Dataset Information

Effectiveness of Mental Health Warnings on Tobacco Packaging in People With and Without Common Mental Health Conditions: An Online Randomised Experiment

ABSTRACT:

Background

Health warning labels on tobacco packaging are a cost-effective means of health risk communication. However, while an extensive range of physical health risks are well-portrayed via current tobacco health warnings in the UK, there are none that currently portray the negative impact of smoking on mental health.

Aims

(i) develop novel mental health warning labels for tobacco packaging and (ii) test perceptions of these warnings in smokers and non-smokers, with and without mental health problems.

Methods

Six mental health warning labels were developed with a consultancy focus group. These warning labels were tested in an online randomised experiment, where respondents (N = 687) rated six Mental Health Warning Labels (MHWLs) and six Physical Health Warning Labels (PHWLs) on measures of perceived effectiveness, believability, arousal, valence, acceptability, reactance and novelty of information.

Results

MHWLs were perceived as low to moderately effective (mean = 4.02, SD = 2.40), but less effective than PHWLs (mean = 5.78, SD = 2.55, p < 0.001, ηp2 = 0.63). MHWLs were perceived as less believable, arousing, unpleasant, and acceptable than PHWLs. MHWLs evoked more reactance and were rated as more novel. Perceptions of MHWLs did not differ in people with and without mental health problems except for reactance and acceptability, but consistent with the PHWL literature, perceptions of MHWLs differed between non-smokers and smokers.

Conclusion

MHWLs could be an effective means to communicate novel information about the effects of smoking on mental health. MHWLs are perceived as less effective, believable, arousing, unpleasant, and acceptable than PHWLs, but MHWLs evoke more reactance and are rated as more novel.

SUBMITTER: Sawyer K

PROVIDER: S-EPMC9331922 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:IntroductionSince May 2017, all cigarettes and roll-your-own (RYO) tobacco in the United Kingdom must be sold in standardized packs with pictorial warnings displaying, for the first time, a stop-smoking website.Aims and methodsData come from three waves of a longitudinal online survey with smokers and ex-smokers conducted pre- and post-standardized packaging, with Wave 1 (W1) in April-May 2016, Wave 2 (W2) in September-November 2017, and Wave 3 (W3) in May-July 2019. Only smokers are included in the analysis: W1 (N = 6233), W2 (N = 3629), and W3 (N = 2412). We explored any change in citing warnings on packs as a source of information about a stop-smoking website, and whether citing warnings as a source was associated with use of a stop-smoking website. As the warnings, and therefore the stop-smoking website, are larger on RYO packs than on cigarette packs due to the larger pack size, we explored differences in awareness of a stop-smoking website among exclusive cigarette smokers (W1 = 3142, W2 = 1884, W3 = 1247) and exclusive RYO smokers (W1 = 2046, W2 = 1119, W3 = 814).ResultsAmong smokers recalling seeing information about a stop-smoking website, citing warnings as a source increased between waves (W1 = 14.0%, W2 = 24.2%, W3 = 25.1%) and was associated with having visited a stop-smoking website (odds ratio = 11.81, 95% confidence interval 8.47-16.46). Citing warnings as a source of a stop-smoking website increased among exclusive RYO smokers at each wave (W1 = 15.5%, W2 = 26.3%, W3 = 32.1%), while for exclusive cigarette smokers it only increased at W2 (W1 = 10.5%, W2 = 22.4%, W3 = 19.9%).ConclusionsWarnings are an important source of cessation resource information. Making this information more prominent may help sustain awareness.ImplicationsThe findings support the inclusion of a stop-smoking website on warnings as awareness among smokers increased and citing warnings as a source of information about a stop-smoking website was associated with having visited a stop-smoking website. We also explored whether the stop-smoking website on warnings on RYO packs, which is larger than on cigarette packs as a function of the larger size of RYO packs, would have any impact on awareness of this information. That exclusive RYO smokers were more likely than exclusive cigarette smokers to notice a stop-smoking website on warnings suggests that this information should be more prominent.

Project description:IntroductionWaterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging.Aims and methodsUsing data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014-October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March-April 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package.ResultsOver half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor "natural" (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including "fresh," "premium," "quality," and "pure." All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were "well-made" (57%), "enjoyable" (55%), and "patriotic" (47%).ConclusionsProhibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm.ImplicationsTobacco packaging is used to convey health-related messages, both explicitly and implicitly; however, information about WT packaging is virtually nonexistent. We conducted a content analysis of WT packaging from the 10 most popular US brands. Over half (54%) of packages had prohibited MRTP claims and over a quarter (26%) included one or more descriptors that may be perceived as implying reduced harm. Use of imagery, including smoking cues, was common. The widespread use of prohibited MRTP claims, other descriptors, and imagery on WT packaging may contribute to misperceptions of reduced harm.