Sven Schneider1, Michael Gadinger, Andreas Fischer. 1. Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical School, Heidelberg University, Mannheim, Germany. Teresa.Pawlikowska@warwick.ac.uk
Abstract
OBJECTIVE: Placing a combination of a written warning and a graphic image on cigarette packaging (so called "pictorial warnings") is one of the WHO Framework Convention on Tobacco Control's most controversial recommendations. Our randomized controlled trial investigated if pictorial warnings lead to significantly higher motivation to quit, as compared to written warnings alone. METHODS: Four pictorial warnings were selected from the EU Commission's official image catalogue. Study arm 1 (44 adult smokers) viewed only the written warnings while study arm 2 (44 adult smokers) viewed the corresponding pictorial warnings. Self-affirmation was a second randomly manipulated factor, and nicotine dependence a quasi-experimental third factor. The main outcome measured was the motivation to quit, with fear intensity as one of the secondary outcomes. RESULTS: Pictorial warnings were associated with a significantly higher motivation to quit. A pictorial warning was also associated with higher fear intensity. The effect of warnings appears to be independent of nicotine dependence and self-affirmation. CONCLUSIONS: Nationwide implementation of pictorial warnings may be effective in increasing heavy smokers' motivation to quit. PRACTICE IMPLICATION: Due to the fact that perceived vulnerability, response and self-efficacy are not more strongly affected by pictorial warnings this effect may turn out to be short-term.
RCT Entities:
OBJECTIVE: Placing a combination of a written warning and a graphic image on cigarette packaging (so called "pictorial warnings") is one of the WHO Framework Convention on Tobacco Control's most controversial recommendations. Our randomized controlled trial investigated if pictorial warnings lead to significantly higher motivation to quit, as compared to written warnings alone. METHODS: Four pictorial warnings were selected from the EU Commission's official image catalogue. Study arm 1 (44 adult smokers) viewed only the written warnings while study arm 2 (44 adult smokers) viewed the corresponding pictorial warnings. Self-affirmation was a second randomly manipulated factor, and nicotine dependence a quasi-experimental third factor. The main outcome measured was the motivation to quit, with fear intensity as one of the secondary outcomes. RESULTS: Pictorial warnings were associated with a significantly higher motivation to quit. A pictorial warning was also associated with higher fear intensity. The effect of warnings appears to be independent of nicotine dependence and self-affirmation. CONCLUSIONS: Nationwide implementation of pictorial warnings may be effective in increasing heavy smokers' motivation to quit. PRACTICE IMPLICATION: Due to the fact that perceived vulnerability, response and self-efficacy are not more strongly affected by pictorial warnings this effect may turn out to be short-term.
Authors: Letícia Silva Cardoso; Fernanda Neves Estrela; Thales Quintão Chagas; Wellington Alves Mizael da Silva; Denys Ribeiro de Oliveira Costa; Igor Pereira; Boniek Gontijo Vaz; Aline Sueli de Lima Rodrigues; Guilherme Malafaia Journal: Environ Sci Pollut Res Int Date: 2018-01-09 Impact factor: 4.223
Authors: An-Li Wang; Zhenhao Shi; Victoria P Fairchild; Catherine A Aronowitz; Daniel D Langleben Journal: Eur J Public Health Date: 2019-02-01 Impact factor: 3.367
Authors: David Hammond; Jessica L Reid; Pete Driezen; James F Thrasher; Prakash C Gupta; Nigar Nargis; Qiang Li; Jiang Yuan; Christian Boudreau; Geoffrey T Fong; K Michael Cummings; Ron Borland Journal: Nicotine Tob Res Date: 2019-06-21 Impact factor: 4.244
Authors: Sarah J Hardcastle; Derwin C K Chan; Kim M Caudwell; Sarwat Sultan; Jo Cranwell; Nikos L D Chatzisarantis; Martin S Hagger Journal: Int J Behav Med Date: 2016-02
Authors: Sahara Byrne; Amelia Greiner Safi; Deena Kemp; Christofer Skurka; Julie Davydova; Leah Scolere; Alan D Mathios; Rosemary J Avery; Michael C Dorf; Joseph Steinhardt; Jeff Niederdeppe Journal: Health Commun Date: 2017-12-13
Authors: Yoo Jin Cho; James F Thrasher; Hua-Hie Yong; André Salem Szklo; Richard J O'Connor; Maansi Bansal-Travers; David Hammond; Geoffrey T Fong; James Hardin; Ron Borland Journal: Soc Sci Med Date: 2017-10-30 Impact factor: 4.634
Authors: Seth M Noar; Diane B Francis; Christy Bridges; Jennah M Sontag; Kurt M Ribisl; Noel T Brewer Journal: Soc Sci Med Date: 2016-07-13 Impact factor: 4.634