Adding graphic warning labels on cigarette packaging can improve smokers' recall of the warning and health risks associated with smoking, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.
Their findings are published online first in the American Journal of Preventive Medicine.
In past studies in Europe and Canada, graphic warning labels have proved to be effective in eliciting negative responses to smoking, increasing reported intention to quit smoking in smokers, and modifying beliefs about smoking dangers, the researchers noted. However, these previous research results have generally been conducted using large, population-based studies that could be confounded by concurrent tax increases or antismoking media campaigns that coincide with the introduction of new warning labels.
"An important first step in evaluating the true efficacy of the warning labels is to demonstrate if smokers can correctly recall its content or message," said lead author Andrew Strasser, PhD, an associate professor in the department of psychiatry. "Based on this new research, we now have a better understanding of two important questions about how U.S. smokers view graphic warning labels: Do smokers get the message and how do they get the message."
In the study, 200 current smokers were randomized to view either a text-only warning label advertisement, which was unaltered and utilized the U.S. surgeon general's warning and Federal Trade Commission (FTC) testing information that has appeared on cigarette advertisements since 1985; or a graphic warning label version that contained a graphic image (depicting a hospitalized patient on a ventilator) and a health warning with larger text, similar to what has been proposed by the U.S. Food and Drug Administration (FDA) to be adopted in the U.S.
To gauge how the participants viewed the layout of the advertisements, the research team utilized sophisticated eye-tracking technology. With this equipment, they were able to measure dwell time (total time viewing various parts of the ad, including the text or graphic warning), time to first viewing of portions of the ad to assess how attention is drawn, and fixations or the number of times they viewed each area of the ad (including the text or graphic warning). After reading the ads, each study participant also had to rewrite the warning label text to demonstrate their recall of the information.
The researchers found a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% versus 83%. In addition, the quicker a smoker looked at the large text in the graphic warning, and the longer they viewed the graphic image, the more likely they were to recall the information correctly.
The researchers say that the new data demonstrate that drawing attention to the warning label can improve recall of health relevant information, which may extend to improving risk perception of smoking. Additionally, attracting attention to the warning before viewing the advertisement body may change the framing of the message in the advertisement body, causing viewers to approach it with greater caution. Finally, time to first viewing has practical application to real-world settings where people may allocate only a few seconds to a print advertisement. Further study on the size, font, color, and location of text may identify the most effective way to draw attention.
The 2009 Family Smoking Prevention and Tobacco Control Act mandated the FDA to require graphic warning labels on cigarette packages. Originally mandated to appear on cigarette packages in September 2012, the implementation of these warning labels has been held up in court.
