The findings of a US study have backed the use of graphic imagery on cigarette packets to deter smoking.
The authors found that graphic imagery was perceived as more credible, relevant, and effective by smokers than other types of imagery and text warnings. This was especially true among people of low socioeconomic status, who are most likely to be smokers.
"The present study provided the first direct test of the hypothesis that pictorial health warning labels work better than text-only labels among people with low health literacy," say James Thrasher (University of South Caroline, Columbia, USA) and colleagues.
The study included 981 members of the public who were current smokers. They were randomly assigned to view either the current US packaging, which includes a text warning label, or experimental packaging, where the label displayed either graphic health images, images of human suffering, or symbolic imagery, such as gravestones.
Overall, smokers found that ratings for the credibility, relevance, and efficacy of pictorial labels were higher than for the current, text-only labels.
Among smokers who viewed pictorial labels, graphic imagery consistently scored higher than imagery of human suffering or symbolic imagery. This held true across high- and low-health literacy groups and across Black and White smokers.
Furthermore, when the authors examined interactions between race and health literacy, and the impact of the labels, they found that graphic labels minimized the differences between health literacy and racial groups, whereas symbolic imagery produced the greatest differences in ratings between these groups.
"The current study suggest that graphic pictorial labels will produce the greatest and most consistent impact across subpopulations of smokers, regardless of health-literacy level or race," write Thrasher and colleagues in the American Journal of Preventive Medicine.
Some of the images tested are part of the US Food and Drug Administration's proposed labels for cigarette packaging, but their implementation is currently blocked by a court ruling.
The authors say that further research will be needed to assess how smokers respond to the imagery over time, and how often it should be rotated to avoid habituation.
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