Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment
Background People who smoke cigars often have misperceptions about the associated risks, contributing to rises in smoking rates. This study investigates the perceived warning effectiveness (PWE) of health warning labels (HWLs) on cigar packages. We tested the impact of warning type and warning size...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e088482.full |
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| author | James F Thrasher Tara L Queen Jennifer Cornacchione Ross Sarah D Kowitt Leah M Ranney Adam O Goldstein Chineme Enyioha Desmond Jenson Paschal Sheeran Sonia A Clark Kristen L Jarman Michelle Z Yang |
| author_facet | James F Thrasher Tara L Queen Jennifer Cornacchione Ross Sarah D Kowitt Leah M Ranney Adam O Goldstein Chineme Enyioha Desmond Jenson Paschal Sheeran Sonia A Clark Kristen L Jarman Michelle Z Yang |
| author_sort | James F Thrasher |
| collection | DOAJ |
| description | Background People who smoke cigars often have misperceptions about the associated risks, contributing to rises in smoking rates. This study investigates the perceived warning effectiveness (PWE) of health warning labels (HWLs) on cigar packages. We tested the impact of warning type and warning size in the HWLs on PWE and other health outcomes.Data and methods In a between-subjects experimental design, participants (n=809) who used little cigars or cigarillos in the past 30 days were randomly assigned to one of four conditions: text-only at 30% size, pictorial+text warning at 30% size, text-only at 50% size and pictorial+text warning at 50% size. In each condition, participants rated six cigarillo HWLs on PWE, self-reported learning, thinking about risks, new knowledge, perceived enjoyment and negative affect. Reactance to the labels was also measured. Data were analysed with mixed-effects models.Results Pictorial+text cigarillo HWLs were deemed more effective than text-only HWLs in PWE (b=0.34, SE=0.08, p<0.001), self-reported learning (b=0.20, SE=0.08, p=0.01), thinking about risks (b=0.18, SE=0.08, p=0.03) and new knowledge (b=0.34, SE=0.12, p<0.01). They also elicited more negative affect than text-only warnings (b=0.39, SE=0.08, p<0.001). Warning size did not impact outcomes, and neither warning type nor size predicted perceived enjoyment of smoking cigarillos or reactance to the warnings.Conclusion Including images with text warning statements for cigarillos can increase PWE. Our findings provide important insights for the US Food and Drug Administration and international regulatory agencies in designing new HWLs for cigars that can more effectively communicate smoking risks, address misinformation and potentially reduce cigar smoking. |
| format | Article |
| id | doaj-art-03e2a865dcd34349bb0303f19eb75912 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-03e2a865dcd34349bb0303f19eb759122025-01-17T23:05:09ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-088482Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experimentJames F Thrasher0Tara L Queen1Jennifer Cornacchione Ross2Sarah D Kowitt3Leah M Ranney4Adam O Goldstein5Chineme Enyioha6Desmond Jenson7Paschal Sheeran8Sonia A Clark9Kristen L Jarman10Michelle Z Yang116 Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA4 Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA5 Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA1 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA1 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA1 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA7 Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, Minnesota, USA2 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA1 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA1 Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA3 Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USABackground People who smoke cigars often have misperceptions about the associated risks, contributing to rises in smoking rates. This study investigates the perceived warning effectiveness (PWE) of health warning labels (HWLs) on cigar packages. We tested the impact of warning type and warning size in the HWLs on PWE and other health outcomes.Data and methods In a between-subjects experimental design, participants (n=809) who used little cigars or cigarillos in the past 30 days were randomly assigned to one of four conditions: text-only at 30% size, pictorial+text warning at 30% size, text-only at 50% size and pictorial+text warning at 50% size. In each condition, participants rated six cigarillo HWLs on PWE, self-reported learning, thinking about risks, new knowledge, perceived enjoyment and negative affect. Reactance to the labels was also measured. Data were analysed with mixed-effects models.Results Pictorial+text cigarillo HWLs were deemed more effective than text-only HWLs in PWE (b=0.34, SE=0.08, p<0.001), self-reported learning (b=0.20, SE=0.08, p=0.01), thinking about risks (b=0.18, SE=0.08, p=0.03) and new knowledge (b=0.34, SE=0.12, p<0.01). They also elicited more negative affect than text-only warnings (b=0.39, SE=0.08, p<0.001). Warning size did not impact outcomes, and neither warning type nor size predicted perceived enjoyment of smoking cigarillos or reactance to the warnings.Conclusion Including images with text warning statements for cigarillos can increase PWE. Our findings provide important insights for the US Food and Drug Administration and international regulatory agencies in designing new HWLs for cigars that can more effectively communicate smoking risks, address misinformation and potentially reduce cigar smoking.https://bmjopen.bmj.com/content/15/1/e088482.full |
| spellingShingle | James F Thrasher Tara L Queen Jennifer Cornacchione Ross Sarah D Kowitt Leah M Ranney Adam O Goldstein Chineme Enyioha Desmond Jenson Paschal Sheeran Sonia A Clark Kristen L Jarman Michelle Z Yang Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment BMJ Open |
| title | Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment |
| title_full | Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment |
| title_fullStr | Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment |
| title_full_unstemmed | Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment |
| title_short | Impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between-subjects experiment |
| title_sort | impact of warning pictorials and size on perceived effectiveness of cigar warning labels in a nationally representative between subjects experiment |
| url | https://bmjopen.bmj.com/content/15/1/e088482.full |
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