title: Adult smokers' reactions to pictorial health warning labels on cigarette packs in Thailand and moderating effects of type of cigarette smoked: findings from the international tobacco control southeast Asia survey.
abstract: BACKGROUND
  In this study, we aimed to examine, in Thailand, the impact on smokers' reported awareness of and their cognitive and behavioral reactions following the change from text-only to pictorial warnings printed on cigarette packs. We also sought to explore differences by type of cigarette smoked (roll-your-own [RYO] vs. factory-made [FM] cigarettes).
  
  
  METHODS
  Data came from the International Tobacco Control Southeast Asia Survey, conducted in Thailand and Malaysia, where a representative sample of 2,000 adult smokers from each country were recruited and followed up. We analyzed data from one wave before (Wave 1) and two waves after the implementation of the new pictorial warnings (two sets introduced at Waves 2 and 3, respectively) in Thailand, with Malaysia, having text-only warnings, serving as a control.
  
  
  RESULTS
  Following the warning label change in Thailand, smokers' reported awareness and their cognitive and behavioral reactions increased markedly, with the cognitive and behavioral effects sustained at the next follow-up. By contrast, no significant change was observed in Malaysia over the same period. Compared to smokers who smoke any FM cigarettes, smokers of only RYO cigarettes reported a lower salience but greater cognitive reactions to the new pictorial warnings.
  
  
  CONCLUSIONS
  The new Thai pictorial health warning labels have led to a greater impact than the text-only warning labels, and refreshing the pictorial images may have helped sustain effects. This finding provides strong support for introducing pictorial warning labels in low- and middle-income countries, where the benefits may be even greater, given the lower literacy rates and generally lower levels of readily available health information on the risks of smoking.
authors.affiliation: VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Carlton, Victoria 3053, Australia. hua.yong@cancervic.org.au
authors.forename: Hua-Hie
authors.initials: HH
authors.lastname: Yong
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Fong
authors.forename: Pete
authors.initials: P
authors.lastname: Driezen
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.forename: Anne C K
authors.initials: AC
authors.lastname: Quah
authors.forename: Buppha
authors.initials: B
authors.lastname: Sirirassamee
authors.forename: Stephen
authors.initials: S
authors.lastname: Hamann
authors.forename: Maizurah
authors.initials: M
authors.lastname: Omar
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D008875:Middle Aged; D011356:Product Labeling; D012907:Smoking / Q000523:psychology*; D013785:Thailand; D062789:Tobacco Products; D055815:Young Adult