Enhancing the effectiveness of tobacco package warning labels: A social psychological perspective

Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
Tobacco Control (Impact Factor: 5.93). 10/2002; 11(3):183-90. DOI: 10.1136/tc.11.3.183
Source: PubMed


To outline social psychological principles that could influence the psychosocial and behavioural effects of tobacco warning labels, and to inform the development of more effective tobacco warning labels.
PsycInfo and Medline literature searches and expert guided selection of principles and theories in social psychology and of tobacco warning labels, including articles, books, and reports.
Tobacco warning labels represent a potentially effective method of influencing attitudes and behaviours. This review describes social psychological principles that could be used to guide the creation of more effective warning labels. The potential value of incorporating warning labels into a broader public health education campaign is discussed, and directions for future research are suggested.

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Available from: Leandre R Fabrigar
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    • "According to Article 11 of the WHO’s FCTC, health warning labels are trying to communicate the health risks associated with smoking to a range of subgroups. A challenge for developers is to create, in a single message, information that is valuable to diverse audiences, from the young non-smoker, to the occasional smoker, to the regular smoker looking towards cessation (Flynn et al. 2007; Strahan et al. 2002). In this study we observed the greatest understanding where the labels featured overt, direct consequences of smoking (Brazil and Pakistan). "
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    ABSTRACT: 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.
    Full-text · Article · Apr 2014 · Journal of Public Health
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    • "Warning labels on cigarette packs are recommended by the Framework Convention on Tobacco Control, are a requirement for EU countries, and are among the most direct and prominent means of communicating with smokers (Hammond, 2011). To increase the potential for effectiveness, warning labels should be prominent, placed on the largest surfaces of the packages, and be very distinct graphically from the rest of the package design (Strahan et al., 2002). Australia requires by law plain packaging of cigarettes, and India, New Zealand and the United Kingdom have all considered bills for plain packaging. "
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    ABSTRACT: Executive summary A core question for policy-makers will be the extent to which investments in preventive actions that address some of the social determinants of health represent an effi cient option to help promote and protect population health. Can they reduce the level of ill health in the population? How strong is the evidence base on their effectiveness and, from an economic perspective, how do they stack up against investment in the treatment of health problems? Are there potential gains to be made by reducing or delaying the need for the consumption of future health care resources? Will they limit some of the wider costs of poor health to society, such as absenteeism from work, poorer levels of educational attainment, higher rates of violence and crime and early retirement from the labour force due to sickness and disability? This policy summary provides an overview of what is known about the economic case for investing in a number of different areas of health promotion and non-communicable disease prevention. It focuses predominantly on addressing some of the risk factors for health: tobacco and alcohol consumption, impacts of dietary behaviour and patterns of physical activity, exposure to environmental harm, risks to mental health and well-being, as well as risks of injury on our roads. It highlights that there is an evidence base from controlled trials and welldesigned observational studies on the effectiveness of a wide range of health promotion and disease prevention interventions that address risk factors to health. Moreover, the cost–effectiveness of a number of health promotion and disease prevention interventions has been shown in multiple studies. Some of these interventions will be cost-saving, but most will generate additional health (and other) benefi ts for additional costs. In many cases combinations of actions, for example in the areas of tobacco, alcohol and road injury prevention, are often more cost-effective than relying on one action alone. In terms of individual actions the use of taxes to infl uence individual choices on the use of tobacco and alcohol, as well as the consumption of food, is consistently seen as a cost-effective intervention to promote better lifestyle choices. Media-based campaigns, in contrast, are not always effective or cost-effective. Interventions targeted at children often have the most potential to be cost-effective because of the longer time-frame over which health benefi ts can be realized. While some interventions may take several decades to be seen to be costeffective, for example impacts on the risk of obesity, there are some health promotion and disease prevention actions that are cost-effective in the short term, for instance related to the protection of mental health in the workplace. There are opportunities to invest in cost-effective health promoting interventions that can be delivered universally as well as to target population groups, for instance in schools or workplaces. However, this evidence base must be treated with caution, given that many interventions have only been assessed in a small number of settings, and different economic methods and assumptions are made in different studies. Most of the economic evidence identifi ed has been undertaken in highincome countries, with very few studies applied to other settings in the WHO European Region. Moreover, much of the evidence on the long-term costs and benefi ts of interventions has been estimated using simulation modelling approaches synthesizing data on effectiveness, epidemiology and costs. This refl ects the lack of long-term observed effectiveness data for many public health and health promoting interventions. It also means that policy-makers need to be cautious on assumptions made about the persistence of effect of health promoting interventions, for example the likelihood of long-term behaviour change. The issue of equity is also a particularly important consideration. If the uptake of a public health intervention is higher in more affl uent groups in society then one unintended consequence of investment in a public health programme could be to inadvertently widen health inequalities. We have little data from our review on the impact of interventions on health inequalities. Finally there are also challenges to be met to in order to help encourage the implementation of cost-effective health promotion and disease prevention actions. Notwithstanding these caveats, it is clear that there is an economics evidence base for health promotion and disease prevention. The challenge now is to strengthen this evidence base further and look at ways in which it may be used to translate evidence-based knowledge into routine everyday practice across all of the WHO European Region. For instance, given that these actions are often delivered outside of the health system it is helpful to speak the same language and highlight the economic benefi ts of most interest to the sectors that are responsible for funding each action.
    Full-text · Book · Dec 2013
    • "pairing healthy behaviours with smoking. This finding might be due to the health-related content of warning labels, which are supposed to enhance smoking-related risk perception and increase cognitive dissonance resulting from smoking (Strahan et al., 2002). However, our data imply that graphic warning labels were not as effective as suggested. "
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    ABSTRACT: Objectives Smokers might think that the negative effects of smoking can be compensated for by other behaviours, such as doing exercise or eating healthily. This phenomenon is known as compensatory health beliefs (CHBs). Graphic warning labels on cigarette packets emphasize the negative effects of smoking, which may impact CHBs. Research so far has assessed CHBs explicitly only via questionnaires, although implicit cognition might be an important factor in continuing to smoke. This study investigated the impact of graphic warning labels on CHBs, by testing CHBs both implicitly and explicitly. DesignThe study had a three-group experimental design. ANOVAs and multiple regression analyses were run on the results. Methods We assessed explicit CHBs among non-smokers, smokers, and smokers confronted with graphic warning labels (N=107; 47 females, 23.89years old, 78 daily smokers). Implicit associations between smoking and CHB-specific behaviours (e.g., eating healthy food) were measured using a Single-Target Implicit Association Test. After the experiment, participants were able to choose between a healthy and unhealthy food reward. ResultsNon-smokers and smokers differed in explicit CHBs but not in implicit cognitions. Warning labels influenced implicit associations among smokers but did not affect explicit CHBs. Most interestingly, implicit associations and explicit CHBs predicted food choice and smoking among smokers not confronted with warning labels. Conclusions Graphic warning labels could be used in interventions to inhibit automatic associations between smoking and healthy behaviours. Unlearning implicit cognitions might in turn affect explicit CHBs, thus decreasing their role in reducing the negative feelings caused by smoking.
    No preview · Article · Jan 2013 · British Journal of Health Psychology
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