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Impact of Graphic vs. Text-Based Health Warning Labels

Principal Investigator: Mary Ellen Wewers

Funding Mechanism: National Institutes of Health- Grant

ID number: 3 R01 CA129771-04S1

Award Date: 9/1/2012

Institution: Ohio State University


While numerous studies have demonstrated the effectiveness of larger, more graphic health warnings for promoting tobacco cessation, nearly all have focused on warning labels on product packaging rather than in advertisements. The purpose of this investigation -- which complements ongoing research on tobacco cessation interventions in Ohio Appalachia, a region characterized by economic disadvantage, low educational levels, and high prevalence of tobacco use -- is to assess the effects of warning labels embedded within tobacco product advertisements. The study will evaluate whether modifications to warning labels in advertisements can impact the attention, recall, perceived health risks, and tobacco cravings of adult smokers and smokeless tobacco users in this vulnerable population. Specific aims are: (1) to evaluate the influence of size on attention to graphic warning labels in cigarette advertisements, by determining if exposure to larger versus smaller labels has an impact on fixation time, message recall, perception of health risks, craving, and cessation self-efficacy and interest; and (2) to test the influence of graphic imagery on attention to warning labels in smokeless tobacco advertisements, by determining if exposure to graphic versus text-based labels has an impact on fixation time, message recall, perception of health risks, craving, and perceptions of relative risk compared to cigarettes, as well as the influence of health literacy on these factors. Investigators will study 172 cigarette smokers and 172 smokeless tobacco users using eye tracking technology that captures detailed information about attention to the advertisement’s warning label and other elements; participants will be randomly assigned to view advertisements with the proposed FDA health warning labels or either a larger health warning label (for smokers) or an advertisement including graphic imagery (for smokeless tobacco users). Study results will reveal the effects of the health warning labels on tobacco users, yield information about potential modifications that may offer greater public health protection, and may inform policy decisions regarding the regulation of tobacco product advertisements.


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