Mediational pathways of the impact of cigarette warning labels on quit attempts
Open accessAbstract
OBJECTIVE: To test and develop, using structural equation modeling, a robust model of the mediational pathways through which health warning labels exert their influence on smokers' subsequent quitting behavior. METHOD: Data come from the International Tobacco Control Four-Country Survey, a longitudinal cohort study conducted in Australia, Canada, the United Kingdom, and the United States. Waves 5-6 data (n = 4,988) were used to calibrate the hypothesized model of warning label impact on subsequent quit attempts via a set of policy-specific and general psychosocial mediators. The finalized model was validated using Waves 6-7 data (n = 5065). RESULTS: As hypothesized, warning label salience was positively associated with thoughts about risks of smoking stimulated by the warnings (β = .58, p < .001), which in turn were positively related to increased worry about negative outcomes of smoking (β = .52, p < .001); increased worry in turn predicted stronger intention to quit (β = .39, p < .001), which was a strong predictor of subsequent quit attempts (β = .39, p < .001). This calibrated model was successfully replicated using Waves 6-7 data. CONCLUSION: Health warning labels seem to influence future quitting attempts primarily through their ability to stimulate thoughts about the risks of smoking, which in turn help to raise smoking-related health concerns, which lead to stronger intentions to quit, a known key predictor of future quit attempts for smokers. By making warning labels more salient and engaging, they should have a greater chance to change behavior.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A recent longitudinal study found that increased attention to cigarette pack warnings led to greater cognitive elaboration, which ultimately predicted quit attempts via mediation through worry and quit intentions.
“A recent longitudinal study found that increased attention to cigarette pack warnings led to greater cognitive elaboration, which ultimately predicted quit attempts (via mediation through worry and quit intentions).81”
From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [81]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Alternative Ways of Assessing Model Fit
Browne, M. W., & Cudeck, R. (1992) · Sociological Methods & Research · doi:10.1177/0049124192021002005 · Cited by 27,200 · see citing works
Comparative fit indexes in structural models.
Bentler, P. M. (1990) · Psychological Bulletin · doi:10.1037/0033-2909.107.2.238 · Cited by 25,266 · see citing works
Testing Structural Equation Models.
Clogg, C. C., Bollen, K. A., & Long, J. S. (1995) · Social Forces · doi:10.2307/2580595 · Cited by 8,244 · see citing works
A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns
Witte, K., & Allen, M. (2000) · Health Education & Behavior · doi:10.1177/109019810002700506 · Cited by 3,216 · see citing works
Ironic processes of mental control.
Wegner, D. M. (1994) · Psychological Review · doi:10.1037//0033-295x.101.1.34 · Cited by 2,609 · see citing works
Health warning messages on tobacco products: a review
Hammond, D. (2011) · Tobacco Control · doi:10.1136/tc.2010.037630 · Cited by 1,162 · see citing works
Self-citationPeters, G.-J. Y., Ruiter, R. A. C., & Kok, G. (2013) · Health Psychology Review · doi:10.1080/17437199.2012.703527 · Cited by 679 · see citing works
Scary warnings and rational precautions: A review of the psychology of fear appeals
Ruiter, R. A. C., Abraham, C., & Kok, G. (2001) · Psychology and Health · doi:10.1080/08870440108405863 · Cited by 632 · see citing works
Vangeli, E., Stapleton, J., Smit, E. S., Borland, R., & West, R. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03565.x · Cited by 607 · see citing works
Self-citationSampling Weights in Latent Variable Modeling
Asparouhov, T. (2005) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1207/s15328007sem1203_4 · Cited by 599 · see citing works
Hyland, A. J., Borland, R., Li, Q., Yong, H.-H., McNeill, A. D., Fong, G. T., O’Connor, R. J., & Cummings, K. M. (2006) · Tobacco Control · doi:10.1136/tc.2005.013516 · Cited by 506 · see citing works
Self-citationThe conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project
Fong, G., Cummings, K., Borland, R., Hastings, G., Hyland, A., Giovino, G., Hammond, D., & Thompson, M. E. (2006) · Tobacco Control · doi:10.1136/tc.2005.015438 · Cited by 435 · see citing works
Self-citationText and Graphic Warnings on Cigarette Packages
Hammond, D., Fong, G. T., Borland, R., Cummings, K. M., McNeill, A., & Driezen, P. (2007) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2006.11.011 · Cited by 434 · see citing works
Self-citationImpact of the graphic Canadian warning labels on adult smoking behaviour
Hammond, D. G., Fong, G. T., McDonald, P., Cameron, R., & Brown, K. S. (2003) · Tobacco Control · doi:10.1136/tc.12.4.391 · Cited by 358 · see citing works
Self-citationImpact of graphic and text warnings on cigarette packs: findings from four countries over five years
Borland, R., Wilson, N., Fong, G. T., Hammond, D. G., Cummings, K. M., Yong, H.-H., Hosking, W., Hastings, G., Thrasher, J. F., & McNeill, A. D. (2009) · Tobacco Control · doi:10.1136/tc.2008.028043 · Cited by 350 · see citing works
Self-citationMethods of the International Tobacco Control (ITC) Four Country Survey
Thompson, M. E., Fong, G. T., Hammond, D. G., Boudreau, C., Driezen, P., Hyland, A. J., Borland, R., Cummings, K. M., Hastings, G., Siahpush, M., et al. (2006) · Tobacco Control · doi:10.1136/tc.2005.013870 · Cited by 340 · see citing works
Self-citationGraphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers
Hammond, D., Fong, G. T., McDonald, P. W., Brown, K. S., & Cameron, R. (2004) · American Journal of Public Health · doi:10.2105/ajph.94.8.1442 · Cited by 331 · see citing works
Self-citationBorland, R., Yong, H., Wilson, N., Fong, G. T., Hammond, D. G., Cummings, K. M., Hosking, W., & McNeill, A. D. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02508.x · Cited by 286 · see citing works
Self-citationUnderstanding how Graphic Pictorial Warnings Work on Cigarette Packaging
Kees, J., Burton, S., Andrews, J. C., & Kozup, J. C. (2010) · Journal of Public Policy & Marketing · doi:10.1509/jppm.29.2.265 · Cited by 242 · see citing works
Borland, R., Yong, H., Balmford, J., Cooper, J., Cummings, K. M., OʼConnor, R., McNeill, A. D., Zanna, M. P., & Fong, G. T. (2010) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq050 · Cited by 214 · see citing works
Self-citationParadoxical and less paradoxical effects of thought suppression A critical review
Rassin, E. (2000) · Clinical Psychology Review · doi:10.1016/s0272-7358(99)00019-7 · Cited by 158 · see citing works
Cigarette Warning Label Policy Alternatives and Smoking-Related Health Disparities
Thrasher, J. F., Carpenter, M. J., Andrews, J. O., Gray, K. M., Alberg, A. J., Navarro, A., Friedman, D. B., & Cummings, K. M. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.08.025 · Cited by 158 · see citing works
Self-citationHammond, D. G., Thrasher, J. F., Reid, J. L., Driezen, P., Boudreau, C., & Santillán, E. J. A. (2012) · Cancer Causes & Control · doi:10.1007/s10552-012-9902-4 · Cited by 156 · see citing works
Self-citationPeters, E. M., Römer, D., Slovic, P., Jamieson, K. H., Wharfield, L., Mertz, C. K., & Carpenter, S. (2007) · Nicotine & Tobacco Research · doi:10.1080/14622200701239639 · Cited by 150 · see citing works
Tobacco health warnings and smoking-related cognitions and behaviours
Borland, R. (1997) · Addiction · doi:10.1111/j.1360-0443.1997.tb02864.x · Cited by 126 · see citing works
Self-citationAffective and Cognitive Mediators of the Impact of Cigarette Warning Labels
Emery, L. F., Römer, D., Sheerin, K. M., Jamieson, K. H., & Peters, E. M. (2013) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntt124 · Cited by 125 · see citing works
Saying is not (always) doing: cigarette warning labels are useless
Ruiter, R. A. C., & Kok, G. (2005) · European Journal of Public Health · doi:10.1093/eurpub/cki095 · Cited by 105 · see citing works
Brennan, E., Durkin, S. J., Cotter, T., et al. (2011) · Tobacco Control · doi:10.1136/tc.2010.039321 · Cited by 99 · see citing works
Thrasher, J. F., Arillo‐Santillán, E., Villalobos, V., Pérez-Hernández, R., Hammond, D. G., Carter, J. W., Sebrié, E. M., Sansores, R. H., & Regalado-Piñeda, J. (2012) · Cancer Causes & Control · doi:10.1007/s10552-012-9899-8 · Cited by 96 · see citing works
Self-citationNorth, D. C., WALLIS, J. J., & Weingast, B. R. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511575839.002 · Cited by 86 · see citing works
Responses of young adults to graphic warning labels for cigarette packages
Cameron, L. D., Pepper, J. K., & Brewer, N. T. (2013) · Tobacco Control · doi:10.1136/tobaccocontrol-2012-050645 · Cited by 86 · see citing works
Fathelrahman, A. I., Omar, M., Awang, R., Borland, R., Fong, G. T., Hammond, D., & Zain, Z. (2009) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntn029 · Cited by 85 · see citing works
Self-citationPartos, T., Borland, R., Yong, H., Thrasher, J. F., & Hammond, D. G. (2012) · Tobacco Control · doi:10.1136/tobaccocontrol-2011-050254 · Cited by 76 · see citing works
Self-citationYong, H., Fong, G. T., Driezen, P., Borland, R., Quah, A. C. K., Sirirassamee, B., Hamann, S. L., & Omar, M. (2013) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts241 · Cited by 70 · see citing works
Self-citationThrasher, J. F., Murukutla, N., Pérez-Hernández, R., Alday, J., Arillo‐Santillán, E., Cedillo, C., & Gutiérrez, J. P. (2012) · Tobacco Control · doi:10.1136/tobaccocontrol-2011-050282 · Cited by 61 · see citing works
Self-citationPerceived Risk and Quitting Behaviors: Results From the ITC 4-Country Survey
Costello, M. J., Logel, C. R., Fong, G. T., et al. (2012) · American Journal of Health Behavior · doi:10.5993/ajhb.36.5.10 · Cited by 59 · see citing works
Self-citationBorland, R., Yong, H., Balmford, J., Fong, G. T., Zanna, M. P., & Hastings, G. (2009) · Preventive Medicine · doi:10.1016/j.ypmed.2009.06.015 · Cited by 49 · see citing works
Self-citationDesire versus Efficacy in Smokers’ Paradoxical Reactions to Pictorial Health Warnings for Cigarettes
Römer, D., Peters, E. M., Strasser, A. A., & Langleben, D. D. (2013) · PLoS ONE · doi:10.1371/journal.pone.0054937 · Cited by 46 · see citing works
Yong, H.-H., & Borland, R. (2008) · Health Psychology · doi:10.1037/0278-6133.27.3(suppl.).s216 · Cited by 44 · see citing works
Self-citation[Towards informed tobacco consumption in Mexico: effect of pictorial warning labels in smokers].
Thrasher, J. F., Pérez-Hernández, R., Arillo‐Santillán, E., & Barrientos‐Gutiérrez, I. (2012) · PubMed · Cited by 41 · see citing works
Self-citationAwareness and impact of New York City's graphic point-of-sale tobacco health warning signs
Coady, M. H., Chan, C. A., Auer, K., Farley, S. M., Kilgore, E. A., & Kansagra, S. M. (2012) · Tobacco Control · doi:10.1136/tobaccocontrol-2011-050261 · Cited by 40 · see citing works
Nagelhout, G. E., de Vries, H., Fong, G. T., Candel, M. J. J. M., Thrasher, J. F., van den Putte, B., Thompson, M. E., Cummings, K. M., & Willemsen, M. C. (2012) · Nicotine & Tobacco Research · doi:10.1093/ntr/nts081 · Cited by 38 · see citing works
Self-citationLi, L., Borland, R., Yong, H., et al. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03668.x · Cited by 33 · see citing works
Self-citationEvaluation of the effectiveness of the graphic health warnings on tobacco product packaging 2008
Division, C. D. (2010) · Cited by 30 · see citing works
Let's Not Further Obscure the Debate About Fear Appeal Messages for Smokers
de Bruin, M., & Peters, G.-J. (2013) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2013.02.006 · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pictorial cigarette pack warnings: a meta-analysis of experimental studies
Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., & Brewer, N. T. (2016) · Tobacco Control · doi:10.1136/tobaccocontrol-2014-051978 · Cited by 674 · see citing works
Evans, A. T., Peters, E., Strasser, A. A., Emery, L. F., Sheerin, K. M., & Romer, D. (2015) · PLOS ONE · doi:10.1371/journal.pone.0142879 · Cited by 142 · see citing works
Perseverative Cognition and Health Behaviors: A Systematic Review and Meta-Analysis
Clancy, F., Prestwich, A., Caperon, L., & O'Connor, D. B. (2016) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2016.00534 · Cited by 110 · see citing works
- Authors
- Yong, H.-H., Borland, R., Thrasher, J. F., Thompson, M. E., Nagelhout, G. E., Fong, G. T., Hammond, D., & Cummings, K. M.
- Affiliations
- Cancer Council Victoria (AU)
- University of South Carolina (US)
- University of Waterloo (CA)
- Maastricht University (NL)
- Medical University of South Carolina (US)
- ORCID
- Venue
- Health Psychology
- Published
- 2014-11
- Volume
- 33
- Issue
- 11
- Pages
- 1410-1420
- ISSN
- 0278-6133 (ISSN-L)
- 1930-7810
- PMC
- PMC4600667
- OpenAlex
- W2162206994
- Cited by
- 128
- References
- 46
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 5 · 2023: 7 · 2022: 7 · 2021: 11 · 2020: 7 · 2019: 7 · 2018: 21 · 2017: 12 · 2016: 14 · 2015: 19 · 2014: 4
- FWCI
- 10.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- Funders
- U.S. National Cancer Institute (R01 CA 100362, P50 CA111236, P01 CA138389)
- Robert Wood Johnson Foundation (Grant 045734)
- Canadian Institutes of Health Research (57897, 79551)
- National Health and Medical Research Council of Australia (265903, 450110, APP1005922)
- Cancer Research United Kingdom (C312/A3726)
- Canadian Tobacco Control Research Initiative (014578)
- Centre for Behavioural Research and Program Evaluation
- National Cancer Institute of Canada/Canadian Cancer Society
- UICC International Cancer Technology Transfer
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Keywords
- cigarette warning labels, smoking cessation, quit attempts, risk perception, turnover intention, tobacco control, smokers
- MeSH terms
- Adolescent, Adult, Australia, Canada, Data Collection, Female, United Kingdom, Humans, Male, Middle Aged, Product Labeling, Smoking, United States, Cohort Studies, Smoking Cessation, Intention, Young Adult, Tobacco Products
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
