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Source publication
Introduction:
We studied adolescent and adult perceptions of the effects of larger size, 85% versus 40%, Graphic Health Warnings (GHWs) on conventional and plain tobacco packs, in India.
Methods:
A cross-sectional survey was conducted with 2121 participants (aged ≥13 years), during the period 2015-16, in Delhi and Telangana, India. Four categori...
Contexts in source publication
Context 1
... these packs were included in this study. Conventional tobacco packs with 40% sized existing (April 2013 -April 2016) warnings (pack category A), dummy tobacco packs with 40% new (April 2016 - present) warnings (pack category B), dummy tobacco packs with 85% new warnings on conventional packs (pack category C) and dummy tobacco packs with 85% new warnings on plain packs (pack category D) were shown ( Figure 1) to participants to elicit responses to questions asked by the interviewer using the questionnaire. ...
Context 2
... were collected on demography, tobacco use behaviour, perceived noticeability of GHWs, the appeal of tobacco packs, and perceived effectiveness of GHWs on various indicators related to tobacco use. Participants were shown four categories of tobacco packs simultaneously 21 to elicit their responses during the survey (Figure 1). ...
Context 3
... we are unable to comment on the actual effectiveness or impact of plain packaging with large GHWs on tobacco initiation, cessation, or other outcomes studied. Further, we used only four types of packs (Figure 1), which represented most likely combinations with respect to pack warnings and types relevant in the Indian policy context. These packs were shown to the participants at the same time to elicit their responses. ...
Citations
... To date, systematic reviews from high-income and middleincome countries suggest that larger GHWs are associated with increased salience and knowledge on smoking harms and health risks and that larger GHWs are more effective in encouraging behavioral change, particularly in influencing intentions to smoke (foregoing cigarettes) and intentions to quit smoking (e.g., quitline calls, quit attempts, and short term cessation) and decreasing smoking prevalence (7)(8)(9)(10)(11). There is also increased effectiveness when larger and new GHWs are introduced in regular intervals to sustain salience (8,9). ...
... To date, systematic reviews from high-income and middleincome countries suggest that larger GHWs are associated with increased salience and knowledge on smoking harms and health risks and that larger GHWs are more effective in encouraging behavioral change, particularly in influencing intentions to smoke (foregoing cigarettes) and intentions to quit smoking (e.g., quitline calls, quit attempts, and short term cessation) and decreasing smoking prevalence (7)(8)(9)(10)(11). There is also increased effectiveness when larger and new GHWs are introduced in regular intervals to sustain salience (8,9). Recently, a global ecological time-series analysis of the comprehensive and simultaneous implementation of smoking bans, GHWs, advertising bans, and tobacco taxes confirmed tobacco control measures' effectiveness in reducing smoking prevalence (12). ...
In line with Article 11 of the WHO Framework Convention on Tobacco Control, the Philippines has implemented graphic health warnings on cigarette packs. To date, there has been no published literature evaluating the perceived effectiveness of GHWs in the Philippines. This study aims to contribute to the evidence on the perceived effects of graphic health warnings (GHWs) in cigarette packaging and the potential impact of plain packaging in the Philippines. The study involved an online convenience survey and a nationwide household survey. Mock-up sets of cigarette packs based on the Philippines’ law on GHWs, and Thailand’s and Singapore’s plain packaging were shown to respondents to rate their attractiveness, quality, taste, cost, social appeal, appeal to youth, noticeability, appeal to non-smokers, attempt to quit, ease of quitting, discouraging smoking, and perceived harm to health on a five-point Lickert scale. The online and household surveys recruited 2,701 respondents in total. Online and household survey respondents considered plain packaging with larger graphic health warnings and visible quitlines from Thailand and Singapore to be more effective in discouraging them from smoking. Both sets of survey respondents also found mock-ups from Thailand and Singapore more motivating for them to attempt quitting than cigarette pack mock-ups from the Philippines. The study concludes that current graphic health warnings in the Philippines are ineffective in instilling health consciousness among Filipinos. Policymakers should consider larger graphic health warnings and plain packaging of cigarettes to motivate smokers to quit and discourage Filipinos from smoking.
... Knowledge of the risks of tobacco use is lower in LMICs than elsewhere 7 . Communication of these risks is fundamental to reducing tobacco use, with pictorial warnings on tobacco packs viewed as the most cost-effective means of educating consumers on these risks 1,8 . The guidelines for Article 11 of the Framework Convention on Tobacco Control encourage Parties to use a range of warnings as different messages resonate with different audiences 9 . ...
Introduction:
In India there is insufficient knowledge of the risks associated with tobacco use. Increasing awareness of these risks is critical, with pictorial warnings on tobacco packs a cost-effective way to communicate this information. We explored perceptions of the current warning, 'Tobacco causes cancer', displayed on packs in India and four novel warnings about other potential impacts of tobacco use including social, financial, and environmental, but also complications with diabetes. As loose cigarette sales are common in India, we also explored perceptions of warnings on cigarette sticks.
Methods:
A cross-sectional survey of college students aged ≥18 years in Karnataka, India, was conducted between January 2019 and February 2020. Participants were asked about salience, believability, and cognitive processing of warnings currently on packs. They were then shown an image of one current and four novel warnings and asked about their perceived effectiveness in preventing uptake and reducing and stopping tobacco use. They were then asked about warnings on cigarette sticks.
Results:
Most participants (70.2%) recalled warnings on packs and considered them believable (55.7%), but only 12.0% read and 12.4% thought about them often. Warnings about the health impacts of tobacco use were viewed as most effective in preventing uptake, and reducing and stopping tobacco use. Nevertheless, at least a third of participants rated warnings pertaining to financial, social, and environmental impacts effective in preventing uptake, and reducing and stopping tobacco use. Approximately one-fifth (22.0%) thought that warnings on cigarette sticks would deter initiation.
Conclusions:
Our results suggest that health warnings are perceived as most effective in discouraging tobacco use among college students in Karnataka. While viewed as less effective than health warnings, novel non-health related messages were viewed as effective in preventing uptake, and reducing and stopping tobacco use by at least one in three participants. Warnings on cigarette sticks may help complement warnings on cigarette packs.
... Many of the included studies reported substantial negative smoking behavior/perceived smoking behavior toward plain packaging among smokers. [30][31][32][33]35,41,42 Four studies stated that plain packaging aided quitting behaviors among smokers 32,35,41,42 Two studies each reported that plain packaging aided the reduction in tobacco consumption 41,42 and the reduction in urges/cravings 30,31 among smokers. Most respondents felt that plain packaging could help them quit smoking or reduce smoking, especially those who had recently started smoking. ...
... Many of the included studies reported substantial negative smoking behavior/perceived smoking behavior toward plain packaging among smokers. [30][31][32][33]35,41,42 Four studies stated that plain packaging aided quitting behaviors among smokers 32,35,41,42 Two studies each reported that plain packaging aided the reduction in tobacco consumption 41,42 and the reduction in urges/cravings 30,31 among smokers. Most respondents felt that plain packaging could help them quit smoking or reduce smoking, especially those who had recently started smoking. ...
... Fewer of the included studies reported the response of nonsmokers to plain packaging in comparison with that of smokers. 32,33,35,41,42 Four studies reported that plain packaging prevented the initiation of smoking among smokers effectively. 32,33,35,42 However, one study reported that some respondents doubted the ability of plain packaging to prevent people from initiating smoking. ...
Context:
Worldwide, the number of cigarette smokers is increasing. All tobacco products come in packs. Packaging and branding are important elements of advertising and promotion. The plain packaging concept introduced by the World Health Organization, where marketing elements such as branding appeal are removed from the cigarette pack, is said to be effective for reducing smoking habits. The objective of this systematic review was to determine the influence of plain packaging on smoking behavior.
Method:
This systematic review was conducted using 2 databases (Scopus and Web of Science). We did not search for unpublished reports. The search was performed from September 2020 to December 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were original article that used a qualitative or quantitative method, English-language article, published in 2016-2020, and availability of full-text article.
Results:
A total of 15 studies were included. All of the studies had adequate methodological quality. Most of the studies reported the effectiveness of plain packaging in preventing smoking initiation among nonsmokers. However, more studies reported no effect of plain packaging on smoking behavior among smokers. Furthermore, there was a greater impact of plain packaging on smoking behavior among female smokers and those who had recently started smoking.
Conclusions:
Plain packaging is more effective for evoking negative smoking behavior among nonsmokers than among smokers. As many of the included studies did not stratify the results based on age group and gender, future research should address these issues.
... Nazar et al. 12 investigated the influence of increased area occupied by graphic health warnings on cigarette packages in India. The results revealed that more area (85%) reserved for health warnings increased their perceived effectiveness by 40%, as compared to 40% of the pack being reserved for health warnings. ...
... Positive effects on motivation to quit and perceived health risks associated with tobacco were found. 12 This study involves a mixed age group and shows that both age groups in the study perceive health warnings as effective. This result may mean that further improvement on the moderation of the cigarette packages could expand the positive influence to a larger population. ...
Objective:
Turkey has recently adopted the regulation of plain and standard packaging for tobacco products and introduced newly designed combined health warnings. In this study, we aimed to reveal how the new combined health warnings are perceived among medical students.
Material and methods:
The study was descriptive and the data were collected by a 3-part questionnaire. The first part covered demographic characteristics, the second part was designed to measure the saliency of the combined health warnings, and the third part evaluated their effect on the motivation to quit.
Results:
Out of 484 students of medicine, 287 (59%) were included in the study; 54.4% of the participants were female and 45.6% were male; and the average age was 21.18 ± 1.94 years. There were 79 (27.5%) smokers and the mean duration of smoking was 39.07 ± 24.07 months. The combined health warning that reads "Smoking causes laryngeal cancer" had the highest score both in terms of saliency and motivation to quit smoking. The one that reads "Protect children: don't let them inhale your smoke" had the lowest score in both categories. Non-smokers found the stimuli more effective than smokers and quitters (P > .05).
Conclusion:
The findings point out that smoking rate is unexpectedly high among participants, and medical students perceived the warnings emphasizing the physical deformities caused by tobacco products on individuals as more effective than combined health warnings aimed at protecting "others." This study suggests that the combined health warnings should be selected in a more nuanced way for different target groups.
This study examined the effects of gender-specific pictorial health warning labels contingent on their intended gender and threat levels (for females) in forming anti-smoking intentions. We conducted a within-subject design experiment with smokers and nonsmokers in Singapore (N = 100, 50% men). Each participant viewed 10 warning labels-four female-specific (high and low threat), four gender-neutral (high and low threat), and two male-specific (only low threat)-in a random order, evaluating each label on personal relevance, attention, cognitive elaboration, reactance, and intentions to purchase or avoid smoking. The findings showed that females reported greater relevance, attention, elaboration, and intentions to avoid smoking for low threat female-specific warning labels than male-specific or gender-neutral counterparts. Males reported less attention, elaboration, and relevance for low threat male-specific warning labels than female-specific or gender-neutral counterparts. Under high threat conditions, female-specific and gender-neutral warning labels were equally effective for both genders. No differences were observed by smoking status. Overall, gender-specific warning labels are potentially more effective than gender-neutral ones for deterring smoking in women contingent on low threat levels. By providing a deeper understanding of persuasive mechanisms and boundary conditions for the effects of gender specificity, findings can aid health policymakers in developing better gender-responsive interventions.
The use of graphic health warnings (GHWs) on tobacco packaging is one of the most widely used public health strategies worldwide, but there is little evidence of the emotional impact of its content and craving they generate. The objective of the present study was to evaluate the emotional and craving responses to GHW content. The study included 300 men and women of different ages (adolescents, young adults, and adults), both smokers and non-smokers. We evaluated the participants’ emotional and craving responses to 16 GHWs with different content (i.e., cancer, cardiovascular disease, abortion, and childhood illness). We analyzed the effects of sex, smoking status, and age. GHWs exhibited the capacity to elicit aversive emotional states, with low levels of arousal and high levels of dominance and did not produce craving. GHWs that showed images of cancer and abortion had the greatest emotional impact. Non-smoking adolescent females experienced the greatest emotional impact of GHWs. The results suggest that GHWs effectively reduce the attractiveness of cigarette packages and discourage consumption, and increasing the size of GHWs may favor avoidance of the package. GHWs that depicted explicit threats had a greater emotional impact, especially in women.
