Graphic warnings on cigarettes effective across demographic groups

The study is one of the first to examine the effectiveness of pictorial warning labels versus text-only labels across diverse racial/ethnic and socioeconomic groups. Although a growing body of research has shown that disadvantaged groups may differ in their ability to access, process and act on health information, little is known about communication inequalities when it comes to cigarette warning labels.

The study authors note that text-only cigarette warnings have been repeatedly characterized as unlikely to be noticed or have an impact, and cite prior research indicating pictorial warning labels are more effective.

"Interventions that have a positive impact on reducing smoking among the general population have often proven ineffective in reaching disadvantaged groups, worsening tobacco-related health disparities," said Jennifer Cantrell, DrPH, MPA, and Assistant Director for Research and Evaluation at Legacy®, a national public health foundation devoted to reducing tobacco use in the U.S. "It's critical to examine the impact of tobacco policies such as warning labels across demographic groups."

Senior author Vish Viswanath, associate professor of society, human development, and health at Harvard School of Public Health, said, "There is a nagging question whether benefits from social policies accrue equally across ethnic and racial minority and social class groups. The evidence from this paper shows that this new policy of mandated Graphic Health Warnings would benefit all groups. Given the disproportionate burden of tobacco-related disease faced by the poor and minorities, mandating strong pictorial warnings is an effective and efficient way to communicate the risk of tobacco use."

The new study, published January 14, 2013, in the journal PLOS ONE, examined reactions to cigarette warning labels from more than 3,300 smokers. Results show that hard-hitting, pictorial graphic warnings are more effective than text-only versions, with smokers indicating the labels are more impactful, credible, and have a greater effect on their intentions to quit. Moreover, the study found that the stronger impact of pictorial warnings was similar across vulnerable subpopulations, with consistent reactions across race/ethnicity, education, and income.

"The implementation of graphic warning labels appears to be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups," Cantrell said.

"Tobacco use is a social justice issue," added Donna Vallone, PhD, Senior Vice President for Research and Evaluation at Legacy®. "Given that low income and minority communities have higher smoking rates and suffer disproportionately from tobacco's health consequences, studies like this show us that graphic warning labels can help us reach these subgroups in a more effective way, ultimately saving more lives."