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Cited by 85Smoking Behavior and CessationGlobal Public Health Policies and EpidemiologyBehavioral Health and Interventions

Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior

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Monárrez-Espino, Joel, Liu, Bojing, Greiner, Felix, Bremberg, Sven, Galanti, Rosaria·2014·American Journal of Public Health
DOI 10.2105/ajph.2014.302129PMC PMC4167086
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Abstract

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.

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  • A 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.”

    From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [30]

  • A 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.”

    From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [30]

  • 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.”

    From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [30]

  • That 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.”

    From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [30]

  • 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”

    From Pictorial cigarette pack warnings: a meta-analysis of experimental studies (2016) · cites this paper as [30]

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Research works printed but not linked: 10

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Authors
Monárrez-Espino, J., Liu, B., Greiner, F., Bremberg, S., & Galanti, R.
Affiliations
  • Joel Monárrez-Espino, Bojing Liu, Felix Greiner, Sven Bremberg, and Rosaria Galanti are with the Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Rosaria Galanti is also with the Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden.
  • Karolinska Institutet (SE)
ORCID
Venue
American Journal of Public Health
Publisher
American Public Health Association
Published
2014-10
Volume
104
Issue
10
Pages
e11-e30
ISSN
  • 0090-0036 (ISSN-L)
  • 1541-0048
DOI
10.2105/ajph.2014.302129
PMC
PMC4167086
OpenAlex
W3023183663
Cited by
85
References
44
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 8 · 2019: 12 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 8
FWCI
1.14
Type
journal article
Language
en
Open access
Locations
  • American Journal of Public Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
pictorial warnings, cigarette packaging, smoking behavior, smoking cessation, smoking reduction, quit attempts, tobacco control, health warnings
MeSH terms
Humans, Motivation, Product Labeling, Smoking, Smoking Cessation, Intention, Tobacco Products

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