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Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content

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Abstract

Objective

The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects.

Methods

Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering).

Results

Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering.

Conclusions

Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

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Acknowledgments

Funding for data collection and analysis on this study came from the Union against Tuberculosis and Lung Disease (Mexico 7-1), with additional support for analysis coming from CONACyT (Convocatoria Salud-2007-C01-70032) and the US National Cancer Institute (P01 CA138389). Dr Ernesto Sebrié was supported by the Flight Attendant Medical Research Institute (FAMRI).

Author information

Authors and Affiliations

  1. Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Room 215, Columbia, SC, 29208, USA

    James F. Thrasher & Jarvis Carter

  2. Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico

    James F. Thrasher, Edna Arillo-Santillán & Rosaura Pérez-Hernández

  3. School of Public Health, University of California, Berkeley, CA, USA

    Victor Villalobos

  4. School of Public Health & Health Systems, University of Waterloo, Waterloo, Canada

    David Hammond

  5. Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA

    Ernesto Sebrié

  6. Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico

    Raul Sansores

  7. Consejo Nacional contra Adicciones, Secretaría de Salud, Mexico City, Mexico

    Justino Regalado-Piñeda

Authors
  1. James F. Thrasher
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  2. Edna Arillo-Santillán
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  4. Rosaura Pérez-Hernández
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  5. David Hammond
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  6. Jarvis Carter
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  7. Ernesto Sebrié
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  9. Justino Regalado-Piñeda
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Corresponding author

Correspondence to James F. Thrasher.

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Thrasher, J.F., Arillo-Santillán, E., Villalobos, V. et al. Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content. Cancer Causes Control 23 (Suppl 1), 69–80 (2012). https://doi.org/10.1007/s10552-012-9899-8

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  • DOI: https://doi.org/10.1007/s10552-012-9899-8

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