Reducing the appeal of smoking: Study confirms tobacco warnings on packages need improvement BMJ_Open
which may help explain our results. Further, marker words were present in only slightly over half of the tobacco warnings we examined. However, the use of a marker word may influence a viewer’s attention. Using a marker word like ‘WARNING’ before the health warning text can increase message recall, message effectiveness, fear and thinking about harms.Several areas of warning content suggest areas for future research.
Our findings also indicate that tobacco warnings stated various health effects associated with tobacco use, but almost always used in broad terms rather than mentioning specific tobacco products. While WHO specifically recommends personalising tobacco warnings to help with believability and relevance, it is unclear whether this recommendation should be interpreted to use precise terms for tobacco products in warning such as ‘cigarette smoke’ or ‘cigar use’.
Finally, every tobacco warning should feature as many key recommendations and attributes from best practice research as feasible. However, very few tobacco warnings in our study included multiple attributes , cessation resources, marker word). Research is needed to determine what combination of tobacco warning design elements are the most effective.
Our study has several limitations including that we collected only English language warnings, and we have no data regarding which pictorial warnings and characteristics were associated with positive and negative behaviours by viewers. In addition, most warnings were identified through warning database searches; warnings that were not available online may not be represented.
The features discussed in this study are best practices but provide no guarantee of increased effectiveness of pictorial warnings. Tobacco warnings are best informed by best practice and evidence of warning effectiveness in the population where they will be implemented.Our systematic evaluation of English language combustible tobacco warnings confirms that the landscape of tobacco warnings can improve considerably to follow proposed WHO FCTC Guidelines and best practice research.
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