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Randomized Controlled Trial
. 2012 Dec;43(6):590-600.
doi: 10.1016/j.amepre.2012.08.025.

Cigarette warning label policy alternatives and smoking-related health disparities

James F Thrasher  1 , Matthew J Carpenter, Jeannette O Andrews, Kevin M Gray, Anthony J Alberg, Ashley Navarro, Daniela B Friedman, K Michael Cummings
Affiliations
Randomized Controlled Trial

Cigarette warning label policy alternatives and smoking-related health disparities

James F Thrasher et al. Am J Prev Med. 2012 Dec.

Abstract

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.

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Figures

Figure 1
Figure 1
Ratings of pictorial health warning label image types by literacy level and race * interactions statistically significant (p<0.05) for graphic vs symbolic imagery by literacy level and by race (not for graphic vs. human suffering imagery).
See this image and copyright information in PMC

Comment in

  • Author response.
    Thrasher JF, Andrews JO, Friedman DB, Carpenter MJ, Gray KM, Cummings KM, Alberg AJ, Navarro A. Thrasher JF, et al. Am J Prev Med. 2013 May;44(5):e51-3. doi: 10.1016/j.amepre.2013.02.007. Am J Prev Med. 2013. PMID: 23597825 No abstract available.
  • Let's not further obscure the debate about fear appeal messages for smokers.
    de Bruin M, Peters GJ. de Bruin M, et al. Am J Prev Med. 2013 May;44(5):e51. doi: 10.1016/j.amepre.2013.02.006. Am J Prev Med. 2013. PMID: 23597826 No abstract available.

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