Pictorial health warning label content and smokers' understanding of smoking-related risks-a cross-country comparison.
The aim of the present study was to assess smokers' level of agreement with smoking-related risks and toxic tobacco constituents relative to inclusion of these topics on health warning labels (HWLs). 1000 adult smokers were interviewed between 2012 and 2013 from online consumer panels of adult smokers from each of the three countries: Australia (AU), Canada (CA) and Mexico (MX). Generalized estimating equation models were estimated to compare agreement with smoking-related risks and toxic tobacco constituents. For disease outcomes described on HWLs across all three countries, there were few statistical differences in agreement with health outcomes (e.g. emphysema and heart attack). By contrast, increases in agreement where the HWLs were revised or introduced on HWLs for the first time (e.g. blindness in AU and CA, bladder cancer in CA). Similarly, samples from countries that have specific health content or toxic constituents on HWLs showed higher agreement for that particular disease or toxin than countries without (e.g. higher agreement for gangrene and blindness in AU, higher agreement for bladder cancer and all toxic constituents except nitrosamines and radioactive polonium in CA). Pictorial HWL content is associated with greater awareness of smoking-related risks and toxic tobacco constituents.
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK swayampa@mailbox.sc.edu.
Kamala
K
Swayampakala
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
James F
JF
Thrasher
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
David
D
Hammond
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
Hua-Hie
HH
Yong
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
Maansi
M
Bansal-Travers
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
Dean
D
Krugman
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
Abraham
A
Brown
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
Ron
R
Borland
Department of Epidemiology and Biostatistics, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1, VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria 3053, Australia, Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA, Department of Advertising and Public Relations, University of Georgia, Athens, GA 30602, USA and Division of Marketing, Nottingham Trent University, Nottingham NG1 4BU, UK.
James
J
Hardin
D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D001364:Awareness; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000139:chemically induced; D003431:Cross-Cultural Comparison; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033182:Intention; D007407:Interviews as Topic; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D011356:Product Labeling / Q000379:methods* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000139:chemically induced; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000208:ethnology* / Q000523:psychology; D016540:Smoking Cessation / Q000208:ethnology / Q000523:psychology; D012959:Socioeconomic Factors; D062789:Tobacco Products / Q000009:adverse effects*; D055815:Young Adult