Impact of Pictorial Cigarette Warnings Compared With Surgeon General's Warnings on Understanding of the Negative Health Consequences of Smoking. Issue 10 (23rd March 2020)

• Record Type: Journal Article
• Authors: Pepper, Jessica K; Nguyen Zarndt, Anh; Eggers, Matthew E; Nonnemaker, James M; Portnoy, David B
• Is Part Of: Nicotine & tobacco research. Volume 22:Issue 10(2020)
• Page Start: 1795
• Page End: 1804
• Publication Date: 2020-03-23
• Subjects: Nicotine -- Periodicals; Tobacco -- Research -- Periodicals; Tobacco habit -- Periodicals; Nicotine -- Periodicals; Tobacco -- Periodicals; Smoking -- Periodicals; 613.85
• DOI: 10.1093/ntr/ntaa032
• Languages: English
• ISSNs: 1462-2203

Abstract

Abstract: Introduction: The Family Smoking Prevention and Tobacco Control Act requires cigarette packages and advertisements to bear health warnings with "color graphics depicting the negative health consequences of smoking." Aims and Methods: This study assessed whether new US Food and Drug Administration developed pictorial cigarette warnings (PCW) increased understanding of smoking-related risks relative to the current Surgeon General's (SG) warnings. In March–May 2019, adolescent and adult smokers and nonsmokers participated in an online experiment with three sessions completed over approximately 2 weeks. Participants viewed 1 of 16 PCW (treatment conditions) or an SG warning (control) on mock cigarette packages and advertisements. Measures assessed whether warnings provided new information, induced thinking about risks, changed smoking-related health beliefs, and were accurately recalled, among other outcomes. Results: The majority of PCW (≥13 conditions) resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks; they were viewed as more informative, understandable, and attention-drawing compared with the control condition. Most participants believed the warning were factual, although 8 PCW were perceived as less factual than the control. There were changes toward more agreement with health beliefs for 11 PCW between Sessions 1 and 2 and 7 PCW between Sessions 1 and 3. Participants in all treatment conditions were more likely than control condition participants to correctly recall the warning. Across outcomes, PCW related to addiction, death, and quitting did not perform as well as other PCW. Conclusions: Many of the PCW tested increased understanding of the risks associated with cigarette smoking relative to current SG warnings. Implications: The Tobacco Control Act requires cigarette packages and advertisements to bear PCW depicting the negative health consequences of smoking. This study tested whether any of 16 newly proposed PCW increased understanding of smoking-related risks relative to existing SG warnings. Results suggest that most PCW tested, particularly those related to less widely known health effects, resulted in greater learning of new information, higher self-reported learning, and greater reports of thinking about smoking risks compared with SG warnings. These results, along with other factors, informed the US Food and Drug Administration's selection of proposed PCW.