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Reclaiming the value of pictorial health warning labels in Jordan
  1. Nour A Obeidat1,
  2. Mai Al-Hadid2,
  3. Asma A Hatoqai1,
  4. Rawan A Shihab1,
  5. Feras I Hawari1
  1. 1Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
  2. 2Independent Researcher, Amman, Jordan
  1. Correspondence to Dr Nour A Obeidat, Head of Applied Research, Cancer Control Office, Cancer Control Office, King Hussein Cancer Center,11941, Amman, Jordan; nobeidat{at}khcc.jo

Abstract

Background In Jordan, four non-graphic pictorial health warning labels (PHWLs) concerning a limited selection of tobacco-caused harms have been used since 2011; however, research suggests that they may be ineffective.

Objectives To explore Jordanian smokers’ reactions to novel PHWLs featuring various health themes and/or graphic and symbolic imagery and to discuss existing PHWLs in light of the novel PHWLs.

Methods We conducted 14 focus groups (FGs) with smokers who assessed 12 novel PHWLs and commented on four existing PHWLs. Data were analysed using an inductive approach.

Results Six themes emerged from the FG discussions: understanding the overall meaning of PHWLs, the impact of graphic images, magnitude and controllability of harm, personal or vicarious experiences, the futility of quitting and fatalism. PHWLs depicting graphic respiratory and oral tobacco-caused harms resonated with most smokers. Smokers also sought direct, harm-specific taglines when trying to understand the overall PHWL. Some smokers viewed the PHWLs as exaggerated, and while the majority acknowledged that smoking was harmful, they felt that PHWLs would not accomplish their goal of inducing quitting.

Conclusions Our findings support the use of graphic imagery to communicate tobacco-caused harms (particularly respiratory ones) and the use of specific taglines explaining the mechanism of harm depicted.

  • low/middle income country
  • packaging and labelling
  • public opinion
  • public policy

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Footnotes

  • Contributors NAO: contributed to the conception and design of the project; data entry, coding and analysis/interpretation of data; drafting the submission and revising it critically with other coauthors; and approving and generating the final version of the manuscript. She is guarantor. MAH: contributed to data entry, coding and analysis/interpretation of data; drafting the submission and revising it critically; and approving the version to be published. AAH: contributed to design of the project; data acquisition and monitoring of overall data collection and study progress; drafting the submission and revising it critically; and approving the version to be published. RAS: contributed to design of the project; data acquisition and monitoring of overall data collection and study progress; drafting the submission and revising it critically; and approving the version to be published. FIH: contributed to the conception and design of the project; drafting the submission and revising it critically; and approving and generating the final version of the manuscript.

  • Competing interests None declared.

  • Ethics approval IRB at King Hussein Cancer Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data can be requested from the corresponding author.

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