Pictorial cigarette pack warnings: a meta-analysis of experimental studies
Open accessAbstract
OBJECTIVE: To inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings. DATA SOURCES: We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles. STUDY SELECTION: We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33,613) met criteria. DATA EXTRACTION AND SYNTHESIS: Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures. RESULTS: Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes. CONCLUSIONS: The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.
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Written from the paper’s full text.
TL;DR
This meta-analysis of experimental studies found that pictorial cigarette pack warnings were generally more effective than text-only warnings across attention, reactions, attitudes, intentions, and perceived effectiveness. The authors conclude the evidence supports pictorial warnings but note major gaps in behavioural outcomes and theory-based research.
Key findings
- Across 37 studies with 48 independent samples (N=33,613), pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes, with 13 of 17 outcomes showing statistically significant effects (most p<0.001).
- Pictorial warnings improved attention attracting (d=0.79) and attention duration (d=1.74), cognitive elaboration (d=1.70), negative affective reactions (d=0.54), negative pack/brand attitudes (d=0.79), negative smoking attitudes (d=0.55), intention to not start smoking (d=1.82), and intention to quit smoking (d=0.54).
- Pictorial warnings were rated as more effective than text warnings on all 8 perceived effectiveness outcomes, including motivating not starting smoking (d=1.03), motivating oneself to quit (d=0.79), motivating others to quit (d=1.09), and deterring giving cigarettes as a gift (d=1.64).
- No significant effects were found for response time, recall/recognition of warning text, perceived likelihood of harm, or self-efficacy to quit; pictorial warnings also elicited greater psychological reactance (d=−0.50).
Methods
- Systematic search of 7 computerised databases in April 2013 plus reference lists; inclusion required an experimental protocol testing cigarette pack warnings and reporting both pictorial and text-only conditions.
- The final synthesis included 37 studies reporting 48 independent samples (N=33,613); two independent coders coded study characteristics with mean 96% agreement and mean Cohen’s κ=0.94.
- Effect sizes used standardised mean difference d, combined with random-effects meta-analytic procedures; heterogeneity assessed with Q and I², and moderator analyses conducted for a composite perceived-effectiveness motivation variable.
Limitations
- The paper states a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects; only a single experimental study assessed behaviour.
- The paper notes that no study placed warnings on smokers’ own cigarette packs, exposures were brief and often on a computer screen, and all but one study assessed participants only immediately after exposure.
- The text makes evident high heterogeneity for many outcomes (6 of 9 heterogeneous outcomes had I²>90), and moderator analyses found within-subject designs produced larger effects than between-subject designs (d=1.37 vs d=0.51), suggesting design-related variability.
Model-written summary. Check it against the paper before relying on it.
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Cites
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Claims the paper makes
0 of 71 cited sources checked · 0 supported · 0 flagged
- Findingown data
Pictorial warnings were more likely to be rated as effective in motivating others to quit smoking (d=1.09).
“Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03), motivating reducing smoking (d=0.41), motivating themselves (d=0.79) or others (d=1.09) to quit smoking, and motivating (smokers or non-smokers) to not smoke (d=0.24).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings were rated as more effective than text warnings for all eight perceived effectiveness outcomes.
“Pictorial warnings exhibited statistically significant effects relative to text warnings for all eight perceived effectiveness outcomes (see table 4 and figure 7).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings were more likely to be rated as effective in motivating (smokers or non-smokers) to not smoke (d=0.24).
“Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03), motivating reducing smoking (d=0.41), motivating themselves (d=0.79) or others (d=1.09) to quit smoking, and motivating (smokers or non-smokers) to not smoke (d=0.24).”
Quote in the paperSubstantial claim - Findingown data
Participants perceived pictorial warnings as generally effective (d=1.00).
“Participants also perceived pictorial warnings as deterrents to giving cigarettes as a gift (d=1.64), as generally effective (d=1.00), and as effective for themselves and others (d=0.52).”
Quote in the paperSubstantial claim - Findingown data
There was no effect of pictorial warnings on response time.
“We observed no effects on response time or recall/recognition of warning text.”
Quote in the paperNot a substantial claim
- Findingown data
Pictorial warnings attracted attention better than text-only warnings (d=0.79).
“pictorial warnings scoring higher on both attention attracting (d=0.79) and attention duration (d=1.74).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings elicited more credibility than text warnings (d=0.15).
“pictorial warnings elicited more cognitive elaboration (d=1.70), negative affective reactions (d=0.54), credibility (d=0.15), lower smoking cravings (d=0.08), and aversiveness (d=0.58).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings were more likely to be rated as effective in motivating themselves to quit smoking (d=0.79).
“Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03), motivating reducing smoking (d=0.41), motivating themselves (d=0.79) or others (d=1.09) to quit smoking, and motivating (smokers or non-smokers) to not smoke (d=0.24).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings elicited lower smoking cravings than text warnings (d=0.08).
“pictorial warnings elicited more cognitive elaboration (d=1.70), negative affective reactions (d=0.54), credibility (d=0.15), lower smoking cravings (d=0.08), and aversiveness (d=0.58).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings exhibited statistically significant effects relative to text warnings for 13 of 17 effectiveness outcomes.
“Pictorial warnings exhibited statistically significant effects relative to text warnings for 13 of 17 effectiveness outcomes (most at p<0.001; see table 3), with 12 of 17 effects favouring pictorial warnings.”
Quote in the paperSubstantial claim - Findingown data
Participants perceived pictorial warnings as deterrents to giving cigarettes as a gift (d=1.64).
“Participants also perceived pictorial warnings as deterrents to giving cigarettes as a gift (d=1.64), as generally effective (d=1.00), and as effective for themselves and others (d=0.52).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings elicited greater psychological reactance than text warnings (d=-0.50).
“However, pictorial warnings also elicited greater psychological reactance (d=−0.50).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings elicited more negative smoking attitudes than text warnings (d=0.55).
“with effects on both negative pack/brand attitudes (d=0.79) and negative smoking attitudes (d=0.55) relative to text warnings.”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings held attention longer than text-only warnings (d=1.74).
“pictorial warnings scoring higher on both attention attracting (d=0.79) and attention duration (d=1.74).”
Quote in the paperSubstantial claim - Findingown data
There was no effect of pictorial warnings on perceived likelihood of harm (d=0.02).
“No effects were observed on perceived likelihood of harm (d=0.02) or self-efficacy to quit (d=0.01).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03).
“Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03), motivating reducing smoking (d=0.41), motivating themselves (d=0.79) or others (d=1.09) to quit smoking, and motivating (smokers or non-smokers) to not smoke (d=0.24).”
Quote in the paperSubstantial claim - Findingown data
There was no effect of pictorial warnings on self-efficacy to quit (d=0.01).
“No effects were observed on perceived likelihood of harm (d=0.02) or self-efficacy to quit (d=0.01).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings were more likely to be rated as effective in motivating reducing smoking (d=0.41).
“Pictorial warnings were more likely to be rated as effective in motivating not starting smoking (d=1.03), motivating reducing smoking (d=0.41), motivating themselves (d=0.79) or others (d=1.09) to quit smoking, and motivating (smokers or non-smokers) to not smoke (d=0.24).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings elicited more negative affective reactions than text warnings (d=0.54).
“pictorial warnings elicited more cognitive elaboration (d=1.70), negative affective reactions (d=0.54), credibility (d=0.15), lower smoking cravings (d=0.08), and aversiveness (d=0.58).”
Quote in the paperSubstantial claim - Findingown data
The meta-analysis included 37 studies with data on 48 independent samples (N=33,613).
“37 studies with data on 48 independent samples (N=33 613) met criteria.”
- Also stated in: § Search strategy · plain
“This process resulted in a total of 35 articles reporting on 37 studies. Since some studies reported results separately for different subgroups, we analysed effect sizes for each independent sample. Thus, the meta-analysis synthesised effects of 48 independent samples.”
Quote in the paperSubstantial claim - Also stated in: § Search strategy · plain
- Findingown data
Pictorial warnings elicited more negative pack/brand attitudes than text warnings (d=0.79).
“with effects on both negative pack/brand attitudes (d=0.79) and negative smoking attitudes (d=0.55) relative to text warnings.”
Quote in the paperSubstantial claim - Findingown data
There is a dearth of theory-based research on how warnings exert their effects.
“Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.”
- Also stated in: § Study characteristics · plain
“Nineteen of 37 studies (51%) mentioned a theory as informing the study.”
Quote in the paperNot a substantial claim - Also stated in: § Study characteristics · plain
- Findingown data
Pictorial warnings elicited more cognitive elaboration than text warnings (d=1.70).
“pictorial warnings elicited more cognitive elaboration (d=1.70), negative affective reactions (d=0.54), credibility (d=0.15), lower smoking cravings (d=0.08), and aversiveness (d=0.58).”
Quote in the paperSubstantial claim - Findingown data
Participants perceived pictorial warnings as effective for themselves and others (d=0.52).
“Participants also perceived pictorial warnings as deterrents to giving cigarettes as a gift (d=1.64), as generally effective (d=1.00), and as effective for themselves and others (d=0.52).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings elicited more aversiveness than text warnings (d=0.58).
“pictorial warnings elicited more cognitive elaboration (d=1.70), negative affective reactions (d=0.54), credibility (d=0.15), lower smoking cravings (d=0.08), and aversiveness (d=0.58).”
Quote in the paperSubstantial claim - Findingown data
There was no effect of pictorial warnings on recall/recognition of warning text.
“We observed no effects on response time or recall/recognition of warning text.”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05).
“Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05).”
- Also stated in: § Effectiveness of pictorial warnings · plain
“with 12 of 17 effects favouring pictorial warnings.”
Quote in the paperSubstantial claim - Also stated in: § Effectiveness of pictorial warnings · plain
- Findingown data
Pictorial warnings increased intention to not start smoking (d=1.82).
“with effects on lower willingness to pay (d=0.26), intention to not start smoking (d=1.82), and intention to quit smoking (d=0.54).”
Quote in the paperSubstantial claim - Findingnone given
The literature lacks assessment of smoking behaviour.
“Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings increased lower willingness to pay (d=0.26).
“with effects on lower willingness to pay (d=0.26), intention to not start smoking (d=1.82), and intention to quit smoking (d=0.54).”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings increased intention to quit smoking (d=0.54).
“with effects on lower willingness to pay (d=0.26), intention to not start smoking (d=1.82), and intention to quit smoking (d=0.54).”
Quote in the paperSubstantial claim - Findingown data
No differences in effect sizes were found by exposure medium (two-dimensional vs three-dimensional pack).
“Analyses of exposure medium (two-dimensional vs three-dimensional pack), exposure channel (digital vs paper or pack), and country of sample (USA vs other countries) found no differences.”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings garnered stronger cognitive and emotional reactions than text warnings.
“Compared with text warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes; and (4) more effectively increased intentions to not start smoking and to quit smoking.”
Quote in the paperSubstantial claim - Findingown data
Smokers and non-smokers rated pictorial warnings as more effective than text warnings at motivating not starting, reducing and quitting smoking.
“Smokers and non-smokers rated pictorial warnings as more effective than text warnings at motivating not starting, reducing and quitting smoking.”
Quote in the paperSubstantial claim - Findingown data
Across an international body of experimental studies, effects favored pictorial warnings for 12 of 17 effectiveness outcomes.
“Across an international body of experimental studies, we found effects favouring pictorial warnings for 12 of 17 effectiveness outcomes.”
Quote in the paperSubstantial claim - Findingown data
Studies using within-subject designs had larger effect sizes for motivation to avoid cigarette use than those using between-subject designs (d=1.37 vs d=0.51; Qb=7.50, p<0.01).
“Moderation analyses found that studies using a within-subject design (k=7) differed from those using a between-subject design (k=8; Qb=7.50, p<0.01; table 5). Studies using within-subject designs (d=1.37) had larger effect sizes than those using between-subject designs (d=0.51).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings had effects on many beliefs and attitudes that are plausible mediators according to theories of health behaviour.
“We saw the effects for many beliefs and attitudes that are plausible mediators according to theories of health behaviour.50 85 86”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings were superior to text warnings on all eight perceived effectiveness outcomes.
“In our review, pictorial warnings were also superior to text warnings on all eight perceived effectiveness outcomes.”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings elicited greater fear-oriented reactions than text warnings.
“In our meta-analysis, pictorial warnings elicited greater fear-oriented reactions than text warnings, as intended.”
Quote in the paperSubstantial claim - Findingown data
Only five studies (with 8 effect sizes) in the meta-analysis assessed perceived likelihood of harm.
“It was surprising that only five studies (with 8 effect sizes) in the meta-analysis assessed perceived likelihood of harm, a component of perceived threat, when much theorising situates this as a central construct in fear appeals and risk communication.52 88 89”
Quote in the paperSubstantial claim - Findingown data
No differences in effect sizes were found by exposure channel (digital vs paper or pack).
“Analyses of exposure medium (two-dimensional vs three-dimensional pack), exposure channel (digital vs paper or pack), and country of sample (USA vs other countries) found no differences.”
Quote in the paperNot a substantial claim - Findingown data
The effect for motivation to avoid cigarette use was statistically heterogeneous (Q=1310, p<0.001, I2=99).
“This effect was statistically heterogeneous, Q=1310, p<0.001, I2=99.”
Quote in the paperNot a substantial claim - Findingown data
The trend suggested that non-smokers and mixed samples rated warnings as more effective than smokers (d=1.39 vs d=0.65).
“The trend, however, suggested that non-smokers and mixed samples (d=1.39), rated warnings as being more effective than did smokers (d=0.65).”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings increased cognitive elaboration more than text-only warnings.
“Our review also demonstrated that pictorial warnings increased cognitive elaboration more than text-only warnings.”
Quote in the paperSubstantial claim - Findingown data
Effect sizes were not significantly correlated with gender composition (r(14)=−0.02, p=0.98).
“Effect sizes were also not significantly correlated with gender composition, r (14)=−0.02 (p=0.98) or age, r(14)=−0.32 (p=0.49).”
Quote in the paperNot a substantial claim - Findingown data
The statistical comparison of smokers to non-smokers and mixed samples on motivation to avoid cigarette use did not reach significance (p=0.07).
“Statistical comparisons of samples of smokers (k=9) to non-smokers and mixed samples (k=6) did not reach statistical significance (p=0.07).”
Quote in the paperNot a substantial claim - Findingown data
No differences in effect sizes were found by country of sample (USA vs other countries).
“Analyses of exposure medium (two-dimensional vs three-dimensional pack), exposure channel (digital vs paper or pack), and country of sample (USA vs other countries) found no differences.”
Quote in the paperNot a substantial claim - Findingown data
Effect sizes were not significantly correlated with age (r(14)=−0.32, p=0.49).
“Effect sizes were also not significantly correlated with gender composition, r (14)=−0.02 (p=0.98) or age, r(14)=−0.32 (p=0.49).”
Quote in the paperNot a substantial claim - Findingown data
The meta-analysis did not find an effect of pictorial warnings on perceived likelihood of harm.
“While our meta-analysis did not find an effect of pictorial warnings on perceived likelihood of harm, the reason is unclear.”
Quote in the paperSubstantial claim - Findingown data
The weighted mean effect size for the composite variable motivation to avoid cigarette use was statistically significant at d=0.95 (CI 0.56 to 1.34, k=15, cumulative n=13,023).
“The weighted mean effect size for the composite variable motivation to avoid cigarette use was statistically significant (p<0.001) at d=0.95 (CI 0.56 to 1.34, k=15, cumulative n=13 023).”
Quote in the paperSubstantial claim - Findingcitation
The lone study that assessed perceived severity of harm found a large effect.
“It is also important to note that the lone study that assessed perceived severity of harm, another component of perceived threat, found a large effect.36”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36] Schneider, 2012, Does the effect go up in smoke? A randomized controlled trial of pictorial warnings on cigarette packaging, Patient Educ Couns source
Not checked in the free run.
- Findingnone given
The meta-analysis included both experiments that manipulated pictorial warnings between subjects and within subjects.
“Our meta-analysis included both experiments that manipulated pictorial warnings between subjects (participants viewed only text or only pictorial warnings) and within subjects (participants viewed both warning types).”
Quote in the paperSubstantial claim - Findingreasoning
The between-subject studies had markedly smaller effect sizes for perceived effectiveness for motivation to avoid cigarette use than within-subject studies.
“The between-subject studies had markedly smaller effect sizes for perceived effectiveness for motivation to avoid cigarette use than within-subject studies.”
Quote in the paperSubstantial claim - Findingnone given
Studies often use discussions about warnings in a composite scale representing depth of processing, making it impossible to tease out the influence of social interactions.
“While some studies have assessed discussions about warnings,19 93 101 102 studies often use this variable in a composite scale representing depth of processing, making it impossible to tease out the influence of social interactions.”
Quote in the paperNot a substantial claim - Findingown data
Pictorial warnings elicited greater reactance than text warnings.
“While we found that pictorial warnings elicited greater reactance than text warnings, the studies in our meta-analysis focused on the emotional aspect of reactance, and largely ignored the cognitive elements.”
Quote in the paperNot a substantial claim - Findingown data
No study in the meta-analysis tested warnings by placing them on smokers' cigarette packs.
“A final study design issue is that no study in this meta-analysis tested warnings by placing them on smokers’ cigarette packs.”
Quote in the paperSubstantial claim - Findingown data
The meta-analysis revealed a lack of consensus as to what outcomes experimental studies should assess.
“Despite the existence of several models to guide warnings research,53–55 our meta-analysis revealed a lack of consensus as to what outcomes experimental studies should assess.”
Quote in the paperSubstantial claim - Findingown data
Pictorial warnings were more effective than text warnings on 20 of 25 outcomes examined in the meta-analysis.
“Pictorial warnings were more effective than text warnings on 20 of 25 outcomes examined in the meta-analysis;”
Quote in the paperSubstantial claim - Findingown data
The meta-analysis identified only a single experimental study that assessed behaviour.
“First, our meta-analysis identified only a single experimental study that assessed behaviour.69”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [69] Malouff, 2012, Effects on smokers of exposure to graphic warning images, Am J Addict source
Not checked in the free run.
- Findingown data
The meta-analysis found pictorial warnings increased aversiveness (the warnings being difficult to look at).
“Finally, our meta-analysis found pictorial warnings increased aversiveness (ie, the warnings being ‘difficult to look at’).”
Quote in the paperNot a substantial claim - Premisecitation
Attention to and recall of a warning influences warning reactions.
“and that attention to (and recall of) the warning influences warning reactions.”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [46] McGuire, 1989, Theoretical foundations of campaigns
Not checked in the free run.
- cites [47] Fishbein, 2010
Not checked in the free run.
- cites [48] Petty, 1986, The elaboration likelihood model of persuasion, Adv Exp Soc Psychol source
Not checked in the free run.
- cites [49] Southwell, 2007, The roles of interpersonal communication in mass media campaigns, Commun Yearbook
Not checked in the free run.
- cites [50] Noar, 2005, Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction, Health Educ Res source
Not checked in the free run.
- cites [51] Cane, 2012, Validation of the theoretical domains framework for use in behaviour change and implementation research, Implement Sci source
Not checked in the free run.
- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
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- cites 29 53–55
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- Interpretationown data
The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings.
“The evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings.”
Quote in the paperSubstantial claim- Rests on an assumption: The intermediate outcomes assessed in the experimental studies (attention, reactions, attitudes, and intentions) are valid indicators of warning effectiveness in changing smoking behaviour.
- Premisereasoning
The Monarrez-Espino review did not examine many factors that are likely pre-requisites to changes in behaviour, such as attention to warnings, cognitive and emotional reactions to warnings, and changes in beliefs about smoking.
“Importantly, this review did not examine many factors that are likely pre-requisites to changes in behaviour, such as attention to warnings, cognitive and emotional reactions to warnings, and changes in beliefs about smoking.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Monarrez-Espino, 2014, Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior, Am J Public Health source
Not checked in the free run.
- Premisecitation
Isolating the effects of pictorial warnings on smoking behaviour in observational studies is difficult because governments often introduce the warnings alongside other tobacco control policies.
“However, isolating the effects of pictorial warnings on smoking behaviour in such studies has proven difficult because governments often introduce the warnings alongside other tobacco control policies.8 12”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 8 12
Not checked in the free run.
- Premisereasoning
Experiments can offer strong evidence of the causal impact of pictorial warnings, isolating the effects of warnings on key outcomes.
“By contrast, experiments can offer strong evidence of the causal impact of pictorial warnings, isolating the effects of warnings on key outcomes.”
Quote in the paperSubstantial claim - Study design and conductreasoning
All within-subject effect sizes were computed from raw statistics rather than inferential statistics to avoid bias.
“Thus, we applied conventional formulas58 and computed all within-subject effect sizes from raw (vs inferential) statistics.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [58] Lipsey, 2001
Not checked in the free run.
- Premisecitation
No meta-analysis has synthesised the experimental literature on pictorial cigarette pack warnings.
“While these recent reviews have summarised portions of the cigarette pack warnings literature,8 9 30 no meta-analysis has synthesised the experimental literature on pictorial cigarette pack warnings.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 8 9 30
Not checked in the free run.
- Study design and conductnone given
Most dependent variables had too few studies to perform moderator analyses.
“Most dependent variables had too few studies to perform moderator analyses.”
Quote in the paperSubstantial claim - Interpretationown data
The experimental studies examined in this meta-analysis showed promising evidence of effects.
“The experimental studies we examined here showed promising evidence of effects.”
Quote in the paperSubstantial claim - Interpretationown data
The meta-analysis provides support for the notion that pictorial warnings elicit changes in an array of psychosocial constructs that are plausible mediators of the warning-behaviour link.
“Our meta-analysis provides support for the notion that pictorial warnings elicit changes in an array of psychosocial constructs that are plausible mediators of the warning-behaviour link.”
Quote in the paperSubstantial claim - Interpretationreasoning
Taken together, the findings on effectiveness and perceived effectiveness offer strong evidence to support pictorial cigarette pack warnings as more effective than text-only warnings.
“Taken together, these findings on effectiveness (eg, increased quit intentions) and perceived effectiveness (eg, increased perception that warnings motivate quitting) offer strong evidence to support pictorial cigarette pack warnings as more effective than text-only warnings.”
Quote in the paperSubstantial claim - Premisecitation
Effect size d can be upwardly biased when based on small sample sizes.
“Because d can be upwardly biased when based on small sample sizes,59 we applied the recommended statistical correction for this bias.58”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [59] Hedges, 1985
Not checked in the free run.
- Interpretationcitation
Cognitive elaboration may play a particularly important role in the quitting process.
“Cognitive elaboration may play a particularly important role in the quitting process.”
Quote in the paperSubstantial claim - Premisecitation
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”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [81] Yong, 2014, Mediational pathways of the impact of cigarette warning labels on quit attempts, Health Psychol source
Not checked in the free run.
- Premisecitation
Internal validity threats make strong causal conclusions from observational studies difficult, especially on outcomes such as smoking behaviour.
“However, internal validity threats make strong causal conclusions from such studies difficult, especially on outcomes such as smoking behaviour.30”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Monarrez-Espino, 2014, Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior, Am J Public Health source
Not checked in the free run.
- Interpretationnone given
This study was the first to estimate the effects of pictorial cigarette pack warnings through a meta-analysis of experimental studies.
“Our study was the first to estimate the effects of pictorial cigarette pack warnings through a meta-analysis of experimental studies.”
Quote in the paperSubstantial claim - Premisecitation
One observational study revealed that Canadian smokers who avoided pictorial warnings were equally likely to think about the warnings or engage in cessation behaviour than those who did not attempt to avoid the warnings.
“One observational study revealed that Canadian smokers who avoided pictorial warnings were equally likely to think about the warnings or engage in cessation behaviour than those who did not attempt to avoid the warnings.93”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [93] Hammond, 2004, Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers, Am J Public Health source
Not checked in the free run.
- Premisecitation
The large body of observational literature examines smokers who have had multiple exposures to warnings on their cigarette packs.
“By contrast, the large body of observational literature examines smokers who have had multiple exposures to warnings on their cigarette packs.8”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Hammond, 2011, Health warning messages on tobacco products: a review, Tob Control source
Not checked in the free run.
- May combine two claims. 22
- Classified as probably not a substantial claim. 24
May combine two claims.
Findingown dataHomogeneity analyses indicated that 9 of 17 effect sizes were heterogeneous, with 6 of these 9 outcomes having an I2 greater than 90.
“Homogeneity analyses indicated that 9 of 17 effect sizes were heterogeneous, with many outcomes exhibiting extremely high heterogeneity: 6 of these 9 outcomes had an I2 of greater than 90 (table 3).”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataPictorial warnings elicited more negative pack attitudes and negative smoking attitudes than text warnings.
“Compared with text warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes; and (4) more effectively increased intentions to not start smoking and to quit smoking.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataCompared with text warnings, pictorial warnings attracted and held attention better.
“Compared with text warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes; and (4) more effectively increased intentions to not start smoking and to quit smoking.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPictorial warnings more effectively increased intentions to not start smoking and to quit smoking than text warnings.
“Compared with text warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes; and (4) more effectively increased intentions to not start smoking and to quit smoking.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataNo effects of pictorial warnings were found on perceived threat and efficacy.
“On these two key constructs, we found no effects of pictorial warnings.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataOnly two studies in the meta-analysis measured self-efficacy, and none manipulated it experimentally.
“However, only two studies in this meta-analysis measured self-efficacy, and none manipulated it experimentally.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataThe studies in the meta-analysis focused on the emotional aspect of reactance and largely ignored the cognitive elements.
“While we found that pictorial warnings elicited greater reactance than text warnings, the studies in our meta-analysis focused on the emotional aspect of reactance, and largely ignored the cognitive elements.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataPictorial warnings were more effective and perceived to be more effective as compared with text warnings.
“Pictorial warnings were more effective (eg, increased quit intentions) and perceived to be more effective (eg, rated as likely to motivate smokers to quit) as compared with text warnings;”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenAn area that remains understudied is the effect of pictorial warnings on reducing smoking initiation.
“Third and finally, an area that remains understudied is the effect of pictorial warnings on reducing smoking initiation.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataParticipants had only brief exposure to warnings, often on a computer screen.
“Instead, participants had only brief exposure to warnings, often on a computer screen.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataThe investigation demonstrated that pictorial warnings were more effective than text warnings on the vast majority of outcomes studied, affecting several constructs, including intention to not start smoking and intention to quit smoking.
“This investigation demonstrated that pictorial warnings were more effective than text warnings on the vast majority of outcomes studied, affecting several constructs, including intention to not start smoking and intention to quit smoking.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataOutcomes varied widely, with little consistency across studies.
“Outcomes varied widely, with little consistency across studies.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationWarning reactions affect attitudes and beliefs.
“Warning reactions are thought to, in turn, affect attitudes/beliefs”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [46] McGuire, 1989, Theoretical foundations of campaigns
Not checked in the free run.
- cites [47] Fishbein, 2010
Not checked in the free run.
- cites [48] Petty, 1986, The elaboration likelihood model of persuasion, Adv Exp Soc Psychol source
Not checked in the free run.
- cites [49] Southwell, 2007, The roles of interpersonal communication in mass media campaigns, Commun Yearbook
Not checked in the free run.
- cites [50] Noar, 2005, Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction, Health Educ Res source
Not checked in the free run.
- cites [51] Cane, 2012, Validation of the theoretical domains framework for use in behaviour change and implementation research, Implement Sci source
Not checked in the free run.
- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
Not checked in the free run.
- cites 29 53–55
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationCigarette pack warnings may spark interpersonal communication and social interactions, which may affect individuals' attitudes, beliefs, and reactions to warnings.
“Given that cigarette pack warnings are often in public view, they may spark interpersonal communication and social interactions.49 These social interactions, such as talking about the warnings with friends and family members, may affect individuals’ attitudes, beliefs, and reactions to the warnings.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] Southwell, 2007, The roles of interpersonal communication in mass media campaigns, Commun Yearbook
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationWarning characteristics affect the extent to which a warning is noticed and later recalled.
“The framework suggests that the characteristics of a warning affect the extent to which the warning will be noticed and later recalled”
Quote in the paperSubstantial claim0 of 8 sources checked- cites [46] McGuire, 1989, Theoretical foundations of campaigns
Not checked in the free run.
- cites [47] Fishbein, 2010
Not checked in the free run.
- cites [48] Petty, 1986, The elaboration likelihood model of persuasion, Adv Exp Soc Psychol source
Not checked in the free run.
- cites [49] Southwell, 2007, The roles of interpersonal communication in mass media campaigns, Commun Yearbook
Not checked in the free run.
- cites [50] Noar, 2005, Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction, Health Educ Res source
Not checked in the free run.
- cites [51] Cane, 2012, Validation of the theoretical domains framework for use in behaviour change and implementation research, Implement Sci source
Not checked in the free run.
- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
Not checked in the free run.
- cites 29 53–55
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationAttitudes and beliefs influence intentions and ultimately behaviour.
“which later influence intentions and ultimately behaviour.”
Quote in the paperNot a substantial claim0 of 8 sources checked- cites [46] McGuire, 1989, Theoretical foundations of campaigns
Not checked in the free run.
- cites [47] Fishbein, 2010
Not checked in the free run.
- cites [48] Petty, 1986, The elaboration likelihood model of persuasion, Adv Exp Soc Psychol source
Not checked in the free run.
- cites [49] Southwell, 2007, The roles of interpersonal communication in mass media campaigns, Commun Yearbook
Not checked in the free run.
- cites [50] Noar, 2005, Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction, Health Educ Res source
Not checked in the free run.
- cites [51] Cane, 2012, Validation of the theoretical domains framework for use in behaviour change and implementation research, Implement Sci source
Not checked in the free run.
- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
Not checked in the free run.
- cites 29 53–55
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationResearch has suggested that messages with higher perceived effectiveness ratings may be more effective than those with lower ratings.
“These findings are noteworthy, as research has suggested that messages with higher perceived effectiveness ratings may be more effective than those with lower ratings.82–84”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [82] Dillard, 2007, The relationship between the perceived and actual effectiveness of persuasive messages: a meta-analysis with implications for formative campaign research, J Commun source
Not checked in the free run.
- cites [83] Davis, 2012, Perceived effectiveness of cessation advertisements: the importance of audience reactions and practical implications for media campaign planning, Health Commun source
Not checked in the free run.
- cites [84] Brennan, 2014, Assessing the effectiveness of antismoking television advertisements: do audience ratings of perceived effectiveness predict changes in quitting intentions and smoking behaviours?, Tob Control source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductcitationThe authors applied the recommended statistical correction for small-sample bias in d.
“Because d can be upwardly biased when based on small sample sizes,59 we applied the recommended statistical correction for this bias.58”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [58] Lipsey, 2001
Not checked in the free run.
- cites [59] Hedges, 1985
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA previous meta-analysis of eight longitudinal studies found that negative smoking attitudes and quit intentions predicted subsequent quit attempts.
“In our meta-analysis, it is especially noteworthy that pictorial warnings changed negative smoking attitudes and quit intentions, as these variables are associated with quitting behaviour. For example, a previous meta-analysis of eight longitudinal studies found that negative smoking attitudes and quit intentions predicted subsequent quit attempts.80”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [80] Vangeli, 2011, Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review, Addiction source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataIntercoder reliability was high, with a mean per cent agreement of 96% and a mean Cohen's kappa of 0.94.
“Most categories had perfect agreement, and the mean per cent agreement was 96%. Cohen's κ34 had a mean of 0.94.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] Cohen, 1960, A coefficient of agreement for nominal scales, Educ Psychol Meas source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMuch theorising situates perceived likelihood of harm as a central construct in fear appeals and risk communication.
“It was surprising that only five studies (with 8 effect sizes) in the meta-analysis assessed perceived likelihood of harm, a component of perceived threat, when much theorising situates this as a central construct in fear appeals and risk communication.52 88 89”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
Not checked in the free run.
- cites [88] Rogers, 1975, A protection motivation theory of fear appeals and attitude change, J Psychol source
Not checked in the free run.
- cites [89] Becker, 1974, The health belief model and personal health behavior, Health Educ Monogr source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe Q statistic and I2 were calculated to examine heterogeneity among effect sizes.
“We calculated the Q statistic and I2 to examine whether heterogeneity existed among the effect sizes.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataTwo reviewers independently examined study titles, abstracts, and full texts, and discrepancies were resolved by a third referee.
“Two reviewers independently examined all study titles for relevance, reducing the number to 497, and then reviewed abstracts, further reducing the number to 98.”
- Also stated in: § Search strategy · plain
“If the two reviewers made a different determination about the classification of a particular article, they consulted with a third referee to resolve the discrepancy and make a final determination.”
Quote in the paperNot a substantial claim- Also stated in: § Search strategy · plain
May combine two claims.
Interpretationown dataPictorial warnings are superior to text warnings at multiple stages of the message impact framework and may move people towards quitting smoking.
“These findings suggest that pictorial warnings are superior to text warnings at multiple stages of our message impact framework (figure 8) and may move people towards quitting smoking.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationA systematic review by Monarrez-Espino et al found that most studies were of poor methodological quality and that their findings on the impact of pictorial warnings on smoking behaviour were inconclusive.
“Monarrez-Espino et al found that most of these studies were of poor methodological quality; for this reason, their findings on the impact of pictorial warnings on smoking behaviour were inconclusive.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Monarrez-Espino, 2014, Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior, Am J Public Health source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFear appeals increase fear as a mechanism for attitude, intention and behavioural change.
“This is consistent with previous research and theory on fear appeals, which has found that such appeals increase fear as a mechanism for attitude, intention and behavioural change.87”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [87] Witte, 2000, A meta-analysis of fear appeals: implications for effective public health campaigns, Health Educ Behav source
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationMany beliefs and attitudes are plausible mediators according to theories of health behaviour.
“We saw the effects for many beliefs and attitudes that are plausible mediators according to theories of health behaviour.50 85 86”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [50] Noar, 2005, Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction, Health Educ Res source
Not checked in the free run.
- cites [85] Ajzen, 1991, The theory of planned behavior, Organ Behav Hum Decis Process source
Not checked in the free run.
- cites [86] Rosenstock, 1974, Historical origins of the health belief model, Health Educ Behav source
Not checked in the free run.
May combine two claims.
PremisecitationNegative smoking attitudes and quit intentions are associated with quitting behaviour.
“In our meta-analysis, it is especially noteworthy that pictorial warnings changed negative smoking attitudes and quit intentions, as these variables are associated with quitting behaviour. For example, a previous meta-analysis of eight longitudinal studies found that negative smoking attitudes and quit intentions predicted subsequent quit attempts.80”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [80] Vangeli, 2011, Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review, Addiction source
Not checked in the free run.
May combine two claims.
PremisecitationThat recent systematic review examined only smoking behaviour and included mostly observational studies.
“While a recent systematic review did not find evidence that pictorial warnings were effective,30 that review examined only smoking behaviour and included mostly observational studies.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Monarrez-Espino, 2014, Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior, Am J Public Health source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
Study design and conductcitationEffect sizes were weighted by inverse variance and combined using random effects meta-analytic procedures.
“Analyses weighted effect sizes by their inverse variance and combined them using random effects meta-analytic procedures.58”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [58] Lipsey, 2001
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationA recent systematic review did not find evidence that pictorial warnings were effective.
“While a recent systematic review did not find evidence that pictorial warnings were effective,30 that review examined only smoking behaviour and included mostly observational studies.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Monarrez-Espino, 2014, Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior, Am J Public Health source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIntentions are one of the strongest predictors of behaviour according to theory and empirical research.
“The potential mediator most proximal to behaviour is intentions, one of the strongest predictors of behaviour according to both theory85 and empirical research.80”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [85] Ajzen, 1991, The theory of planned behavior, Organ Behav Hum Decis Process source
Not checked in the free run.
- cites [80] Vangeli, 2011, Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review, Addiction source
Not checked in the free run.
May combine two claims.
PremisecitationUsing statistics such as t and F for effect-size computation in within-subject designs can bias effect-size estimates, whereas using raw statistics such as means and SDs does not yield this bias.
“For within-subject designs, using statistics such as t and F for effect-size computation can bias effect-size estimates.60 However, using raw statistics such as means and SDs does not yield this bias.60 61”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [60] Dunlap, 1996, Meta-analysis of experiments with matched groups or repeated measures designs, Psychol Methods source
Not checked in the free run.
- cites 60 61
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenTwo independent coders coded all study characteristics.
“Two independent coders coded all study characteristics.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPerceived threat and efficacy help explain how people respond to fear appeals.
“However, fear appeal theories, such as the extended parallel process model (EPPM),52 also suggest that two key constructs help explain how people respond to fear appeals—perceived threat and efficacy.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [52] Witte, 1992, Putting the fear back into fear appeals: the extended parallel process model, Commun Monogr source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPrevious fear appeal research and theory suggest that fear-oriented communications can elicit reactance.
“Previous fear appeal research and theory also suggest that fear-oriented communications can elicit reactance.87”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [87] Witte, 2000, A meta-analysis of fear appeals: implications for effective public health campaigns, Health Educ Behav source
Not checked in the free run.
May combine two claims.
InterpretationreasoningIn the real world, participants are likely to see only text or pictorial warnings on cigarette packs, and so between-subject studies may provide a more accurate estimate of effect size of that difference.
“In the real world, participants are likely to see only text or pictorial warnings on cigarette packs, and so it may be that between-subject studies provide a more accurate estimate of effect size of that difference.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationSmoking is a social behaviour.
“Second, given that smoking is a social behaviour,100 a better understanding of how social interactions influence warning effectiveness is needed.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [100] Christakis, 2008, The collective dynamics of smoking in a large social network, N Engl J Med source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationResearch characterises reactance as a construct comprised of both emotion and cognition.
“Research characterises reactance as a construct comprised of both emotion (eg, anger, irritation) and cognition (eg, defensive processing, denial).92”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [92] Dillard, 2005, On the nature of reactance and its role in persuasive health communication, Commun Monogr source
Not checked in the free run.
The paper relies on this without support.
Perceived effectiveness ratings do not play a direct role in warning message effects.
“However, currently, there is no evidence to suggest that these ratings play a direct role in warning message effects (ie, that participants must perceive a message to be effective in order for it to be so).”
The paper relies on this without support.
The intermediate outcomes assessed in the experimental studies (attention, reactions, attitudes, and intentions) are valid indicators of warning effectiveness in changing smoking behaviour.
“Pictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05).”
“Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.”
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- Authors
- Noar, S. M., Hall, M. G., Francis, D. B., Ribisl, K. M., Pepper, J. K., & Brewer, N. T.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Noar, Seth M
- Venue
- Tobacco Control
- Publisher
- BMJ
- Published
- 2015-05-06
- Volume
- 25
- Issue
- 3
- Pages
- 341-354
- ISSN
- 0964-4563 (ISSN-L)
- 1468-3318
- PMC
- PMC4636492
- OpenAlex
- W2126304455
- Semantic Scholar
- ba775abdc6588bfe20a61c1407c851b70557c9b9
- Cited by
- 674
- References
- 101
- Citations by year
- 2026: 31 · 2025: 49 · 2024: 43 · 2023: 56 · 2022: 53 · 2021: 72 · 2020: 117 · 2019: 67 · 2018: 83 · 2017: 67 · 2016: 32 · 2015: 4
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Tobacco Control (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health
- Centers for Disease Control and Prevention (U48DP001944)
- U.S. Public Health Service (P3OCAO1 6086-3832)
- University of North Carolina at Chapel Hill
- National Cancer Institute (P30CA016086)
- Center for Tobacco Products
- 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
- text-only warnings, tobacco warning labels, smoking prevention, smoking cessation intentions, attitudes toward smoking
- MeSH terms
- Smoking Prevention, Attention, Cognition, Health Education, Humans, Health Knowledge, Attitudes, Practice, Motivation, Photography, Product Labeling, Risk Factors, Smoking, Visual Perception, Health Behavior, Smoking Cessation, Risk Assessment, 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.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.
Statistics and arithmetic are recomputed, not judged.
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