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

ABSTRACT: BACKGROUND: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. METHODS: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. RESULTS: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). CONCLUSIONS: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.

SUBMITTER: Tan ASL

PROVIDER: S-EPMC5693685 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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

Tan Andy S L ASL Bigman Cabral A CA Nagler Rebekah H RH Minsky Sara S Viswanath Kasisomayajula K

Cancer causes & control : CCC 20170902 10

<h4>Background</h4>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.<h4>Methods</h4>Data ...[more]

PMID: 28866791

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Project description:IntroductionThe social and health care costs of smoking are immense. To reduce these costs, several tobacco control policies have been introduced (eg, graphic health warnings [GHWs] on cigarette packs). Previous research has found plain packaging (a homogenized form of packaging), in comparison to branded packaging, effectively increases attention to GHWs using UK packaging prototypes. Past studies have also found that illness sensitivity (IS) protects against health-impairing behaviors. Building on this evidence, the goal of the current study was to assess the effect of packaging type (plain vs. branded), IS level, and their interaction on attention to GHWs on cigarette packages using proposed Canadian prototypes.Aims and methodsWe assessed the dwell time and fixations on the GHW component of 40 cigarette pack stimuli (20 branded; 20 plain). Stimuli were presented in random order to 50 smokers (60.8% male; mean age = 33.1; 92.2% daily smokers) using the EyeLink 1000 system. Participants were divided into low IS (n = 25) and high IS (n = 25) groups based on scores on the Illness Sensitivity Index.ResultsOverall, plain packaging relative to branded packaging increased fixations (but not dwell time) on GHWs. Moreover, low IS (but not high IS) smokers showed more fixations to GHWs on plain versus branded packages.ConclusionsThese findings demonstrate that plain packaging is a promising intervention for daily smokers, particularly those low in IS, and contribute evidence in support of impending implementation of plain packaging in Canada.ImplicationsOur findings have three important implications. First, our study provides controlled experimental evidence that plain packaging is a promising intervention for daily smokers. Second, the findings of this study contribute supportive evidence for the impending plain packaging policy in Canada, and can therefore aid in defense against anticipated challenges from the tobacco industry upon its implementation. Third, given its effects in increasing attention to GHWs, plain packaging is an intervention likely to provide smokers enhanced incentive for smoking cessation, particularly among those low in IS who may otherwise be less interested in seeking treatment for tobacco dependence.

Project description:IntroductionInnovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries.MethodsAn online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis.ResultsParticipants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75-4.25, p<0.001 and OR=2.85, 95% CI: 2.29-3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either 'agreed' or 'strongly agreed' to the use of cigarette-stick warnings.ConclusionsThe findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.

Project description:BACKGROUND:Graphic health warnings on tobacco packaging and the plain packaging of tobacco products are key tobacco control interventions. This systematic review investigates the perceptions of adolescents towards these packaging interventions. METHODS:Published, original-research, English-language articles from 1 January 2000 to 1 September 2017 were identified through a systematic literature search of the PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases. Articles describing investigations into the perceptions of adolescents aged 11 to 19?years towards graphic health warnings and/or plain-packaged cigarettes were included in this review. RESULTS:Nineteen articles, involving 15,935 adolescent participants, of which 72.85% were non-smokers or ex-smokers and 27.15% occasional or daily smokers, met the eligibility criteria. Graphic health warnings were perceived as more effective than text-only warnings, with warnings depicting lung cancer, and oral diseases being perceived as particularly effective. Health warnings increased viewer fear, anxiety, shock, and guilt and were considered effective in preventing non-smokers from experimenting with tobacco and prompting current smokers to quit. Plain packaging reduced the attractiveness and other positive attributes of cigarette packaging, with darker colours found to be the most effective. When used in combination, plain packaging increased the visibility of graphic health warnings, with participants also perceiving them as having an increased tar content and having more serious health risks, and increased thoughts of quitting amongst smokers. CONCLUSIONS:Graphic health warnings and plain packaging appear to increase adolescent awareness of the dangers of tobacco use. Further research into the most effective warnings to use in combination with plain packaging is needed to ensure the greatest reduction in tobacco use and prevent tobacco-attributable morbidity and mortality in this vulnerable population.

Project description:IntroductionCigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.MethodsNationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over 2 weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling.ResultsParticipants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = 0.21; bTeen = 0.27, p's < .004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -0.18; bTeen = -0.22, p's < .018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult = 0.66; bTeen = 0.85, p's < .001) and greater quit intentions among adults (bAdult = 1.00, p < .001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions.ConclusionWarning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions versus text-only warnings.ImplicationsThis research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and 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.

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

Publications

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

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