The effects of tobacco-related health-warning images on intention to quit smoking among urban Chinese smokers

Abstract

Objective:

The purpose of this study was to explore the effects of different tobacco health-warning images on intention to quit smoking among urban Chinese smokers. The different tobacco health-warning images utilised in this study addressed the five variables of age, gender, cultural-appropriateness, abstractness and explicitness.

Design:

Participants were administered a questionnaire that contained 10 graphic anti-smoking images. Of the 10 images, two each represented the independent variables of age, gender, cultural-appropriateness, abstractness and explicitness. The dependent variable in this study was intention to quit smoking.

Setting:

A cross-sectional survey was conducted using face-to-face interviews with 699 residents of Hangzhou, China. The study focused on 202 of those residents who self-reported as smokers.

Method:

Data were collected using a multi-stage sampling design. A Likert-type scale was used to measure quitting intentions after viewing graphic health-warning images. Data analysis was conducted using SAS version 9.3, and paired Chi-square tests were performed to analyse the effect of different graphic tobacco health-warning images on intention to quit smoking among current smokers.

Results:

More than 50% of smokers studied reported they were interested in quitting smoking after viewing the graphic images. Images featuring children and women, real pictures of damaged lungs and pictures that were more explicit produced higher intentions to quit smoking than abstract, male-dominated or less explicit images.

Conclusion:

When designing tobacco-related health-warning images for mass media campaigns, utilising more explicit photos and photographs involving women and children is potentially most effective. These findings provide evidence that the Chinese government should consider when initiating future anti-smoking campaigns utilising such images. Furthermore, these images should appear on all cigarette packages replacing the current text-only warnings.

Keywords

Effects intention quit smoking tobacco-warning images urban Chinese smokers

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References

Andrews

Netemeyer

Burton

. (2004) Understanding adolescent intentions to smoke: An examination of relationships among social influence, prior trial behavior, and antitobacco campaign advertising. Journal of Marketing 68(3): 110–123.

Bazzo

Battistella

Riscica

. (2012) Evaluation of the impact of the image used in a communication campaign to raise awareness about the effects of alcohol use during pregnancy (dagger). Alcohol and Alcoholism 47(6): 657–662.

Borland

Wilson

Fong

. (2009) Impact of graphic and text warnings on cigarette packs: Findings from four countries over five years. Tobacco Control 18(5): 358–364.

Cantrell

Vallone

Thrasher

. (2013) Impact of tobacco-related health warning labels across socioeconomic, race and ethnic groups: Results from a randomized web-based experiment. PLoS One 8(1): e52206.

Chang

Chung

. (2011) The impact of graphic cigarette warning labels and smoke-free law on health awareness and thoughts of quitting in Taiwan. Health Education Research 26(2): 179–191.

Chinese Center for Disease Control and Prevention (2010) Global Adult Tobacco Survey (GATS) China 2010 Country Report. Beijing, China: China Three Gorges Publishing House.

Crespo

Barrio

Cabestrero

. (2008) Cognitive processing and assessment of anti-smoking combined warning labels proposed by the European Commission: An empirical study with a Spanish sample. Psychology in Spain 12(1): 26–36.

Davies

Haines

Norris

. (1998) Safety pictograms: Are they getting the message across? Applied Ergonomics 29(1): 15–23.

Dreyfuss

(1984) Symbol Sourcebook: An Authoritative Guide to International Graphic Symbols. New York: John Wiley & Sons, Inc.

10.

Fathelrahman

Omar

Awang

. (2009) Smokers’ responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy. Nicotine & Tobacco Research 11(3): 248–253.

11.

Feng

Jiang

. (2010) Individual-level factors associated with intentions to quit smoking among adult smokers in six cities of China: Findings from the ITC China Survey. Tobacco Control 19(Suppl. 2): i6–i11.

12.

Fong

Hammond

Jiang

. (2010) Perceptions of tobacco health warnings in China compared with picture and text-only health warnings from other countries: An experimental study. Tobacco Control 19(Suppl. 2): i69–i77.

13.

Framework Convention Alliance (2008) Dirty Ashtray Award (FCA Bulletin 82). Geneva: Framework Convention Alliance.

14.

Friend

Levy

(2002) Reductions in smoking prevalence and cigarette consumption associated with mass-media campaigns. Health Education Research 17(1): 85–98.

15.

Gallopel-Morvan

Gabriel

Le Gall-Ely

. (2011) The use of visual warnings in social marketing: The case of tobacco. Journal of Business Research 64(1): 7–11.

16.

Hammond

(2011) Health warning messages on tobacco products: A review. Tobacco Control 20(5): 327–337.

17.

Hammond

Fong

Borland

. (2007) Text and graphic warnings on cigarette packages: Findings from the international tobacco control four country study. American Journal of Preventive Medicine 32(3): 202–209.

18.

Hammond

Fong

McDonald

. (2003) Impact of the graphic Canadian warning labels on adult smoking behaviour. Tobacco Control 12(4): 391–395.

19.

Hammond

Fong

McDonald

. (2004) Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. American Journal of Public Health 94(8): 1442–1445.

20.

Kees

Burton

Craig Andrews

. (2010) Understanding how graphic pictorial warnings work on cigarette packaging. Journal of Public Policy & Marketing 29(2): 265–276.

21.

Laroche

Toffoli

Zhang

. (2001) A cross-cultural study of the persuasive effect of fear appeal messages in cigarette advertising: China and Canada. International Journal of Advertising 20(3): 297–318.

22.

Hong

. (2011) Implementation of the WHO framework convention on tobacco control in mainland China. Tobacco Control 20(4): 309–314.

23.

O’Hegarty

Pederson

Yenokyan

. (2007) Young adults’ perceptions of cigarette warning labels in the United States and Canada. Preventing Chronic Disease 4(2): A27.

24.

Pechmann

Knight

(2002) An experimental investigation of the joint effects of advertising and peers on adolescents’ beliefs and intentions about cigarette consumption. Journal of Consumer Research 29(1): 5–19.

25.

Reardon

Miller

Foubert

. (2006) Antismoking messages for the international teenage segment: The effectiveness of message valence and intensity across different cultures. Journal of International Marketing 14(3): 115–138.

26.

Shanahan

Elliott

(2009) Evaluation of the Effectiveness of the Graphic Health Warnings on Tobacco Product Packaging 2008. Canberra, ACT, Australia: Department of Health and Ageing, Australian Government, pp. 144–145.

27.

Sobani

Nizami

Raza

. (2010) Graphic tobacco health warnings: Which genre to choose? International Journal of Tuberculosis and Lung Disease 14(3): 356–361.

28.

Strahan

White

Fong

. (2002) Enhancing the effectiveness of tobacco package warning labels: A social psychological perspective. Tobacco Control 11(3): 183–190.

29.

Sweet

Willis

Ashida

. (2003) Use of fear-appeal techniques in the design of tailored cancer risk communication messages: Implications for healthcare providers. Journal of Clinical Oncology 21(17): 3375–3376.

30.

Thrasher

Carpenter

Andrews

. (2012) Cigarette warning label policy alternatives and smoking-related health disparities. American Journal of Preventive Medicine 43(6): 590–600.

31.

Thrasher

Hammond

Fong

. (2007) Smokers’ reactions to cigarette package warnings with graphic imagery and with only text: A comparison between Mexico and Canada. Salud Pública de México 49(Suppl. 2): S233–S240.

32.

Vardavas

Connolly

Karamanolis

. (2009) Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels. European Journal of Public Health 19(2): 212–217.

33.

Witte

Allen

(2000) A meta-analysis of fear appeals: Implications for effective public health campaigns. Health Education & Behavior 27(5): 591–615.

34.

World Health Organization (WHO) (2003) WHO Framework Convention on Tobacco Control. Geneva: WHO.

35.

World Health Organization (WHO) (2008) WHO Report on the Global Tobacco Epidemic, 2008: The MPOWER Package. Geneva: WHO.

36.

World Health Organization (WHO) (2009) World No Tobacco Day 2009: Pictorial Health Warnings on Tobacco Packaging. Geneva: WHO.

37.

World Health Organization (WHO) (2011) WHO Report on the Global Tobacco Epidemic, 2011: Warning About the Dangers of Tobacco. Geneva: WHO.

38.

World Health Organization (WHO) (2013) WHO Report on the Global Tobacco Epidemic, 2013: Enforcing Bans on Tobacco Advertising, Promotion and Sponsorship. Geneva: WHO.

39.

Yang

(2010) Tobacco Control Theory and Implementation. Beijing, China: People’s Medical Publishing House.

40.

Yang

Rockett

. (2012a) Tobacco advertising, environmental smoking bans, and smoking in Chinese urban areas. Drug and Alcohol Dependence 124(1): 121–127.

41.

Yang

Rockett

. (2012b) Stress status and related characteristics among urban residents: A six-province capital cities study in China. PLoS One 7(1): 1.

42.

Yang

Abdullah

. (2007) Attitudes and behavioral response toward key tobacco control measures from the FCTC among Chinese urban residents. BMC Public Health 7: 248.

43.

Zhou

Cheng

(2006) Research on Countering Tactics for WHO Framework Convention on Tobacco Control and Impact from Tobacco in China. Beijing, China: Economic Science Press.