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

• 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
• Journal Title: International Journal of Environmental Research and Public Health
• Volume: Volume 15, Number 10
• Publisher: MDPI | 2018-10-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/ijerph15102221
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Environmental Sciences; Public, Environmental & Occupational Health; Environmental Sciences & Ecology; tobacco control; tobacco control policy; tobacco use; public health policy; low- and middle-income countries; CIGARETTE PACKAGES; ELABORATION LIKELIHOOD; SMOKERS REACTIONS; TOBACCO CONTROL; TEXT; IMPACT; PERCEPTIONS; DISPARITIES; POLICY; MEXICO

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.