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. 2016 Sep:164:118-129.
doi: 10.1016/j.socscimed.2016.06.011. Epub 2016 Jul 13.

The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies

Seth M Noar  1 , Diane B Francis  2 , Christy Bridges  3 , Jennah M Sontag  2 , Kurt M Ribisl  4 , Noel T Brewer  4
Affiliations

The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies

Seth M Noar et al. Soc Sci Med. 2016 Sep.

Abstract

Objectives: Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings.

Methods: We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior.

Results: We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies.

Conclusions: Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.

Keywords: Graphic; Observational; Pictorial; Smoking; Theory; Warning.

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Figures

Figure 1
Figure 1
PRISMA flow diagram showing the study screening process
Figure 2
Figure 2
Message impact framework showing outcomes assessed in the set of studies.
Figure 3
Figure 3
Knowledge about the health effects of smoking before and after implementation of strengthened warnings
Figure 4
Figure 4
Knowledge about novel health effects of smoking before and after implementation of strengthened warnings
Figure 5
Figure 5
Quit attempts before and after implementation of strengthened warnings
Figure 6
Figure 6
Smokingprevalence before and after implementation of strengthened warnings
See this image and copyright information in PMC

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