Document Detail

Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content.
MedLine Citation:
PMID:  22350859     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects.
METHODS: Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering).
RESULTS: Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering.
CONCLUSIONS: Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.
James F Thrasher; Edna Arillo-Santillán; Victor Villalobos; Rosaura Pérez-Hernández; David Hammond; Jarvis Carter; Ernesto Sebrié; Raul Sansores; Justino Regalado-Piñeda
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-02-15
Journal Detail:
Title:  Cancer causes & control : CCC     Volume:  23 Suppl 1     ISSN:  1573-7225     ISO Abbreviation:  Cancer Causes Control     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-09     Completed Date:  2012-09-11     Revised Date:  2013-09-11    
Medline Journal Info:
Nlm Unique ID:  9100846     Medline TA:  Cancer Causes Control     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  69-80     Citation Subset:  IM    
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA.
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MeSH Terms
Aged, 80 and over
Educational Status
Healthcare Disparities*
Middle Aged
Product Labeling / methods*
Smoking / adverse effects*,  prevention & control*,  psychology
Young Adult
Grant Support
P01 CA138389/CA/NCI NIH HHS; P01 CA138389/CA/NCI NIH HHS; P01 CA138389-03/CA/NCI NIH HHS

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