Perceived Effectiveness of Differing Health Warning Label Messaging Strategies among Adults in the Republic of Georgia: One Size Does Not Fit All

• Type of Material: Article
• Authors: Cailyn Lingwall, Emory University; Eric Nehl, Emory University; Marina Topuridze, National Center for Disease Control; Lela Sturua, National Center for Disease Control; Nuka Maglakelidze, National Center for Disease Control; Carla Berg, Emory University
• Language: English
• Date: 2018-10-01
• Publisher: MDPI
• Publication Version: Final Published Version
• Copyright Statement: © 2018 by the authors.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3390/ijerph15102221
• Title of Journal or Parent Work: International Journal of Environmental Research and Public Health
• ISSN: 1661-7827
• Volume: 15
• Issue: 10
• Grant/Funding Information: This research was funded by the U.S. National Cancer (K07 CA139114; PI: Berg), the Georgia Cancer Coalition (PI: Berg), and the Council for International Exchange of Scholars Fulbright Scholars Program.
• Keywords: Public, Environmental & Occupational Health; Environmental Sciences & Ecology; POLICY; tobacco control; CIGARETTE PACKAGES; IMPACT; Environmental Sciences; tobacco control policy; Science & Technology; MEXICO; PERCEPTIONS; tobacco use; Life Sciences & Biomedicine; public health policy; ELABORATION LIKELIHOOD; SMOKERS REACTIONS; TOBACCO CONTROL; DISPARITIES; low- and middle-income countries; TEXT
• Research Categories: Health Sciences, Public Health

Abstract

Licensee MDPI, Basel, Switzerland. Background: While pictorial health warning labels (HWLs) are evidence-based, the different messaging strategies are understudied. Methods: We analyzed 2014 national survey data from 1163 Georgian adults to examine: (1) perceived effectiveness of pictorial vs. text-only HWLs; (2) pictorial HWL themes; and (3) correlates of perceived effectiveness of different pictorial themes. Participants were randomized to evaluate the effectiveness of either Set A or Set B of HWLs (each contained half pictorial, half text-only). Results: All but 2 pictorial HWLs were perceived as more effective than text-only. Factor analyses identified one factor among Set A (“benign”) and two in Set B pictorial HWLs (“benign”, “gruesome”). Among Set A pictorial HWLs, correlates of greater perceived effectiveness included being female, rural residence, not having children, and nonsmoker status. Among smokers, correlates included being female and unmarried, fewer smoking friends, and higher quitting importance. Among Set B, 43.8% rated gruesome pictorial HWLs more effective, 12.9% benign more effective, and 43.4% equally effective. Correlates of perceiving benign more effective included fewer smoking friends and higher income. Among smokers, lower income predicted gruesome being perceived as more effective; fewer smoking friends and higher quitting importance predicted perceiving benign as more effective. Conclusion: A variety of pictorial HWL strategies should be used.