The Efficacy of Cigarette Warning Labels on Health Beliefs in the United States and Mexico

Abstract

Concern over health risks is the most common motivation for quitting smoking. Health warnings on tobacco packages are among the most prominent interventions to convey the health risks of smoking. Face-to-face surveys were conducted in Mexico (n = 1,072), and a web-based survey was conducted in the US (n = 1,449) to examine the efficacy of health warning labels on health beliefs. Respondents were randomly assigned to view two sets of health warnings (each with one text-only warning and 5–6 pictorial warnings) for two different health effects. Respondents were asked whether they believed smoking caused 12 different health effects. Overall, the findings indicate high levels of health knowledge in both countries for some health effects, although significant knowledge gaps remained; for example, less than half of respondents agreed that smoking causes impotence and less than one third agreed that smoking causes gangrene. Mexican respondents endorsed a greater number of correct beliefs about the health effects of smoking than did the U.S. sample. In both countries, viewing related health warning labels increased beliefs about the health risks of smoking, particularly for less well-known health effects such as gangrene, impotence, and stroke.

Acknowledgments

This research was funded by the National Institutes of Health (grant number 1 P01 CA138-389-01: “Effectiveness of Tobacco Control Policies in High vs. Low Income Countries”). Additional support was provided by the Propel Centre for Population Health Impact, a Canadian Institutes of Health Research New Investigator Award (Hammond), and the CIHR Training Grant in Population Interventions for Chronic Disease Prevention (Mutti).

Notes

^a Low = high school or less (United States) and primary, middle, or technical/vocational school or less (Mexico); moderate = technical/trade school or community college or some university (United States) and high school or some university (Mexico); and high = university or postgraduate degree (United States, Mexico).

^b Minority includes Black or African American, Hispanic or Latino, Asian or Pacific Islander, Native American Indian, mixed race, and other.

— refers to no data.

Data are shown only from respondents who did not view the health warnings specific to the health effect listed. Within this population, logistic regression models were conducted for each health effect to examine whether beliefs differed by age group (youth vs. adults) and by country (Mexico vs. United States).

^a Percentage responding “yes”; remainder include “no” and “don't know” responses.

†Significant differences between adults and youth within each country (p < .05). < .05).

*Significant differences “overall” between Mexico and the United States (p < .05). < .05).