Australian University Student Perceptions of Health Messages on Cigarette Sticks

ABSTRACT

University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on individual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and individual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings (divided into four themes; immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on individual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (n = 479; Mean age = 22 years) rated three themes (ISC, LMC, and SFC) as being overall more effective (all p < .001) than current packaging warnings (Odds Ratios = 5.93 [4.51–7.80], 3.60 [2.79–4.64], and 2.86 [2.21–3.69] respectively). Participants described a desensitisation to current packaging warnings, and the novel warnings displayed potentially overcoming this issue, with over 85% agreeing that individual cigarette sticks should include health warnings. Health warnings on cigarette sticks may serve as an effective means in reducing tobacco use, with the provision of this additional intervention for communicating the health and other negative consequences of smoking likely reinforcing the effects of current packaging warnings.     

Waterpipe Tobacco Smoking on a U.S. College Campus: Prevalence and Correlates

PURPOSE: Waterpipe tobacco smoking is reported to be growing in popularity, particularly among college students. This study examined the prevalence of waterpipe tobacco smoking prevalence and perceptions in a university-based population. METHOD: This was a cross-sectional Internet-based survey of first-year university students, which examined waterpipe tobacco smoking and other tobacco use, risk perceptions, influences, and perceived social acceptability. RESULTS: Waterpipe tobacco smoking within the past 30 days was reported by 20% (151/744). Relative to never users, users were more likely to perceive waterpipe tobacco smoking as less harmful than cigarette use. CONCLUSIONS: Because waterpipe tobacco smoking is increasing in prevalence and because it can involve toxicant inhalation at even greater levels than with cigarette smoking, it represents a growing public health issue.     

Warnhinweise auf Zigarettenschachteln

The implementation of health warnings leads to continuous dissemination of the latest scientific findings on the health consequences of smoking. In combination with other recognized effective tobacco control measures, a lower consumption and an increased quit-rate are thus to be stimulated. The effectiveness of health warnings depends on their content as well as on their design and size. Thus, large warnings are by far better than smaller warnings. The same applies for warnings that are placed on the front of cigarette packets. Warnings that incorporate pictures are considerably more effective than warnings based solely on text. The combination of pictures and text format is most effective. International experience shows that the dissemination of Quitline phone numbers in combination with health warnings on every packet clearly improves the effectiveness and broad reach of smoking cessation advice via Quitlines. The implementation of pictorial health warnings combined with the imprint of the phone number of the Quitline of the Federal Center for Heath Education is highly recommended in Germany.     

Evaluating the Emotional Impact of Warning Images on Young Adult Smokers and Susceptible Non-Smokers

On-pack tobacco warnings typically feature long-term health risks, which many young adults rationalize or reject. We examined the emotions generated by more proximal warnings to see if we could identify common features among the most effective warnings. Respondents in a sample of 474 smokers and 476 susceptible non-smokers used a modified Geneva Emotion Wheel (GEW) to assess cigarette packs displaying 12 test warnings and one current warning. The strongest emotions aroused in smokers were disgust, disappointment, and regret. Three warnings showing the effect of smoking on babies and animals had significantly higher emotional potency scores than a current health warning. Among susceptible non-smokers, warnings showing harm to animals, child labor, and a dying smoker had the highest emotional potency. Stronger negative emotions were elicited from both smokers and susceptible non-smokers by warnings that featured more proximal outcomes than are typically shown in on-pack tobacco warnings. On-pack warnings that resonate with young people, the group most at risk of smoking and most likely to benefit from quitting, could promote cessation and deter initiation more effectively than warnings depicting long-term health outcomes. The GEW could be used to screen potential warning images to identify those most likely to be worth evaluating.     

Do cigarette warnings warn? Understanding what it will take to develop more effective warnings

Warnings in cigarette advertisements have been the principal method mandated by the federal government to educate consumers about the risks of smoking. Warnings have been required in all cigarette ads for 30 years and have remained largely unchanged during this time. The current warning program was neither developed nor implemented with specific communication goals in mind. Instead, it was negotiated by the government and tobacco industry representatives. The warning program has served the tobacco industry well by providing it with a key argument in tobacco litigation: "We warned you." It has, however, failed as a public health strategy, since much research has shown that the current warnings are ineffective communication devices. If Congress is to be effective in its efforts to educate consumers about the risks of smoking, it needs to rethink the warning strategy while making use of knowledge regarding how warnings work. The paper draws from current studies in order to develop realistic cigarette warning objectives and points out the considerations necessary to create such warnings. To be effective, warnings must be developed, targeted, tested, and revised over time.     

Association between infection early in life and mental disorders among youth in the community: a cross-sectional study

Background

Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages.

Methods

This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers.

Results

Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers.

Conclusion

Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.     

Smoking control strategies in developing countries: report of a WHO Expert Committee

An Expert Committee met in World Health Organization Headquarters in Geneva in November 1982 to discuss Smoking Control Strategies in Developing Countries. They reviewed the harmful health effects of different types of tobacco which characterized developing countries and the adverse effects of tobacco use on their economics due to smoking related diseases and higher smokers' work absenteeism. It advised on the objectives of smoking control programs, including data collection; education and information; legislation; smoking cessation; the role of medical, political, social, and religious leaders; the role of WHO, UN agencies, and nongovernmental organizations; research on smoking behavior; and evaluation of program efficacy. In addition, the Committee provided guidance on how to counteract tobacco industry arguments. More than a million people worldwide die prematurely each year because of cigarette smoking. In developed countries smoking is generally understood to cause lung cancer, coronary heart disease, chronic bronchitis, and other respiratory disorders. Major campaigns have been launched to reduce the rate of smoking. The public in most developing countries are unaware of the dangers, and no educational, legislative, or other measures are being taken to combat the smoking epidemic. The Committee called for firm steps to be taken to prevent this unnecessary modern epidemic. The incidence of tobacco related diseases is increasing in developing countries. Many of the developing countries have cigarettes on sale with high yields of tar and nicotine. Tobacco cultivation has spread to about 120 countries, becoming a substantial source of employment and creating new vested interests. Overall, the costs outweigh the "benefits." Tobacco taxes may be Politically comfortable," that is, easy to administer and generally acceptable to smokers, but these taxes do not contribute to national wealth but merely redistribute wealth. They cannot offset the economic losses caused by tobacco production and use: health service expenditures on smoking related diseases, disablement and work absenteeism, domestic and forest fires, use of scarce fule to cure tobacco, and reduced food production. Action against smoking can be inexpensive yet effective. Health warnings can be placed on cigarette packets, and legislation can be enacted to put an end to the double standards in marketing practices, whereby cigarettes of the same brand carrying health warnings in developed countries are marketed without these warnings in developing countries. Recommendations issued to governments and public health authorities in developing countries are listed.     

Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study

BACKGROUND: Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the United States. The current study examined the effectiveness of health warnings on cigarette packages in four countries. METHODS: Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (n=14,975): Canada (n=3687), United States (n=4273), UK (n=3634), and Australia (n=3381). Surveys were conducted between 2002 and 2005, before and at three time points following implementation of new package warnings in the UK. RESULTS: At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave. CONCLUSIONS: Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.     

上海市杨浦区职校学生吸烟现状及影响因素分析

目的 了解上海杨浦区职校学生吸烟现况及其影响因素。方法 通过整群抽样方法,选择杨浦区一所职校233名学生进行此项调查。结果 调查人群的尝试吸烟率是22.32%,现在使用卷烟制品率为9.01%,现在吸烟率为6.44%,不同人群的男生发生率均显著高于女生,差异有统计学意义(P<0.05);家人吸烟的学生尝试吸烟率高于家人不吸烟的学生,差异无统计学意义。任课老师吸烟的学生尝试吸烟率和现在使用卷烟制品率高于老师不吸烟的学生,差异无统计学意义;好朋友吸烟的学生尝试吸烟率、现在使用卷烟制品率和现在吸烟率均高于好朋友不吸烟的学生,差异有统计学意义(P<0.05);学习成绩中等以下的学生现在使用卷烟制品率显著高于成绩中等及以上的学生,差异有统计学意义(P<0.05);接触烟制品的人群对烟草危害的知晓率低于不接触烟制品的学生,差异无统计学意义。Logistic回归分析显示,男生是吸烟行为的危险因素,好朋友吸烟是尝试吸烟行为的危险因素,学习成绩中等及以上是现在使用卷烟制品行为的保护因素。结论 吸烟严重危害着学生的身心健康,我们要关注不同的类型的学生,特别是职业技术类学校的学生,要做好宣传教育工作,把吸烟行为控制在初始状态。