title: Mediational pathways of the impact of cigarette warning labels on quit attempts.
abstract: OBJECTIVE
  To test and develop, using structural equation modeling, a robust model of the mediational pathways through which health warning labels exert their influence on smokers' subsequent quitting behavior.
  
  
  METHODS
  Data come from the International Tobacco Control Four-Country Survey, a longitudinal cohort study conducted in Australia, Canada, the United Kingdom, and the United States. Waves 5-6 data (n = 4,988) were used to calibrate the hypothesized model of warning label impact on subsequent quit attempts via a set of policy-specific and general psychosocial mediators. The finalized model was validated using Waves 6-7 data (n = 5065).
  
  
  RESULTS
  As hypothesized, warning label salience was positively associated with thoughts about risks of smoking stimulated by the warnings (β = .58, p < .001), which in turn were positively related to increased worry about negative outcomes of smoking (β = .52, p < .001); increased worry in turn predicted stronger intention to quit (β = .39, p < .001), which was a strong predictor of subsequent quit attempts (β = .39, p < .001). This calibrated model was successfully replicated using Waves 6-7 data.
  
  
  CONCLUSIONS
  Health warning labels seem to influence future quitting attempts primarily through their ability to stimulate thoughts about the risks of smoking, which in turn help to raise smoking-related health concerns, which lead to stronger intentions to quit, a known key predictor of future quit attempts for smokers. By making warning labels more salient and engaging, they should have a greater chance to change behavior.
authors: VicHealth Centre for Tobacco Control, The Cancer Council Victoria.
authors: Hua-Hie
authors: HH
authors: Yong
authors: VicHealth Centre for Tobacco Control, The Cancer Council Victoria.
authors: Ron
authors: R
authors: Borland
authors: Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina.
authors: James F
authors: JF
authors: Thrasher
authors: Department of Statistics and Actuarial Science, University of Waterloo.
authors: Mary E
authors: ME
authors: Thompson
authors: Department of Health Promotion, Maastricht University.
authors: Gera E
authors: GE
authors: Nagelhout
authors: Department of Psychology, University of Waterloo.
authors: Geoffrey T
authors: GT
authors: Fong
authors: School of Public Health and Health Systems, University of Waterloo.
authors: David
authors: D
authors: Hammond
authors: Hollings Cancer Center, Medical University of South Carolina.
authors: K Michael
authors: KM
authors: Cummings
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002170:Canada; D015331:Cohort Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D011356:Product Labeling; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D062789:Tobacco Products / Q000009:adverse effects*; D006113:United Kingdom; D014481:United States; D055815:Young Adult