Examining Interpretations of Graphic Cigarette Warning Labels Among U.S. Youth and Adults

Abstract

Few studies have examined how diverse populations interpret warning labels. This study examined interpretations of 9 graphic cigarette warning labels (image plus text) proposed by the U.S. Food and Drug Administration among a convenience sample of youth (ages 13–17) and adults (18+) across the United States. Participants (N = 1,571) completed a cross-sectional survey. Participants were asked to select 1 of 3 plausible interpretations (1 preferred vs. 2 alternative) created by the research team about the particular consequence of smoking addressed in each warning label. Participants also rated each label for novelty, counterarguing, perceived effectiveness, and harm. Smokers reported their thoughts of quitting, self-efficacy, and motivation to quit. Although at least 70% of the sample chose the preferred interpretation for 7 of 9 labels, only 13% of participants chose all 9 preferred interpretations. The odds of selecting the preferred interpretation were lower among African Americans, among those with less education, and for labels perceived as being more novel. Smokers reported greater counterarguing and less perceived effectiveness and harms than nonsmokers, but results were not consistent across all labels and interpretations. The alternative interpretations of cigarette warning labels were associated with lower perceived effectiveness and lower perceived harms of smoking, both of which are important for motivating quit attempts.

Funding

Research reported in this publication was cofunded by the U.S. Food and Drug Administration and the National Cancer Institute (NCI) of the National Institutes of Health as a supplement to the NCI’s Centers of Excellence in Cancer Communication Research program (P50 CA95815-09S1; principal investigator: Kreuter). The content is solely our own responsibility and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. The first author was also supported by NCI Grant No. R03 CA175571-01. Dr. Vetta L. Sanders Thompson was also supported by NCI Program for the Elimination of Cancer Disparities Grant No. U54 CA153460. Dr. Erika A. Waters was supported by the Barnes Jewish Hospital Foundation.

Supplemental Material

A supplemental online appendix (showing the nine graphic warning labels proposed by the U.S. Food and Drug Administration) is available on the publisher’s website at http://dx.doi.og/10.1080/10810730.2016.1177142.

Additional information

Funding

Research reported in this publication was cofunded by the U.S. Food and Drug Administration and the National Cancer Institute (NCI) of the National Institutes of Health as a supplement to the NCI’s Centers of Excellence in Cancer Communication Research program (P50 CA95815-09S1; principal investigator: Kreuter). The content is solely our own responsibility and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. The first author was also supported by NCI Grant No. R03 CA175571-01. Dr. Vetta L. Sanders Thompson was also supported by NCI Program for the Elimination of Cancer Disparities Grant No. U54 CA153460. Dr. Erika A. Waters was supported by the Barnes Jewish Hospital Foundation.