Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups

Results from a Randomized Web-Based Experiment

Jennifer Cantrell, Donna M. Vallone, James F. Thrasher, Rebekah H. Nagler, Shari P. Feirman, Larry R. Muenz, David Y. He, Kasisomayajula Viswanath

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22-1.62), and intention to quit (OR = 1.30, 95% CI = 1.10-1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.

Original languageEnglish (US)
Article numbere52206
JournalPloS one
Volume8
Issue number1
DOIs
StatePublished - Jan 18 2013

Fingerprint

Tobacco
nationalities and ethnic groups
Ethnic Groups
socioeconomics
Labels
tobacco
Health
Product Packaging
education
Education
Experiments
Research
packaging
income
Aptitude
health information
Smoking Cessation
Population
communication (human)
Smoking

Cite this

Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups : Results from a Randomized Web-Based Experiment. / Cantrell, Jennifer; Vallone, Donna M.; Thrasher, James F.; Nagler, Rebekah H.; Feirman, Shari P.; Muenz, Larry R.; He, David Y.; Viswanath, Kasisomayajula.

In: PloS one, Vol. 8, No. 1, e52206, 18.01.2013.

Research output: Contribution to journalArticle

Cantrell, Jennifer ; Vallone, Donna M. ; Thrasher, James F. ; Nagler, Rebekah H. ; Feirman, Shari P. ; Muenz, Larry R. ; He, David Y. ; Viswanath, Kasisomayajula. / Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups : Results from a Randomized Web-Based Experiment. In: PloS one. 2013 ; Vol. 8, No. 1.
@article{01f56c5fbed446e7872592e49b2d5c6d,
title = "Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment",
abstract = "Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95{\%} CI = 1.22-1.62), and intention to quit (OR = 1.30, 95{\%} CI = 1.10-1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.",
author = "Jennifer Cantrell and Vallone, {Donna M.} and Thrasher, {James F.} and Nagler, {Rebekah H.} and Feirman, {Shari P.} and Muenz, {Larry R.} and He, {David Y.} and Kasisomayajula Viswanath",
year = "2013",
month = "1",
day = "18",
doi = "10.1371/journal.pone.0052206",
language = "English (US)",
volume = "8",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "1",

}

TY - JOUR

T1 - Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups

T2 - Results from a Randomized Web-Based Experiment

AU - Cantrell, Jennifer

AU - Vallone, Donna M.

AU - Thrasher, James F.

AU - Nagler, Rebekah H.

AU - Feirman, Shari P.

AU - Muenz, Larry R.

AU - He, David Y.

AU - Viswanath, Kasisomayajula

PY - 2013/1/18

Y1 - 2013/1/18

N2 - Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22-1.62), and intention to quit (OR = 1.30, 95% CI = 1.10-1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.

AB - Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing text-only health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p<.001); perceived impact (b = 0.44, p<.001); credibility (OR = 1.41, 95% CI = 1.22-1.62), and intention to quit (OR = 1.30, 95% CI = 1.10-1.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities.

UR - http://www.scopus.com/inward/record.url?scp=84872354268&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872354268&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0052206

DO - 10.1371/journal.pone.0052206

M3 - Article

VL - 8

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 1

M1 - e52206

ER -