Labels that use graphic images as warnings on cigarette packaging have the most pronounced impact on adult smokers compared with other images or text-only labels, say researchers.
They believe that their findings will help drive the implementation of pictorial labels on cigarette packaging in the USA, where they are not yet used, and help identify the type of images that should be featured.
Lead author James Thrasher (University of South Carolina, Columbia, USA) commented in a press statement: "To inform future warning label policy development and implementation, more data are needed on US consumer responses to various kinds of warning label content."
A group of 774 adult current (daily) smokers who had smoked at least 100 cigarettes in their lifetime were exposed to nine pictorial labels, referring to a variety of health risks associated with secondhand smoke including cancer, heart disease, and lung disease. Each message combined text with an image depicting either a graphic image of diseased organs, human suffering, or an abstract symbol (such as a row of gravestones).
A control group of 207 smokers rated each of the four text-only health warning labels currently on cigarette packs, which warn about the risks for lung cancer, heart disease, emphysema, pregnancy complications, and carbon monoxide inhalation.
As reported in the American Journal of Preventive Medicine, compared with text-only warning labels, pictorial warning labels overall were rated on a 10-point scale as being more personally relevant (5.7 vs 6.8) and effective (5.4 vs 6.8). Pictorial labels were also described as being more credible than text-only labels (8.2 vs 7.6), but only by participants with low health literacy (defined as three or fewer correct responses using the Newest Vital Sign test).
Compared with pictorial health warning labels with images of either human suffering or symbolic imagery, those with graphic imagery consistently had higher mean ratings for credibility (7.99 and 7.05 vs 8.58), relevance (6.98 and 5.81 vs 7.82), and effectiveness (6.95 and 5.69 vs 7.84).
The participants in the study were recruited from low- and middle-income areas, which the authors say shows that the greater impact of pictorial health warning labels over text-only labels applies to smokers from poor backgrounds too.
"These results suggest that the US Food and Drug Administration (FDA) should consider implementing warning labels with more graphic imagery in order to maximize the impact of warnings across different populations of adult smokers, including more disadvantaged smokers," said Thrasher.
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