Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial
Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial
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DOI：
10.1371/journal.pone.0142879
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发表时间：
2015-12-16
期刊：
影响因子：
3.7
通讯作者：
Romer, Daniel
中科院分区：
文献类型：
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作者：
Evans, Abigail T.;Peters, Ellen;Romer, Daniel
目的观察性研究表明，在香烟警告标签上放置图形图像可以降低吸烟率，但实地研究缺乏实验控制。我们的主要目的是在一项随机临床试验中，确定在4周的时间内接触改良烟盒的人群中，自然接触图形警告和纯文本警告所引发的心理过程。通过考察对吸烟的影响、警告信息的可信度、风险认知、戒烟意图、警告标签记忆和吸烟风险知识来检验图形警告影响理论。方法：从宾夕法尼亚州费城和俄亥俄州哥伦布市招募每天吸烟5 - 40支的成年人（N = 293，平均年龄= 33.7），无禁症且不打算戒烟。吸烟者被随机分配在三种警告条件下接受自己品牌的香烟，三种警告条件是：只有文字，图文加文字，或者图文加详细文字。结果244名完成试验的参与者的数据采用结构方程模型进行分析。图形图像的存在（与纯文本相比）对吸烟产生了更多的负面影响，这一过程间接影响了风险感知和戒烟意图（例如，图像->负面影响->风险感知->戒烟意图）。图形图像的负面影响也提高了警告的可信度，包括通过增加对警告的审查，这一过程也间接影响了风险感知和戒烟意图（例如，图像->负面影响->风险审查->警告可信度->风险感知->戒烟意图）。没想到，详尽的文字降低了警告的可信度。最后，在试验结束和一个月后，图形警告增加了警告信息的回忆，并间接增加了吸烟风险知识。结论在进行的第一次自然主义临床试验中，在鼓励吸烟者考虑戒烟和教育他们吸烟的风险方面，图形警告标签比文字警告更有效。对吸烟的负面情感反应、对风险的思考和对可信度的认知是其影响的中介。
ObjectiveObservational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates, but field studies lack experimental control. Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a randomized clinical trial involving exposure to modified cigarette packs over a 4-week period. Theories of graphic-warning impact were tested by examining affect toward smoking, credibility of warning information, risk perceptions, quit intentions, warning label memory, and smoking risk knowledge.MethodsAdults who smoked between 5 and 40 cigarettes daily (N = 293; mean age = 33.7), did not have a contra-indicated medical condition, and did not intend to quit were recruited from Philadelphia, PA and Columbus, OH. Smokers were randomly assigned to receive their own brand of cigarettes for four weeks in one of three warning conditions: text only, graphic images plus text, or graphic images with elaborated text.ResultsData from 244 participants who completed the trial were analyzed in structural-equation models. The presence of graphic images (compared to text-only) caused more negative affect toward smoking, a process that indirectly influenced risk perceptions and quit intentions (e.g., image->negative affect->risk perception->quit intention). Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings, a process that also indirectly affected risk perceptions and quit intentions (e.g., image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention). Unexpectedly, elaborated text reduced warning credibility. Finally, graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later.ConclusionsIn the first naturalistic clinical trial conducted, graphic warning labels are more effective than text-only warnings in encouraging smokers to consider quitting and in educating them about smoking's risks. Negative affective reactions to smoking, thinking about risks, and perceptions of credibility are mediators of their impact.