title: Interpersonal communication about pictorial health warnings on cigarette packages: Policy-related influences and relationships with smoking cessation attempts.
abstract: This study evaluated the relationship between interpersonal communication about cigarette health warning labels (HWLs), psychological responses to HWLs, and smoking cessation attempts. Data were analyzed from online consumer panels of adult smokers in Australia, Canada and Mexico, during implementation of new pictorial health warning labels (HWLs) on cigarette packs. Approximately 1000 adult smokers were surveyed in each country every four months (September 2012, January 2013, May 2013, September 2013, January 2014). Only smokers followed for at least two waves were included in the analytic sample. Participants reported the frequency of talking about HWLs in the last month (in general, with family members, and with friends). For each country, poisson generalized estimating equation (GEE) models were estimated to assess the bivariate and adjusted correlates of talking about HWLs. Logistic GEE models regressed having attempted to quit by the subsequent wave on HWL talk, sociodemographics and psychological responses to HWLs. The frequency of HWL talk gradually decreased in Canada (48%-36%) after new HWLs were implemented; an increase (30%-58%) in Australia corresponded with implementation of new HWLs, after which talking stabilized; and the frequency of HWL talk in Mexico was stable over time, where new HWLs are implemented every six months. Talk about HWLs was an independent predictor of subsequent quit attempts in Canada (AOR = 1.50; 95% CI = 1.11-2.02), Australia (AOR = 1.41; 95% CI = 1.05-1.89), and Mexico (AOR = 1.53; 95% CI = 1.11-2.10), as was cognitive responses to HWLs (Australia AOR = 1.66; 95% CI = 1.22-2.24; Canada AOR = 1.56; 95% CI = 1.15-2.11; Mexico AOR = 1.30; 95% CI = 0.91-1.85). No interaction between talk and cognitive reactions to HWLs were found. These results suggest that interpersonal communication about HWLs influences smoking cessation attempts independent of other established predictors of smoking cessation, including cessation-related HWL responses. Future research should determine ways to catalyze interpersonal communication about HWLs and thereby potentiate HWL effects.
authors.affiliation: Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA; Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico. Electronic address: thrasher@sc.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.affiliation: Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
authors.forename: Erika N
authors.initials: EN
authors.lastname: Abad-Vivero
authors.affiliation: Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Liling
authors.initials: L
authors.lastname: Huang
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Connor
authors.affiliation: School of Public Health & Health Systems, University of Waterloo, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hammond
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Maansi
authors.initials: M
authors.lastname: Bansal-Travers
authors.affiliation: Cancer Council Victoria, Melbourne, Australia.
authors.forename: Hua-Hie
authors.initials: HH
authors.lastname: Yong
authors.affiliation: Cancer Council Victoria, Melbourne, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.affiliation: Department of Sociology, University of South Carolina, Columbia, USA.
authors.forename: Barry
authors.initials: B
authors.lastname: Markovsky
authors.affiliation: Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, USA.
authors.forename: James
authors.initials: J
authors.lastname: Hardin
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002170:Canada; D016009:Chi-Square Distribution; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011356:Product Labeling / Q000379:methods / Q000592:standards*; D000074285:Smokers / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D062789:Tobacco Products / Q000009:adverse effects
keywords: Australia; Canada; Communication; Health warning labels; Mexico; Policy; Smoking cessation; Tobacco