Pictorial Warnings on Cigarette Packs and Smoking Behavior
Pictorial Warnings on Cigarette Packs and Smoking Behavior
Although most smokers are aware of the harmful effects of tobacco, lack of knowledge and underestimation of the specific health risks associated with smoking constitute relevant factors that affect people's decision to quit or reduce smoking. It is therefore important to instigate tactics and policy enhancements that drive individuals toward more probable behavior change.
Even though many countries have incorporated PWCP into their legislation, some are still hesitant or restrained because of insufficient evidence that PWCP can actually reduce smoking rates. In the United States, for example, the Food and Drug Administration was given the authority to regulate tobacco products in 2009 via the Family Smoking Prevention and Tobacco Control Act, which opened up the path to initiate the implementation of PWCP. However, the United States has not yet introduced PWCP because the overarching theme is still set in legal contentions. Thus, in countries with complex legal systems, substantial evidence to support PWCP is clearly needed.
So far, evidence has shown that PWCP are a cost-effective health communication, have high awareness and visibility among nonsmokers and youths, and are significantly more effective than text-only messages because they depict health risks vividly. Research has also shown that regularly updated, large, and prominent PWCP located on the top of packages are credible, have public support, and can increase health knowledge and motivation to quit. Frequent reminders about behavior change have generally been shown to be effective. PWCP might have this effect.
However, evidence in terms of behavior change has not been systematically reviewed. Therefore, we conducted this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the evidence pertaining to the effect of PWCP on smoking behavior. We used a structured approach consisting of 5 criteria (type of population, intervention, comparator group, outcome, and study design) to frame our research question, namely, whether active smokers presented with PWCP had a higher probability of quitting, reducing, and attempting to quit smoking than smokers not presented with the PWCP. We purposely excluded outcomes not related to behavior change, such as those looking at perceptions, attitudes, reactions, knowledge, or even motivation and intention to quit.
Effects of PWCP on Behavior
Although most smokers are aware of the harmful effects of tobacco, lack of knowledge and underestimation of the specific health risks associated with smoking constitute relevant factors that affect people's decision to quit or reduce smoking. It is therefore important to instigate tactics and policy enhancements that drive individuals toward more probable behavior change.
Even though many countries have incorporated PWCP into their legislation, some are still hesitant or restrained because of insufficient evidence that PWCP can actually reduce smoking rates. In the United States, for example, the Food and Drug Administration was given the authority to regulate tobacco products in 2009 via the Family Smoking Prevention and Tobacco Control Act, which opened up the path to initiate the implementation of PWCP. However, the United States has not yet introduced PWCP because the overarching theme is still set in legal contentions. Thus, in countries with complex legal systems, substantial evidence to support PWCP is clearly needed.
So far, evidence has shown that PWCP are a cost-effective health communication, have high awareness and visibility among nonsmokers and youths, and are significantly more effective than text-only messages because they depict health risks vividly. Research has also shown that regularly updated, large, and prominent PWCP located on the top of packages are credible, have public support, and can increase health knowledge and motivation to quit. Frequent reminders about behavior change have generally been shown to be effective. PWCP might have this effect.
However, evidence in terms of behavior change has not been systematically reviewed. Therefore, we conducted this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations to assess the evidence pertaining to the effect of PWCP on smoking behavior. We used a structured approach consisting of 5 criteria (type of population, intervention, comparator group, outcome, and study design) to frame our research question, namely, whether active smokers presented with PWCP had a higher probability of quitting, reducing, and attempting to quit smoking than smokers not presented with the PWCP. We purposely excluded outcomes not related to behavior change, such as those looking at perceptions, attitudes, reactions, knowledge, or even motivation and intention to quit.
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