College student reactions to health warning labels: Sociodemographic and psychosocial factors related to perceived effectiveness of different approaches
Highlights
► Cigarette health warning labels may impact smoking initiation and cessation. ► Several factors are related to perceived effectiveness of different warning labels. ► Those at greatest risk for smoking perceive gruesome warnings as most effective. ► Those at least risk for smoking perceive testimonial messages as most effective. ► Policy should ensure using warnings that will effectively target young adults.
Introduction
Health concerns are the most common motivation for cessation (Hyland et al., 2004). Textual warnings on cigarette packaging increase knowledge regarding smoking-related risks (Hammond, 2011). However, pictorial (versus text-only) warnings are more effective in increasing knowledge and promoting quitting (Borland et al., 2009, Thrasher et al., 2007, Hammond, 2011). Although research suggests that gruesome imagery is more effective than symbolism (Thrasher et al., 2006), most of this research has focused on adult smokers (Hammond et al., 2007, Hammond et al., 2003). Examining those in young adulthood is critical, as it is an important transition period for smoking (Everett et al., 1999). Thus, we examined: (1) perceptions of effectiveness of health warning imagery in preventing uptake of smoking or promoting cessation, and (2) characteristics related to perceiving different types of warnings as effective among college students.
Section snippets
Participants and procedures
In Fall, 2010, among 24,055 students at six Southeast colleges recruited to complete an online survey, 4840 (20.1%) participated, with 2600 completing all questions on health warning images. As incentive, participants received entry into a drawing for cash prizes (for detailed methods description, see Berg et al., in press). The Emory University Institutional Review Board approved this study, IRB# 00030631.
Measures
Participants were presented with four different message themes (cancer risk,
Results
Participants' mean age was 23.43 years (SD = 6.93), the majority (71.1%) was female, 46.2% were non-Hispanic White, 38.2% were Black, 62.4% had parents with < BA degree, and 23.5% were current smokers.
Participants endorsed gruesome images as most effective in each content area, with testimonials rated as most effective second most frequently (Fig. 1). We categorized participants who rated three or four of any one approach as most effective into one of four categories. The proportion consistently
Discussion
This is the first study documenting differences in perceived effectiveness of different types of pictorial warning labels in motivating smokers to quit or preventing smoking initiation among U.S. young adults. Consistent with prior research (Hammond et al., 2007, Hammond et al., 2004, Thrasher et al., 2006, Thrasher et al., 2010), gruesome images were consistently rated most effective (78.6%), whereas one-fifth of participants consistently rated testimonials most effective. Few rated suffering
Conclusions
Individuals at greatest risk for smoking and lowest motivation and self-efficacy for quitting perceive gruesome warning labels to be most effective; thus, this is a promising approach for framing health warning labels. However, some are more appropriately addressed using testimonial messages. Thus, policy should ensure that young adults are being effectively targeted in tobacco control efforts.
Conflict of interest statement
The authors declare no conflicts of interest.
Acknowledgment
This research was supported by the National Cancer Institute (1K07CA139114-01A1; PI: Berg) and the Georgia Cancer Coalition (PI: Berg). Dr. Ahluwalia is supported in part by 1P60MD003422 from the National Institute for Minority Health Disparities. We would like to thank our collaborators across the state of Georgia in developing and administering this survey.
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