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Soc Sci Med. 2016 Sep;164:118-129. doi: 10.1016/j.socscimed.2016.06.011. Epub 2016 Jul 13.

The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies.

Author information

1
School of Media and Journalism, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA. Electronic address: noar@email.unc.edu.
2
School of Media and Journalism, University of North Carolina at Chapel Hill, USA.
3
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
4
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA.

Abstract

OBJECTIVES:

Cigarette pack warnings are a tobacco control strategy used globally. To understand their impact, we systematically reviewed longitudinal observational studies examining national implementation of strengthened warnings.

METHODS:

We used comprehensive search procedures to identify observational studies examining the impact of strengthening cigarette pack warnings. We report longitudinal changes in knowledge, beliefs, attitudes, intentions, and behavior.

RESULTS:

We identified 32 studies conducted in 20 countries with 812,363 participants. Studies commonly examined changes from text to pictorial warnings (64%); the remainder examined strengthened text or strengthened pictorial warnings. Knowledge increased in all 12 studies that assessed it. Studies of beliefs/attitudes and intentions showed mixed results. Quitline calls increased in four of six studies, while foregoing of cigarettes did not increase. Cigarette consumption decreased in three of eight studies; quit attempts increased in four of seven studies; and short-term cessation increased in two of three studies. Smoking prevalence decreased in six of nine studies.

CONCLUSIONS:

Strengthening warnings was associated with longitudinal increases in knowledge, quitline calls and reductions in smoking behavior. Strengthening warning policies should be a priority for tobacco control globally.

KEYWORDS:

Graphic; Observational; Pictorial; Smoking; Theory; Warning

PMID:
27423739
PMCID:
PMC5026824
DOI:
10.1016/j.socscimed.2016.06.011
[Indexed for MEDLINE]
Free PMC Article

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