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Communicating Smoking Risks Through Graphic Warning Labels

Principal Investigator: Daniel Romer

Funding Mechanism: National Institutes of Health- Grant

ID number: 1R01CA157824-01A1

Award Date: 9/1/2012

Institution: University of Pennsylvania


Although decreasing cigarette use requires a range of strategies, one particularly effective way to reach smokers is through graphic warning labels on cigarette packaging. The goal of these studies is to identify warning label components that can maximize quit intentions by decreasing the motivation to smoke and/or increasing the motivation to quit.  Study aims are: (1) to determine whether different combinations of graphic label components lead to greater overall quit intentions among adult smokers; (2) to determine in an Internet study how well the most effective warning labels from Aim 1 perform for adolescent smokers and vulnerable nonsmokers; (3) to determine in an Internet study how well these same most effective warning labels perform for adult smokers; and (4) to examine the effects of the program on individuals with low education/literacy levels to determine whether the labels are effective for them. To fulfill Aim 1, investigators will conduct a randomized controlled trial of adult smokers given their own brand of cigarettes with one of three sets of warning labels for a period of 28 days. The three sets of labels include one control text-only condition with no image, an experimental condition with the same text plus images originally mandated by the FDA, and a second experimental condition that includes the same text and images plus additional text elaborating the hazards of smoking each additional cigarette. The trial will involve weekly assessments to evaluate responses to the labels and the effects on quit intention, amount smoked, motivation to smoke, and motivation to quit; expired breath carbon monoxide will also be measured at each visit as an indicator of cigarette smoke exposure. To fulfill Aims 2 and 3, investigators will conduct a second study in which they will examine the effects of warning labels used in the U.S. on adolescents vulnerable to smoking, adolescent smokers and adult smokers. To fulfill Aim 4, investigators will analyze the data from the second study to determine whether graphic warnings increase quit contemplations among less-educated populations by comparing the relationship between health literacy and quit intentions observed at baseline vs. follow-up; a reduction in the relationship between health literacy and quit intentions will serve as evidence that the program reduces disparities. These research outcomes could inform the optimal design of new tobacco warning labels.


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