Do graphic cigarette warning labels better influence smoking behaviour? – Medical News Bulletin

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Researchers seek to understand whether graphic cigarette warning labels actually influence people’s implicit evaluations regarding smoking.

Smoking is a significant cause of preventable disease and death across the world. One of the primary strategies employed in tobacco control efforts is the use of cigarette warning labels on tobacco products. These labels are typically comprised of a text message whose aim is to inform individuals of the negative consequences associated with smoking. Recently, several countries have begun to employ the use of graphic warning labels, which include an attention-catching colour photograph alongside the text message; the use of these images is based on the premise that fear can serve as a significant motivator for behavioural change.

Previous research has found that graphic warnings are better at motivating individuals to carefully consider the risks of smoking, as well as, more strongly increase smoker’s intentions to stop smoking. Despite these findings, there have been questions surrounding the effectiveness of GWs, for instance, in producing behavioural change (smoking cessation) through an influence on an individual’s intention to quit. In a recent study published in PLoS One, Belgian researchers sought to determine whether GWs generated more negative implicit evaluations of smoking than text-based messages.

The Project Implicit Study

The study recruited English-speaking participants via the Project Implicit website. The study sample of 5833 participants, from 103 different countries, were randomly assigned to view one of 49 cigarette warning labels (36 graphic warnings and 13 text-only warnings) before having half of them complete an Implicit Association Test (IAT) to measure implicit evaluations of smoking. IAT scores have been found to sometimes be a good predictor of individuals’ changes in smoking behaviour. The implicit evaluation consisted of categorizing 14 attribute words (i.e. happy, evil) as either “positive” or “negative” and 12 images of smoking-related and non-smoking related stimuli as “smoking” or “not smoking”.

The other half of the participants were asked to report their explicit liking of smoking by providing responses to two separate questions using a 7-point response scale; the first question relating to a statement that best described the participant’s preference for smoking or not smoking and the second question relating to the extent to which they thought smoking is positive or negative. These two ratings were then averaged into one explicit score. All participants were subsequently asked to rate the effectiveness of the cigarette warning labels they were shown, on a scale from 1 (not very effective) to 6 (extremely effective).

The participants were then asked about their smoking behaviours so that the study authors could divide the data collected into three categories based on participant smoking behaviours: non-smokers, who reported they never smoke; occasional smokers, who reported smoking less than one cigarette per day and daily smokers, who smoked at least one cigarette per day.

Graphic warnings do not elicit negative implicit evaluations in smokers and non-smokers

The current findings suggest that the one-time viewing of graphic warnings does not have any beneficial effect on implicit (or explicit) evaluations of smoking in smokers or non-smokers. In general, the study found that one-time viewing of graphic warnings did not have a beneficial effect on smokers’ and non-smokers’ implicit (and explicit) evaluations of smoking, although occasional smokers and non-smokers rated GWs as more effective than text-only warnings. Interestingly, the graphic warnings actually produced more positive implicit evaluations of smoking in daily and occasional smokers, as well as more positive explicit evaluations of smoking in daily smokers.

These findings are in stark contrast to the intuitive belief that graphic images would be effective in promoting a change in behaviour, or even a desire to change behaviour. The authors speculate the findings could be explained by psychological reactance in the smoking groups, whereby these individuals try to reduce the negative feelings produced by the GWs by raising counterarguments to the messaging, rather than changing behaviours.

Some of the study’s strengths included the use of a large sample size, the random assignment of participants to the cigarette warning label messaging which would reduce bias and the use of large variability in the number of warning labels they exposed participants to, to allow for generalizability.

Implications for future warning labels

These findings may help to shed light on why graphic warnings do not always translate into beneficial effects on smoking behaviour. As such, it might be of benefit to use messaging that produces changes in automatic evaluative reactions to smoking. When considering graphic warnings that lead to psychological reactance, it may be helpful to use images that are less focused on evoking fear, resulting in less psychological reactance.

Written by Sara Alvarado BSc, MPH

Reference: Van Dessel, P., Smith, C.T., De Houwer, J. (2018). Graphic cigarette pack warnings do not produce more negative implicit evaluations of smoking compared to text-only warnings. PloS ONE 13(3): e0194627. https://doi.org/10.1371/journal.pone.0194627



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