In what the researchers say is the first-of-its-kind study in the U.S., the addition of graphic warning labels on cigarette packaging was found to improve smokers' recall of the warning and health risks associated with smoking. The study by researchers at the Perelman School of Medicine at the University of Pennsylvania is now available online ahead of print in the American Journal of Preventive Medicine.
As the authors explained in a news release, in past studies in Europe and Canada, graphic warning labels have proven to be effective in eliciting negative responses to smoking, increasing reported intention to quit smoking in smokers, and modifying beliefs about smoking dangers. These previous research results, though, have generally been conducted using large, population-based studies that could be confounded by concurrent tax increases or anti-smoking 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 the study's lead author, Andrew A. Strasser, PhD, 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 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 FDA to be adopted in the U.S.
To gauge how the participants viewed the layout of the advertisements, the researchers used eye-tracking technology, which made it possible to measure “dwell time” (the total time viewing various parts of the ad, including the text or graphic warning), the 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, study participants also had to rewrite the warning label text to demonstrate their recall of the information.
A significant difference was found in the percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50 vs. 83 percent. In addition, the quicker smokers looked at the large text in the graphic warning, and the longer they viewed the graphic image, the more likely they were at recalling the information correctly.
“In addition to showing the value of adding a graphic warning label, this research also provides valuable insight into how the warning labels may be effective, which may serve to create more effective warning labels in the future,” Strasser said. “We're hopeful that once the graphic warning labels are implemented, we will be able to make great strides in helping people to be better informed about their risks, and to convince them to quit smoking.”
The 2009 Family Smoking Prevention and Tobacco Control Act mandated that the FDA require graphic warning labels on cigarette packages. Originally mandated to appear this September, the implementation of these warning labels has now been held up in court.
The researchers note that this particular study was designed to gauge short-term recall of the graphic warning information and that additional research addressing long-term recall and behavior changes is now under way at Penn.