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Published in: Annals of Behavioral Medicine 4/2015

01-08-2015 | Original Article

Do Young Adults Perceive That Cigarette Graphic Warnings Provide New Knowledge About the Harms of Smoking?

Authors: Renee E. Magnan, PhD, Linda D. Cameron, PhD

Published in: Annals of Behavioral Medicine | Issue 4/2015

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Abstract

Background

Although much research on graphic cigarette warnings has focused on motivational responses, little focus has been given to how much individuals learn from these labels.

Purpose

This study aims to investigate whether graphic warnings provide greater perceived new knowledge of smoking consequences compared to text-only warnings, and to test a mediational model whereby perceived new knowledge promotes discouragement from smoking through its impact on worry.

Methods

In two studies, young adult smokers and nonsmokers (ages 18–25) evaluated graphic + text and corresponding text-only labels on perceived knowledge, worry about the harms addressed by the warning, and discouragement from smoking.

Results

Compared to text-only labels, graphic + text labels were rated as providing better understanding, more new knowledge, and being more worrisome and discouraging. Perceived new knowledge predicted greater discouragement from smoking directly and through worry.

Conclusions

Graphic warnings may be more efficacious than text-based warnings in increasing knowledge and worry about harms, and discouragement from smoking.
Appendix
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Footnotes
1
Due to the relatively low alphas, we computed separate mediation analyses for personal understanding and perceived new knowledge. Each model yielded identical patterns of findings (tests of the direct and indirect effects were significant at p < .001 in both models), thus we only report the mediation analyses for the combined-item measure.
 
Literature
1.
go back to reference Centers for Disease Control and Prevention (CDC). Current Cigarette Smoking Among Adults—United States, 2005–2012. Morbidity and Morality Weekly Report 2014; 63: 29–34. [accessed 2014 Apr 25]. Centers for Disease Control and Prevention (CDC). Current Cigarette Smoking Among Adults—United States, 2005–2012. Morbidity and Morality Weekly Report 2014; 63: 29–34. [accessed 2014 Apr 25].
2.
go back to reference U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014.
3.
go back to reference World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland, 2003. World Health Organization. WHO Framework Convention on Tobacco Control. Geneva, Switzerland, 2003.
4.
go back to reference Hammond D. Health warning messages on tobacco products: A review. Tob Control. 2011; 20(5): 327-337.PubMedCrossRef Hammond D. Health warning messages on tobacco products: A review. Tob Control. 2011; 20(5): 327-337.PubMedCrossRef
5.
go back to reference Azagba S, Sharaf MF. The effect of graphic cigarette warning labels on smoking behavior: Evidence from the Canadian experience. Nicotine Tob Res. 2013; 15(3): 708-717.PubMedCrossRef Azagba S, Sharaf MF. The effect of graphic cigarette warning labels on smoking behavior: Evidence from the Canadian experience. Nicotine Tob Res. 2013; 15(3): 708-717.PubMedCrossRef
6.
7.
go back to reference Huang J, Chaloupka FJ, Fong GT. Cigarette graphic warning labels and smoking prevalence in Canada: A critical examination and reformulation of the FDA regulatory impact analysis. Tob Control. 2014; 23(Suppl 1): i7-12.PubMedCentralPubMedCrossRef Huang J, Chaloupka FJ, Fong GT. Cigarette graphic warning labels and smoking prevalence in Canada: A critical examination and reformulation of the FDA regulatory impact analysis. Tob Control. 2014; 23(Suppl 1): i7-12.PubMedCentralPubMedCrossRef
8.
go back to reference Bayer R, Johns D, Colgrove J. The FDA and graphic cigarette-pack warnings—thwarted by the courts. N Engl J Med. 2013; 369(3): 206-208.PubMedCrossRef Bayer R, Johns D, Colgrove J. The FDA and graphic cigarette-pack warnings—thwarted by the courts. N Engl J Med. 2013; 369(3): 206-208.PubMedCrossRef
9.
go back to reference R.J. Reynolds Tobacco Co. V. Food and Drug Admin.: D.C. Cir., 2012. R.J. Reynolds Tobacco Co. V. Food and Drug Admin.: D.C. Cir., 2012.
10.
go back to reference Leventhal H, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. In: Cameron LD, Leventhal H, eds. The self-regulation of health and illness behaviour. London: Routledge; 2003: 42-65. Leventhal H, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. In: Cameron LD, Leventhal H, eds. The self-regulation of health and illness behaviour. London: Routledge; 2003: 42-65.
11.
go back to reference Cameron LD. Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk. Psychol Health. 2008; 23(1): 91-112.PubMedCrossRef Cameron LD. Illness risk representations and motivations to engage in protective behavior: The case of skin cancer risk. Psychol Health. 2008; 23(1): 91-112.PubMedCrossRef
12.
go back to reference Cameron LD, Williams B. Which images and features in graphic cigarette warnings predict their perceived effectiveness? Findings from an online survey of residents in the United Kingdom. Ann Behav Med 2015; in press. Cameron LD, Williams B. Which images and features in graphic cigarette warnings predict their perceived effectiveness? Findings from an online survey of residents in the United Kingdom. Ann Behav Med 2015; in press.
13.
go back to reference Curry SJ, Grothaus L, McBride C. Reasons for quitting: Intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers. Addict Behav. 1997; 22: 727-739.PubMedCrossRef Curry SJ, Grothaus L, McBride C. Reasons for quitting: Intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers. Addict Behav. 1997; 22: 727-739.PubMedCrossRef
14.
go back to reference Hammond D, Fong GT, McDonald PW, et al. Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. Am J Public Health. 2004; 94: 1442-1445.PubMedCentralPubMedCrossRef Hammond D, Fong GT, McDonald PW, et al. Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. Am J Public Health. 2004; 94: 1442-1445.PubMedCentralPubMedCrossRef
15.
go back to reference Mutti S, Hammond D, Reid JL, et al. The efficacy of cigarette warning labels on health beliefs in the United States and Mexico. J Health Commun. 2013; 18(10): 1180-1192.PubMedCentralPubMedCrossRef Mutti S, Hammond D, Reid JL, et al. The efficacy of cigarette warning labels on health beliefs in the United States and Mexico. J Health Commun. 2013; 18(10): 1180-1192.PubMedCentralPubMedCrossRef
16.
go back to reference Dijkstra A, Brosschot J. Worry about health in smoking behaviour change. Behav Res Ther. 2003; 41(9): 1081-1092.PubMedCrossRef Dijkstra A, Brosschot J. Worry about health in smoking behaviour change. Behav Res Ther. 2003; 41(9): 1081-1092.PubMedCrossRef
17.
go back to reference Magnan RE, Köblitz AR, Zielke DJ, et al. The effects of warning smokers on perceived risk, worry, and motivation to quit. Ann Behav Med. 2009; 37(1): 46-57.PubMedCrossRef Magnan RE, Köblitz AR, Zielke DJ, et al. The effects of warning smokers on perceived risk, worry, and motivation to quit. Ann Behav Med. 2009; 37(1): 46-57.PubMedCrossRef
18.
go back to reference Köblitz AR, Magnan RE, McCaul KD, et al. Smokers’ thoughts and worries: A study using ecological momentary assessment. Health Psychol. 2009; 28(4): 484-492.PubMedCrossRef Köblitz AR, Magnan RE, McCaul KD, et al. Smokers’ thoughts and worries: A study using ecological momentary assessment. Health Psychol. 2009; 28(4): 484-492.PubMedCrossRef
19.
go back to reference White V, Webster B, Wakefield M. Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviours? Addiction. 2008; 103(9): 1562-1571.PubMedCrossRef White V, Webster B, Wakefield M. Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviours? Addiction. 2008; 103(9): 1562-1571.PubMedCrossRef
20.
go back to reference Hammond D, Fong GT, McNeill A, et al. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: Findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006; 15(Suppl 3): iii19-25.PubMedCentralPubMed Hammond D, Fong GT, McNeill A, et al. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: Findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006; 15(Suppl 3): iii19-25.PubMedCentralPubMed
21.
go back to reference Strasser AA, Tang KZ, Romer D, et al. Graphic warning labels in cigarette advertisements: Recall and viewing patterns. Am J Prev Med. 2012; 43(1): 41-47.PubMedCentralPubMedCrossRef Strasser AA, Tang KZ, Romer D, et al. Graphic warning labels in cigarette advertisements: Recall and viewing patterns. Am J Prev Med. 2012; 43(1): 41-47.PubMedCentralPubMedCrossRef
22.
go back to reference Stacy AW, Ames SL, Knowlton BJ. Neurologically plausible distinctions in cognition relevant to drug use etiology and prevention. Subst Use Misuse. 2004; 39: 1571-1623.PubMedCrossRef Stacy AW, Ames SL, Knowlton BJ. Neurologically plausible distinctions in cognition relevant to drug use etiology and prevention. Subst Use Misuse. 2004; 39: 1571-1623.PubMedCrossRef
23.
go back to reference McCaul KD, Mullens AB, Romaneck KM, et al. The motivational effects of thinking and worrying about the effects of smoking cigarettes. Cogn Emot. 2007; 21: 1780-1798.CrossRef McCaul KD, Mullens AB, Romaneck KM, et al. The motivational effects of thinking and worrying about the effects of smoking cigarettes. Cogn Emot. 2007; 21: 1780-1798.CrossRef
24.
go back to reference Cameron LD, Chan CKY. Designing health communications: Harnessing the power of affect, imagery, and self-regulation. Soc Personal Psychol Compass. 2008; 2(1): 262-282.CrossRef Cameron LD, Chan CKY. Designing health communications: Harnessing the power of affect, imagery, and self-regulation. Soc Personal Psychol Compass. 2008; 2(1): 262-282.CrossRef
25.
go back to reference Hammond D, Reid JL, Driezen P, et al. Pictorial health warnings on cigarette packs in the United States: An experimental evaluation of the proposed FDA warnings. Nicotine Tob Res. 2013; 15(1): 93-102.PubMedCentralPubMedCrossRef Hammond D, Reid JL, Driezen P, et al. Pictorial health warnings on cigarette packs in the United States: An experimental evaluation of the proposed FDA warnings. Nicotine Tob Res. 2013; 15(1): 93-102.PubMedCentralPubMedCrossRef
26.
go back to reference Cameron LD, Pepper JK, Brewer NT. Responses of young adults to graphic warning labels for cigarette packages. Tob Control 2013. Cameron LD, Pepper JK, Brewer NT. Responses of young adults to graphic warning labels for cigarette packages. Tob Control 2013.
27.
go back to reference Thrasher JF, Carpenter MJ, Andrews JO, et al. Cigarette warning label policy alternatives and smoking-related health disparities. Am J Prev Med. 2012; 43(6): 590-600.PubMedCentralPubMedCrossRef Thrasher JF, Carpenter MJ, Andrews JO, et al. Cigarette warning label policy alternatives and smoking-related health disparities. Am J Prev Med. 2012; 43(6): 590-600.PubMedCentralPubMedCrossRef
28.
go back to reference Houts PS, Doak CC, Doak LG, et al. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006; 61(2): 173-190.PubMedCrossRef Houts PS, Doak CC, Doak LG, et al. The role of pictures in improving health communication: A review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006; 61(2): 173-190.PubMedCrossRef
29.
go back to reference Environics Research Group. Consumer research on the size of health warning messages: Quantitative study of Canadian youth smokers and vulnerable nonsmokers. Toronto, Canada: Prepared for Health Canada; 2008. Environics Research Group. Consumer research on the size of health warning messages: Quantitative study of Canadian youth smokers and vulnerable nonsmokers. Toronto, Canada: Prepared for Health Canada; 2008.
30.
go back to reference Kirst M, Mecredy G, Borland T, et al. Predictors of substance use among young adults transitioning away from high school: A narrative review. Subst Use Misuse. 2014; 49(13): 1795-1807.PubMedCrossRef Kirst M, Mecredy G, Borland T, et al. Predictors of substance use among young adults transitioning away from high school: A narrative review. Subst Use Misuse. 2014; 49(13): 1795-1807.PubMedCrossRef
32.
go back to reference Tercyak KP, Rodriguez D, Audrain-McGovern J. High school seniors' smoking initiation and progression 1 year after graduation. Am J Public Health. 2007; 97(8): 1397-1398.PubMedCentralPubMedCrossRef Tercyak KP, Rodriguez D, Audrain-McGovern J. High school seniors' smoking initiation and progression 1 year after graduation. Am J Public Health. 2007; 97(8): 1397-1398.PubMedCentralPubMedCrossRef
33.
go back to reference O'Loughlin J, DiFranza J, Tyndale RF, et al. Nicotine-dependence symptoms are associated with smoking frequency in adolescents. Am J Prev Med. 2003; 25: 219-225.PubMedCrossRef O'Loughlin J, DiFranza J, Tyndale RF, et al. Nicotine-dependence symptoms are associated with smoking frequency in adolescents. Am J Prev Med. 2003; 25: 219-225.PubMedCrossRef
34.
go back to reference Dierker L, Mermelstein R. Early emerging nicotine-dependence symptoms: A signal of propensity for chronic smoking behavior in adolescents. J Pediatr. 2010; 156(5): 818-822.PubMedCentralPubMedCrossRef Dierker L, Mermelstein R. Early emerging nicotine-dependence symptoms: A signal of propensity for chronic smoking behavior in adolescents. J Pediatr. 2010; 156(5): 818-822.PubMedCentralPubMedCrossRef
35.
go back to reference Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. Br Med J. 2004; 328: 1519.CrossRef Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. Br Med J. 2004; 328: 1519.CrossRef
36.
go back to reference Doll R, Peto R, Boreham J, et al. Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer. 2005; 92: 426-429.PubMedCentralPubMedCrossRef Doll R, Peto R, Boreham J, et al. Mortality from cancer in relation to smoking: 50 years observations on British doctors. Br J Cancer. 2005; 92: 426-429.PubMedCentralPubMedCrossRef
37.
go back to reference Nonnemaker J, Farrelly M, Kamyab K, Busey A, Mann N. Experimental Study of Graphic Cigarette Warning Labels. Rockville, MD: Center for Tobacco Products, Food and Drug Administration. 2010. Contract No. HHSF-223-2009-10135G. Nonnemaker J, Farrelly M, Kamyab K, Busey A, Mann N. Experimental Study of Graphic Cigarette Warning Labels. Rockville, MD: Center for Tobacco Products, Food and Drug Administration. 2010. Contract No. HHSF-223-2009-10135G.
38.
go back to reference Villanti AC, Cantrell J, Pearson JL, et al. Perceptions and perceived impact of graphic cigarette health warning labels on smoking behavior among U.S. young adults. Nicotine Tob Res. 2014; 16(4): 469-477.PubMedCentralPubMedCrossRef Villanti AC, Cantrell J, Pearson JL, et al. Perceptions and perceived impact of graphic cigarette health warning labels on smoking behavior among U.S. young adults. Nicotine Tob Res. 2014; 16(4): 469-477.PubMedCentralPubMedCrossRef
39.
go back to reference Peters E, Romer D, Slovic P, et al. The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers. Nicotine Tob Res. 2007; 9(4): 473-481.PubMedCrossRef Peters E, Romer D, Slovic P, et al. The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers. Nicotine Tob Res. 2007; 9(4): 473-481.PubMedCrossRef
40.
go back to reference Berg CJ, Thrasher JF, Westmaas JL, et al. College student reactions to health warning labels: Sociodemographic and psychosocial factors related to perceived effectiveness of different approaches. Prev Med. 2011; 53(6): 427-430.PubMedCentralPubMedCrossRef Berg CJ, Thrasher JF, Westmaas JL, et al. College student reactions to health warning labels: Sociodemographic and psychosocial factors related to perceived effectiveness of different approaches. Prev Med. 2011; 53(6): 427-430.PubMedCentralPubMedCrossRef
41.
go back to reference Hammond D, Thrasher J, Reid JL, et al. Perceived effectiveness of pictorial health warnings among Mexican youth and adults: A population-level intervention with potential to reduce tobacco-related inequities. Cancer Causes Control. 2012; 23(Suppl 1): 57-67.PubMedCrossRef Hammond D, Thrasher J, Reid JL, et al. Perceived effectiveness of pictorial health warnings among Mexican youth and adults: A population-level intervention with potential to reduce tobacco-related inequities. Cancer Causes Control. 2012; 23(Suppl 1): 57-67.PubMedCrossRef
42.
go back to reference Swayampakala K, Thrasher JF, Hammond D, Yong HH, Bansal-Travers M, Krugman D, Brown A, Borland R, Hardin J. Pictorial health warning label content and smokers’ understanding of smoking-related risks—a cross-country comparison. Health Educ Res 2014. Swayampakala K, Thrasher JF, Hammond D, Yong HH, Bansal-Travers M, Krugman D, Brown A, Borland R, Hardin J. Pictorial health warning label content and smokers’ understanding of smoking-related risks—a cross-country comparison. Health Educ Res 2014.
43.
go back to reference Cohen J, Cohen P, West SG, et al. Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed. Mahwah, NJ: Lawrence Erlbaum; 2003. Cohen J, Cohen P, West SG, et al. Applied multiple regression/correlation analysis for the behavioral sciences. 3rd ed. Mahwah, NJ: Lawrence Erlbaum; 2003.
44.
go back to reference Bauer DJ, Preacher KJ, Gil KM. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychol Methods. 2006; 11(2): 142-163.PubMedCrossRef Bauer DJ, Preacher KJ, Gil KM. Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychol Methods. 2006; 11(2): 142-163.PubMedCrossRef
45.
go back to reference Emery LF, Romer D, Sheerin KM, et al. Affective and cognitive mediators of the impact of cigarette warning labels. Nicotine Tob Res. 2014; 16(3): 263-269.PubMedCentralPubMedCrossRef Emery LF, Romer D, Sheerin KM, et al. Affective and cognitive mediators of the impact of cigarette warning labels. Nicotine Tob Res. 2014; 16(3): 263-269.PubMedCentralPubMedCrossRef
46.
go back to reference Buhrmester M, Kwang T, Gosling SD. Amazon’s Mechanical Turk: A new source of inexpensive, yet high-quality data? Perspect Psychol Sci. 2011; 6: 3-5.CrossRef Buhrmester M, Kwang T, Gosling SD. Amazon’s Mechanical Turk: A new source of inexpensive, yet high-quality data? Perspect Psychol Sci. 2011; 6: 3-5.CrossRef
Metadata
Title
Do Young Adults Perceive That Cigarette Graphic Warnings Provide New Knowledge About the Harms of Smoking?
Authors
Renee E. Magnan, PhD
Linda D. Cameron, PhD
Publication date
01-08-2015
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 4/2015
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-015-9691-6

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