Objectives: Cigarette pack warnings are widely used internationally for reducing smoking behaviour. Current warnings typically consist of a textual or graphic warning that smoking can lead to negative (health) outcomes. Though these warnings have proven benefits, they also have important limitations. Most notably, they do not produce beneficial changes in important cognitive determinants of smoking cessation such as self-efficacy to refrain from smoking and they do not reduce smoking for specific subsets of the target population. Recent studies provide evidence for the effectiveness of health warnings that include health-related testimonies from former smokers. Methods: We designed cigarette pack warnings that consist of more general testimonial statements from former smokers, selected in a pilot study for their potential impact on two important cognitive determinants of smoking (i.e., self-efficacy beliefs and outcome expectancies). In the main study, online participants were either exposed to the new testimonial warnings, to graphic health warnings, or to text-only health warnings on four separate occasions during a 24-h window. Results: In a sample of 416 daily smokers, we observed beneficial changes in self-reported cigarette smoking, craving, quit intentions, evaluations of smoking, self-efficacy, and outcome expectancies, immediately after viewing the warnings a first time and after multiple exposures. These effects were comparable for participants in the three warning type groups, with some (small) differences for changes in outcome expectancies and craving. Conclusions: Warnings with general testimonies from former smokers might provide a useful evidence-based addition to currently used cigarette pack health warnings.
Bibliographical noteFunding Information:
This work was supported by the Scientific Research Foundation, Flanders (FWO16/PDO/201 to P.V.D). The funding body had no role in the study design, data collection, analysis, or interpretation or in writing of the manuscript. We would like to thank Saïdia Havegheer, Tom Vanderschoot, and Irene De Hertogh for their help facilitating data collection and collection of images and stories used in the testimonial warnings. We would also like to thank the former smokers who provided their testimonial statements and images.
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