Perceived effectiveness of tobacco packaging and cigarette stick warnings as anti-tobacco interventions

Drovandi, Aaron (2018) Perceived effectiveness of tobacco packaging and cigarette stick warnings as anti-tobacco interventions. PhD thesis, James Cook University.

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View at Publisher Website: https://doi.org/10.25903/5d23d483771df
 
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Abstract

Introduction: Tobacco use remains the largest preventable cause of mortality in Australia, despite significant reductions in the prevalence of daily smoking over the past 25 years. Multiple public health interventions have contributed to these reductions, including health warnings and graphic images on cigarette packaging. Whilst initially effective in curbing tobacco use, recent research has identified that these packaging health warnings have become less effective as an anti-tobacco intervention. As tobacco is still the cause of death of an estimated 15 000 Australians per year, further improvements in anti-tobacco interventions are needed. A novel anti-tobacco medium being investigated is the cigarette stick itself. As the primary packaging of tobacco leaf used whilst smoking, it represents a logical and appropriate medium for communicating the consequences of smoking. This research first aimed to confirm recent findings suggesting that current cigarette packaging warnings have lost their effectiveness. It also evaluated the perceptions of a diverse participant cohort towards the use of cigarette sticks as a novel anti-tobacco intervention medium, and to inform on the development of warnings and messages effective both in preventing non-smokers from experimenting with cigarettes, and prompting current smokers to quit smoking.

Methods: A mixed methods approach was utilised, incorporating the use of online surveys, and semi-structured focus groups and interviews. Established health warnings on current cigarette packaging, and novel warnings and messages on individual cigarette sticks were presented to a range of participants, including adolescents and young adults, pharmacists, an international cohort of current smokers, and the wider Australian community. The Health Belief Model (HBM) was utilised in developing the interventional materials. These materials aimed to increase readers' perceived susceptibility and severity of the negative consequences of tobacco use, whilst also outlining the benefits of not smoking, and acting as an additional prompt for quit attempts. A sequential explanatory design was used, where initial survey and focus group findings were triangulated and used to refine the health warnings and messages used in subsequent surveys, focus groups and interviews. Quantitative data on participants' perceived effectiveness of cigarette packaging and cigarette stick warnings were collected using 5-point Likert scales, and analysed using Chi squared and proportional odds logistic regression analyses. In-depth qualitative information was gathered to support and expand upon the quantitative data, achieved through free-text comments in the surveys, and from focus groups and interviews, which were analysed using content and thematic analyses respectively.

Results and Discussion: A total of 2 045 participants were involved in the research, of which 75% were Australian, 60% were female, 37% were smokers, and 80% were of Caucasian descent. These participants were split amongst five primary populations: the wider Australian community (637), pharmacists (79), school students (150), university students (501), and an international cohort of smokers (678). Perceptions of the effectiveness of current cigarette packaging warnings were generally consistent amongst all participant groups. These warnings were considered minimally effective in prompting current smokers to quit, though slightly more effective in preventing non-smokers from experimenting with cigarettes. Analyses of the qualitative data identified several reasons for these poor ratings, including a loss of shock value due to repetitive exposure over several years, simply ignoring the packaging warnings, and a feeling that the warnings were irrelevant, particularly amongst the younger participants.

In comparison, several of the novel warnings and messages on individual cigarette sticks were rated as significantly more effective than current packaging warnings in preventing nonsmokers from smoking, and prompting current smokers to quit. These warnings were considered particularly effective in increasing participants' perceived susceptibility and severity to a wider range of consequences of smoking, and outlining the benefits of not smoking. The financial costs of smoking was a message considered novel, engaging, and widely applicable to the broader population compared to current packaging warnings, particularly by current smokers (Odds Ratio [OR] = 3.42, 95% Confidence Interval [CI] 2.75- 4.25, p<.001). This was supported by the open-text comments, with participants indicating that financial stability is valued over avoiding potential health issues. Other warnings perceived as effective throughout this research in comparison to current packaging warnings include the 'minutes of life lost' per cigarette (OR = 3.60, 95% CI 2.79-4.64, p<.001 amongst university students), and the negative effects of smoking on family members (OR = 2.85, 95% CI 2.29- 3.55, p<.001 amongst current smokers). These warnings were considered novel, relatable, and engaging, making them capable of eliciting strong emotional responses likely to motivate changes in smoking behaviour amongst smokers, and prevent experimentation amongst nonsmokers. Participants were also in favour of the inclusion of warnings and messages on cigarette sticks, with over half (54%) of smokers and over three-quarters (87%) of non-smokers either 'agreeing' or 'strongly agreeing'. They believed that this anti-tobacco intervention would be more difficult to avoid, and would reduce the aesthetic appeal of smoking, particularly amongst adolescents.

Conclusions: This research has confirmed shortcomings in the effectiveness of current cigarette packaging warnings, emphasising the need for improvements in anti-tobacco interventions. The inclusion of novel and engaging warnings and messages on individual cigarette sticks was found to be a potentially effective next step in combating the global tobacco epidemic. It is essential that these warnings are able to elicit strong reactions by persons of any age and smoking status. The vast majority of non-smokers, and over half of smokers were in support of this novel anti-tobacco intervention. Future warning and message development for both cigarette packaging and cigarette sticks should therefore include short-term health, and non-health related consequences of tobacco use, since in this research they were found to be the most engaging, and likely to elicit positive public health changes in the community.

Item ID: 58867
Item Type: Thesis (PhD)
Keywords: adolescent health, cigarette attributes, health behavior, health behaviour, health literacy, health promotion, public health, smoking appeal, smoking reduction, social medicine, tobacco control, youth
Related URLs:
Copyright Information: Copyright © 2018 Aaron Drovandi.
Additional Information:

Publications arising from this thesis are available from the Related URLs field. The publications are:

Chapter 2: Drovandi, Aaron, Teague, Peta-Ann, Glass, Beverley, and Malau-Aduli, Bunmi (2019) A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes. Systematic Reviews, 8. 25.

Chapter 3: Drovandi, Aaron, Teague, Peta-ann, Glass, Beverley, and Malau-Aduli, Bunmi (2018) A systematic review of smoker and non-smoker perceptions of visually unappealing cigarette sticks. Tobacco Induced Diseases, 16 (2).

Chapter 5: Drovandi, Aaron, Teague, Peta-Ann, Glass, Beverley, and Malau-Aduli, Bunmi (2019) Australian community pharmacist experiences with smoking cessation and opinions of health warnings on individual cigarette sticks. International Journal of Pharmacy Practice, 27 (2). pp. 121-130.

Chapter 6: Drovandi, Aaron, Teague, Peta-ann, Glass, Beverley, and Malau-Aduli, Bunmi (2018) Australian school student perceptions of effective anti-tobacco health warnings. Frontiers in Public Health, 6. 297.

Chapter 7: Drovandi, Aaron, Teague, Peta-Ann, Glass, Beverley, and Malau-Aduli, Bunmi (2019) Australian university student perceptions of health messages on cigarette sticks. Health Communication. (In Press)

Chapter 8: Drovandi, Aaron, Teague, Peta-Ann, Glass, Beverley, and Malau-Aduli, Bunmi (2019) Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students. Psychology Research and Behavior Management, 12. pp. 361-373.

Chapter 9: Drovandi, Aaron, Teague, Peta-Ann, Glass, Beverley, and Malau-Aduli, Bunmi (2019) Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: a four-country study. Tobacco Induced Diseases, 17. 23.

Date Deposited: 09 Jul 2019 01:21
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111712 Health Promotion @ 35%
17 PSYCHOLOGY AND COGNITIVE SCIENCES > 1701 Psychology > 170106 Health, Clinical and Counselling Psychology @ 30%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 35%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 50%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920414 Substance Abuse @ 50%
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