandated pictorial warnings do not serve the desired purpose since they are not properly understood. The scorpion becomes associated with the product in a non-scientific manner. X-rays of lung are hardly understood by anybody and pictures of diseased lungs are not used by tobacco manufacturers. The results of both the focus group discussions and the field survey indicate that most people have seen text and pictorial warnings on smokeless and smoking tobacco products, but that they lack relevance to the text messages. Irrespective of education the early proposed pictorial warnings by the government were more effective than the currently implemented warnings. People would like to see the warnings mainly in Hindi and Marathi (local language) and want them to be placed on the top or middle of both sides of tobacco packaging.

  15. Lack of pregnancy warnings on over-the-counter dermatologic products containing potentially harmful hydroquinone.

    PubMed

    Bio, L L; Cies, J J

    2017-07-01

    To determine the presence of pregnancy warnings on over-the-counter (OTC) dermatologic products with hydroquinone, a potentially harmful ingredient. Data were obtained from the Food and Drug Administration National Drug Code Directory and Label Repository to identify OTC dermatologic products containing hydroquinone. Products were stratified based on pregnancy or general warning presence (WP) or absence (WA). Product characteristics were compared between groups: hydroquinone concentration, presence of external packaging, indication and warning statements. Of the 112 products studied, 21 had a pregnancy warning and 3 included a general warning against use: WP (n=24) and WA (n=88) group. External packaging was more prevalent in the WP group compared to WA (62.5% vs 29.5%, P=0.004). Majority of OTC dermatologic products containing hydroquinone did not have a pregnancy warning. This highlights the need for improved labeling and informs providers caring for pregnant women of OTC labeling limitations.

  16. Mobilization Responses to Warning.

    DTIC Science & Technology

    1983-04-01

    reluctance by those leaders to authorized some form of response (political, economic or military) to counter early warning indicators. Strategic...MOBILIZATION RESPONSES TO WARNING Jil This document has been aIpproved L.A INDUSTRIAL COLLEGE OF THE ARMED FORCES 83 12 29 034 4 N;. -nou-n_. -Aa- f",1...48 BILIZATION RESPONSES TO WARNING MSP #46 AY 82/83 A ERFORMING :)S REPR’~ ’.,MSEP - 8.ZNRZ ~R~AN% MBEQ,’ GREGORY W. MASON, LTC, USA S ~ SI% R NAN1ZA

  17. Outdoor Warning Systems Guide

    DTIC Science & Technology

    1979-06-01

    Fig. 3, it is recommended I i | that the device carry a large sign advising bystanders to leave the immediate area when the warning device begins to...Bolt Beranek and Newman Inc. l-- AA 016 LEVEL I Report No. 4100 I I I Outdoor Warning Systems Guide (Approved and Cleared Final Report) I I Contract...2234E *5~**5 E~34*CAQ~E4. T IT L E (and " #,,h s, S. T Y P E O F’ R E PO ,,T & P E RIO D C O V E R E D OUTDOOR WARNING SYSTEMS GUIDE p FINAL

  18. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study.

    PubMed

    Wakefield, Melanie A; Hayes, Linda; Durkin, Sarah; Borland, Ron

    2013-01-01

    To determine whether smokers smoking from packs required under Australia's plain packaging law had different smoking beliefs and quitting thoughts, compared with those still smoking from branded packs. Cross-sectional survey during the roll-out phase of the law, analysed by timing of survey. Australian state of Victoria, November 2012. 536 cigarette smokers with a usual brand, of whom 72.3% were smoking from a plain pack and 27.7% were smoking from a branded pack. Perceived quality and satisfaction of cigarettes compared with 1 year ago, frequency of thoughts of smoking harm, perceived exaggeration of harms, frequency of thoughts of quitting, quitting priority in life, intention to quit, approval of large graphic health warnings and plain packaging. Compared with branded pack smokers, those smoking from plain packs perceived their cigarettes to be lower in quality (adjusted OR (AdjOR)=1.66, p=0.045), tended to perceive their cigarettes as less satisfying than a year ago (AdjOR=1.70, p=0.052), were more likely to have thought about quitting at least once a day in the past week (AdjOR=1.81, p=0.013) and to rate quitting as a higher priority in their lives (F=13.11, df=1, p<0.001). Plain pack smokers were more likely to support the policy than branded pack smokers (AdjOR=1.51, p=0.049). Branded and plain pack smokers did not differ on measures of less immediate smoking intentions, frequency of thoughts about harms or perceived exaggeration of harms. Appeal outcomes, but not other outcomes, were sensitive to the extent of roll-out, with responses from branded pack smokers approaching those of plain pack smokers, once 80% of survey respondents were smoking from plain packs 1-2 weeks before the December implementation date. The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers.

  19. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study

    PubMed Central

    Wakefield, Melanie A; Hayes, Linda; Durkin, Sarah; Borland, Ron

    2013-01-01

    Objective To determine whether smokers smoking from packs required under Australia's plain packaging law had different smoking beliefs and quitting thoughts, compared with those still smoking from branded packs. Design Cross-sectional survey during the roll-out phase of the law, analysed by timing of survey. Setting Australian state of Victoria, November 2012. Participants 536 cigarette smokers with a usual brand, of whom 72.3% were smoking from a plain pack and 27.7% were smoking from a branded pack. Primary outcome measures Perceived quality and satisfaction of cigarettes compared with 1 year ago, frequency of thoughts of smoking harm, perceived exaggeration of harms, frequency of thoughts of quitting, quitting priority in life, intention to quit, approval of large graphic health warnings and plain packaging. Results Compared with branded pack smokers, those smoking from plain packs perceived their cigarettes to be lower in quality (adjusted OR (AdjOR)=1.66, p=0.045), tended to perceive their cigarettes as less satisfying than a year ago (AdjOR=1.70, p=0.052), were more likely to have thought about quitting at least once a day in the past week (AdjOR=1.81, p=0.013) and to rate quitting as a higher priority in their lives (F=13.11, df=1, p<0.001). Plain pack smokers were more likely to support the policy than branded pack smokers (AdjOR=1.51, p=0.049). Branded and plain pack smokers did not differ on measures of less immediate smoking intentions, frequency of thoughts about harms or perceived exaggeration of harms. Appeal outcomes, but not other outcomes, were sensitive to the extent of roll-out, with responses from branded pack smokers approaching those of plain pack smokers, once 80% of survey respondents were smoking from plain packs 1–2 weeks before the December implementation date. Conclusions The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers

  20. The cigarette pack as image: new evidence from tobacco industry documents

    PubMed Central

    Wakefield, M; Morley, C; Horan, J; Cummings, K

    2002-01-01

    Methods: A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001. Results: Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and "satisfaction". Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women. Conclusions: Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be "safer". There is a need to consider regulation of cigarette packaging. PMID:11893817

  1. Perceptions of "Natural" and "Additive-Free" Cigarettes and Intentions to Purchase.

    PubMed

    O'Connor, Richard J; Lewis, M Jane; Adkison, Sarah E; Bansal-Travers, Maansi; Cummings, K Michael

    2017-04-01

    In August 2015, the Food and Drug Administration (FDA) issued warning letters to cigarette manufacturers promoting brands as "natural" or "additive-free" because of concerns that such marketing claims might mislead consumers into believing that these brands are less dangerous to smoke than others. The current study examined consumer beliefs about the relative harms of "natural" cigarettes, and whether these beliefs influenced perceptions of advertising and purchase intentions when participants were shown an advertisement for American Spirit cigarettes. Data were collected using a web-based survey conducted in 2013 among 3,006 U.S.-based web panel members aged 15 to 65 years. Ratings of "natural" cigarette health risks (i.e., misperceptions) differed by sex, race, education, smoking status, and age. Controlling for perceived risks of other cigarette types, never smokers ( B = -0.31, p < .001) and ever/former smokers ( B = -0.15, p = .002) had significantly fewer misperceptions of "natural" cigarettes than current smokers. Current smoking (odds ratio [OR] = 17.8), believing the ad was truthful (OR = 1.18), and having more misperceptions about "natural" cigarette health risks (OR = 1.13) were independently associated with greater purchase intention. Consumers perceived cigarettes marketed as "natural" or "additive-free" as less harmful, and this influenced their perceptions of advertising claims and intention to purchase, controlling for other factors. These findings underscore Food and Drug Administration's recent warning letters.

  2. Design and marketing features influencing choice of e-cigarettes and tobacco in the EU.

    PubMed

    Laverty, Anthony A; Vardavas, Constantine I; Filippidis, Filippos T

    2016-10-01

    Data were analysed from the 2014 Special Eurobarometer for Tobacco survey. We estimated self-rated importance of various factors in the choice of both tobacco and electronic cigarettes (e-cigarettes) among tobacco smokers who had ever used an e-cigarette. Among ever users of tobacco and e-cigarettes (N = 2430), taste (39.4%), price (39.2%) and amount of nicotine (27.3%) were the most commonly cited reasons for choosing their brand of e-cigarettes. Those aged 15-24 were more likely to cite external packaging [adjusted prevalence ratio (aPR = 2.06, 95% CI 1.00-4.23)] and design features (aPR = 1.99, 1.20-3.29) as important. As further legislation is debated and enacted enhanced regulation of price, design and marketing features of e-cigarettes may help to reduce the appeal of e-cigarettes.

  3. Design and marketing features influencing choice of e-cigarettes and tobacco in the EU

    PubMed Central

    Vardavas, Constantine I.; Filippidis, Filippos T.

    2016-01-01

    Data were analysed from the 2014 Special Eurobarometer for Tobacco survey. We estimated self-rated importance of various factors in the choice of both tobacco and electronic cigarettes (e-cigarettes) among tobacco smokers who had ever used an e-cigarette. Among ever users of tobacco and e-cigarettes (N = 2430), taste (39.4%), price (39.2%) and amount of nicotine (27.3%) were the most commonly cited reasons for choosing their brand of e-cigarettes. Those aged 15–24 were more likely to cite external packaging [adjusted prevalence ratio (aPR = 2.06, 95% CI 1.00–4.23)] and design features (aPR = 1.99, 1.20–3.29) as important. As further legislation is debated and enacted enhanced regulation of price, design and marketing features of e-cigarettes may help to reduce the appeal of e-cigarettes. PMID:27471217

  4. Electronic cigarette aerosol induces significantly less cytotoxicity than tobacco smoke.

    PubMed

    Azzopardi, David; Patel, Kharishma; Jaunky, Tomasz; Santopietro, Simone; Camacho, Oscar M; McAughey, John; Gaça, Marianna

    2016-07-01

    Electronic cigarettes (E-cigarettes) are a potential means of addressing the harm to public health caused by tobacco smoking by offering smokers a less harmful means of receiving nicotine. As e-cigarettes are a relatively new phenomenon, there are limited scientific data on the longer-term health effects of their use. This study describes a robust in vitro method for assessing the cytotoxic response of e-cigarette aerosols that can be effectively compared with conventional cigarette smoke. This was measured using the regulatory accepted Neutral Red Uptake assay modified for air-liquid interface (ALI) exposures. An exposure system, comprising a smoking machine, traditionally used for in vitro tobacco smoke exposure assessments, was adapted for use with e-cigarettes to expose human lung epithelial cells at the ALI. Dosimetric analysis methods using real-time quartz crystal microbalances for mass, and post-exposure chemical analysis for nicotine, were employed to detect/distinguish aerosol dilutions from a reference Kentucky 3R4F cigarette and two commercially available e-cigarettes (Vype eStick and ePen). ePen aerosol induced 97%, 94% and 70% less cytotoxicity than 3R4F cigarette smoke based on matched EC50 values at different dilutions (1:5 vs. 1:153 vol:vol), mass (52.1 vs. 3.1 μg/cm(2)) and nicotine (0.89 vs. 0.27 μg/cm(2)), respectively. Test doses where cigarette smoke and e-cigarette aerosol cytotoxicity were observed are comparable with calculated daily doses in consumers. Such experiments could form the basis of a larger package of work including chemical analyses, in vitro toxicology tests and clinical studies, to help assess the safety of current and next generation nicotine and tobacco products.

  5. Electronic cigarette aerosol induces significantly less cytotoxicity than tobacco smoke

    PubMed Central

    Azzopardi, David; Patel, Kharishma; Jaunky, Tomasz; Santopietro, Simone; Camacho, Oscar M.; McAughey, John; Gaça, Marianna

    2016-01-01

    Abstract Electronic cigarettes (E-cigarettes) are a potential means of addressing the harm to public health caused by tobacco smoking by offering smokers a less harmful means of receiving nicotine. As e-cigarettes are a relatively new phenomenon, there are limited scientific data on the longer-term health effects of their use. This study describes a robust in vitro method for assessing the cytotoxic response of e-cigarette aerosols that can be effectively compared with conve