The Adolescent Label Impact Index in a Multicentric Observational Study. Have the Tobacco Advertisements an Impact on the Adolescents?

Abstract

Background

Pictorial warnings may contribute to lower attractiveness of smoking, particularly among adolescents. The present study compared the impact of two different label styles of tobacco product warnings (textual and pictorial) among adolescents in a new standardized way, using the Adolescent Label Impact Index (ALII).

Methods

A school-based cross-sectional study was conducted. Adolescent aged 10–20 years completed an online questionnaire. The ALII score was used to assess the impact of only-textual (ALII-T) and pictorial advertisements (ALII-P).

Results

A total of 1,759 students (68.4% response-rate) declared that graphic warnings have a significant impact than textual ones (p < 0.05). The younger group, which has never smoked or just tried and believed in the harmful effects of tobacco, is associated with both scales of ALII scales (T and P) (p < 0.01). The socioeconomic status was associated with ALII-T (p < 0.01), but not ALII-P; female gender, smoker-peers, perception of the body weight are related to the ALII-P (p < 0.05) but not ALII-T.

Conclusions

The pictorial labels represent a policy of tobacco use control that has potential effects, in particular in reducing communication inequalities between socio-economic categories, reinforcing the knowledge about the damage of smoking, discouraging adolescents, especially the younger ones who do not have never smoked or have just tried to become smokers.

Collaborative Group

• Siriana Campioni, Department of Public Health and Infectious Disease, “Sapienza” University of Rome

• Gabriele Castorina, Armando Platania, Specialization School of Hygiene and Preventive Medicine, Department “GF Ingrassia” Hygiene and Public Health, University of Catania, Italy;

• Ilenia Bellini, School of Specialization in Hygiene and Preventive Medicine, University of Florence

• Omar Enzo Santangelo, Specialization School of Hygiene and Preventive Medicine, Department of Sciences for Health Promotion and Mother and Child Care “Giuseppe D’Alessandro,” University of Palermo

• Clara Ferrara, Department of Gynecology and Obstetrics Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli) Palermo, Italy.

Keywords:

• tobacco labels
• graphic warnings
• impact
• index

Acknowledgments

The authors thank the deans and the students of the following schools:

• IISS Liceo Scientifico “Cipolla” di Castelvetrano (Trapani, Sicily), Dean Prof. Tania Barresi;

• Liceo “MT Varrone” (Cassino, Latium), Dean Prof. F De Vincenzo and Prof. P Pelosi; MRs. P Nottola e AM Marra;

• Scuola Secondaria di I grado “Dante Alighieri,” Catania, Sicily, Dean Prof. RD Alloro;

• Liceo Artistico Statale “Emilio Greco,” Catania, Sicily, Dean Prof. G Carvaruso;

• Liceo Scientifico Statale “Antonio Meucci,” Aprilia, Latium, Dean Prof. A Ferrone;

• Liceo Scientifico Statale “Niccolò Copernico,” Prato, Tuscany, Dean Prof. Stefano Gestri;

• Liceo Classico Statale “Giulio Cesare,” Rome, Latium, Dean Prof. Micaela Ricciardi.

The authors gratefully acknowledge the correspondence it has had with Sara C Hitchman (Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada) to clarify the analytic aspects of Label Impact Index (LII) tool. We thank Maria Cristina Di Giovancarlo (Research Center Impresapiens, Sapienza University of Rome) for her translation support, and all the people who participated in the study.

Ethical approval

Received from Ethics Committees of the Teaching Hospital Umberto I, Sapienza University of Rome (Prot.460/14).

Authors’ contributions

AM, GLT conceived the study and drafted the manuscript. AM and FG performed the measurements. AM, FG, AF, SP, MFi, MFe, EL, EDV, CL, GB collected the data. AM and VC performed the analysis. IB and GLT critically revised the manuscript. AM wrote the manuscript in consultation with PV and GLT.

Disclosure statement

No potential conflict of interest was reported by the author(s).