Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Cancer Causes & Control
Published in: Cancer Causes & Control 1/2012

01-03-2012 | Original paper

Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content

Authors: James F. Thrasher, Edna Arillo-Santillán, Victor Villalobos, Rosaura Pérez-Hernández, David Hammond, Jarvis Carter, Ernesto Sebrié, Raul Sansores, Justino Regalado-Piñeda

Published in: Cancer Causes & Control | Special Issue 1/2012

Login to get access

Abstract

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.
Literature
1.
WHO (2003) Framework convention on tobacco control. World Health Organization, Tobacco Free Initiative, Geneva
2.
WHO (2009) Guidelines for implementation of Article 11 of the WHO Framework Convention On Tobacco Control (packaging and labelling of tobacco products). World Health Organization, Geneva
3.
IOM (2002) Speaking of health: assessing health communication strategies for diverse populations. National Academy of Sciences, Institute of Medicine, Washington
4.
Rice RE, Atkin CK (eds) (2001) Public communication campaigns. Sage, Thousand Oaks
5.
Hornik R (ed) (2002) Public health communication: evidence for behavior change. Lawrence Erlbaum, Mahwah
6.
WHO (2010) Guidelines for implementation of Article 12 of the WHO Framework Convention on Tobacco Control—education, communication, training and public awareness. World Health Organization, Geneva
7.
Cunningham R (2011) Cigarette package warning size and use of pictures: international summary. Canadian Cancer Society, Ottawa
8.
Sebrié EM, Blanco A, Glantz SA (2010) Cigarette labeling policies in Latin America and the Caribbean: progress and obstacles. Salud Pública de México 52(Supp 2):233–243CrossRef
9.
Murray CJL, Lopez AD (1997) Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet 329:1436–1442CrossRef
10.
WHO (2008) WHO report on the global tobacco epidemic, 2008: the MPOWER package. World Health Organization, Geneva
11.
Franco-Marina F (2007) Adult smoking trends in Mexico: an analysis of the Mexican National Addictions Surveys. Salud Pública de México 49(Supp 2):S137–S146CrossRef
12.
Campuzano JC, Hernández-Avila M, Samet J, Méndez I, Tapia R, Sepúlveda J (2005) Comportamiento de los fumadores en México según las Encuestas Nacionales de Adicciones 1988 a 1998. In: Lazcano-Ponce E, Valdés-Salgado R, Hernández-Avila M (eds) Primer informe sobre combate al tabaquismo. México ante el Convenio Marco para el Control del Tabaco. Instituto Nacional de Salud Pública, Cuernavaca, pp 21–27
13.
WHO (2004) Tobacco and poverty. World Health Organization, Geneva
14.
Link B (2008) Epidemiological sociology and the social shaping of population health. J Health Soc Behav 49:367–384PubMedCrossRef
15.
Garrett BE, Dube SR, Trosclair A, Caraballo RS, Pechacek TF (2011) Cigarette Smoking—United States, 1965–2008. MMWR 60(01):109–113PubMed
16.
Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong H et al (2009) Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tobacco Control 18:358–364PubMedCrossRef
17.
Fong GT, Hammond D, Hitchman SC (2009) The impact of graphic pictures on the effectiveness of tobacco health warnings. Bull WHO 87:640–643PubMed
18.
Hammond D, Fong GT, Borland R, Cummings KM, McNeil AD, Driezen P (2007) Text and graphic warnings on cigarette packages: findings from the International Tobacco Control Four Country Study. Am J Prev Med 32(3):210–217CrossRef
19.
Hammond D, Fong GT, MacDonald P, Cameron R, Brown K (2003) Impact of graphic Canadian warning labels on adult smoking behavior. Tobacco Control 12:391–395PubMedCrossRef
20.
Hammond D, Fong GT, McNeil A, Borland R, Cummings KM (2006) Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 15(Supp 3):iii19–iii25PubMedCrossRef
21.
O’Hegarty M, Pederson LL, Nelson DE, Mowery P, Gable JM, Wortley P (2006) Reactions of young adult smokers to warning labels on cigarette packages. Am J Prev Med 30(6):467–473PubMedCrossRef
22.
Thrasher JF, Rousu MC, Anaya-Ocampo R, Reynales-Shigematsu LM, Arillo-Santillán E, Hernández-Ávila M (2007) Estimating the impact of graphic warning labels on cigarette packs: the auction method. Addict Behav 32(12):2915–2916CrossRef
23.
Thrasher JF, Hammond D, Fong GT, Arillo-Santillan E (2007) Smokers’ reactions to cigarette package warnings with graphic imagery and with only text: a comparison between Mexico and Canada. Salud Pública de México 49(Sup 2):S233–S240PubMedCrossRef
24.
Thrasher J, Villalobos V, Szklo A, Fong GT, Pérez C, Sebrié EM et al (2010) Assessing the impact of cigarette package warning labels: a cross-country comparison in Brazil, Uruguay and Mexico. Salud Pública de México 52(Sup 2):S206–S215PubMedCrossRef
25.
Kutner M, Greenberg E, Jin Y, Paulsen C (2006) The health literacy of America’s adults: results from the 2003 National Assessment of Adult Literacy Washington. National Center for Education Statistics, DC
26.
Thrasher JF, Price AE, Thompson ME, Borland R, Yong H, Fong GC, et al. A latent growth curve analysis of cigarette warning label wear out: findings from the ITC Four Country Survey. Under review
27.
Durkin SJ, Biener L, Wakefield M (2009) Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups. Am J Public Health 99(12):2217–2223PubMedCrossRef
28.
Thrasher J, Arillo-Santillán E, Pérez-Hernández R, Sansores R, Regalado-Piñeda J (2011) Evaluación de advertencias sanitarias de las cajetillas de tabaco: Cuatro investigaciones del impacto y recomendaciones para la Segunda Ronda de Pictogramas en México. [Cigarette package warning labels: Four studies of impact and recommendations for the second round of pictorial warning labels in Mexico]. Instituto Nacional de Salud Pública, Cuernvaca, México
29.
Kreuter M, Green M, Cappella J, Slater M, Wise M, Storey D et al (2007) Narrative communication in cancer prevention and control: a framework to guide research and application. Arch Behav Med 33(3):221–235CrossRef
30.
USDHHS (2006) The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. US Department of Health and Human Services, Washington
31.
IARC (2009) IARC Handbooks of cancer prevention: tobacco control. Methods for evaluating tobacco control policies, vol 12. International Agency for Research on Cancer, Lyon
32.
Swayampakala K, Thrasher JF, Sansores RH, Regalado J, Berg C, Carpenter M et al. Low cigarette consumption and smoking cessation in Mexico. Under review
33.
Willis GB (2005) Cognitive interviewing. Sage, London
34.
Thrasher JF, Quah ACK, Dominick G, Awang R, Omar M, Borland R, et al (2011) Mixing cognitive interviewing and behavioral coding methods to determine measurement equivalence across linguistic and cultural groups: an example from international tobacco survey research. Field Meth 23(4):439–460
35.
Cox D, Cox A (2001) Communicating the consequences of early detection: the role of evidence and framing. J Marke 65:91–103CrossRef
36.
Slater M, Rouner D (1996) Value-affirmative and value-protective processing of alcohol education messages that include statistical evidence or anecdotes. Commun Res 23:210–235CrossRef
37.
Hammond D, Thrasher JF, Reid JL, Daniel S, Driezen P, Boudreau C (2011) United States health warning study: international packaging study, preliminary results. University of Waterloo, Waterloo
38.
39.
White V, Webster B, Wakefield M (2008) Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviors? Addiction 103(9):1562–1571PubMedCrossRef
40.
Brennan E, Durkin S, Rish Cotter T, Harper T, Wakefield MA (2011) Mass media campaigns designed to complement new pictorial health warnings on cigarette packets: evidence of a complementary relationship. Tobacco Control 20(6):412–418
41.
Thrasher JF, Murukutla N, Arillo-Santillán E, Pérez-Hernández R, Alday J. Creating synergies between pictorial warning labels on cigarette packages and media campaigns: a case study of Mexico. Under review
42.
Pandit AU, Tang JW, Cooper Baily S, Davis TC, Bocchini MV, Persell SD et al (2009) Education, literacy, and health: mediating effects on hypertension knowledge and control. Patient Educ Couns 75:381–385PubMedCrossRef
43.
Schillinger D, Barton LR, Karter AJ, Wang F, Adler N (2006) Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep 121:245–254PubMed
44.
Matsuyama RK, Wilson-Genderson M, Kuhn L, Mohganaki D, Vachhani H, Paasche-Orlow M (2011) Education level, not lealth literacy, associated with information needs for patients with cancer. Patient Educ Couns. doi:10.​1016/​j.​pec.​2011.​03.​022:​1-8
45.
Paasche-Orlow MK, Clarke JG, Hebert MR, Ray MK, Stein MD (2005) Educational attainment but not literacy is associated with HIV risk behavior among incarcerated women. J Womens Health 14(9):852–859CrossRef
46.
CONAPO (2005) Delimitación de las zonas metropolitanas de México 2005. Consejo Nacional de Población, Distrito Federal, México, p 2007
47.
Saenz de Miera B, Thrasher JF, Chaloupka FJ, Watters H, Hernández-Avila M, Fong GT (2010) Self-reported price, consumption and brand switching of cigarettes in a cohort of Mexican smokers before and after a cigarette tax increase. Tobacco Control 19:481–487PubMedCrossRef
48.
INSP (2009) Encuesta Mundial de Tabaquismo en Adultos, México 2009 [Global Adult Tobacco Survey, México 2009]. Instituto Nacional de Salud Pública & PanAmerican Health Organization, México, p 2010
Metadata
Title
Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content
Authors
James F. Thrasher
Edna Arillo-Santillán
Victor Villalobos
Rosaura Pérez-Hernández
David Hammond
Jarvis Carter
Ernesto Sebrié
Raul Sansores
Justino Regalado-Piñeda
Publication date
01-03-2012
Publisher
Springer Netherlands
Published in
Cancer Causes & Control / Issue Special Issue 1/2012
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-012-9899-8

Other articles of this Special Issue 1/2012

Cancer Causes & Control 1/2012 Go to the issue

Original Paper

Mass media exposure, social stratification, and tobacco consumption among Nigerian adults

Original paper

Exposure to second-hand smoke at home and its associated factors: findings from the Global Adult Tobacco Use survey in Vietnam, 2010

Original paper

Global socioeconomic inequalities in tobacco use: internationally comparable estimates from the World Health Surveys

Acknowledgment

Acknowledgments

Original paper

Using a smokeless tobacco control mass media campaign and other synergistic elements to address social inequalities in India

Original paper

The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits