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Linking mass media campaigns to pictorial warning labels on cigarette packages: a cross-sectional study to evaluate effects among Mexican smokers
  1. James F Thrasher1,2,
  2. Nandita Murukutla3,
  3. Rosaura Pérez-Hernández2,
  4. Jorge Alday3,
  5. Edna Arillo-Santillán2,
  6. Claudia Cedillo3,
  7. Juan Pablo Gutierrez4
  1. 1Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  2. 2Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
  3. 3World Lung Foundation, New York, New York, USA
  4. 4Center for Survey Research, National Institute of Public Health, Cuernavaca, Mexico
  1. Correspondence to Dr James F Thrasher, Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC 29208, USA; thrasher{at}


Objective This study assessed the effects of pictorial health warning labels (HWLs) and a linked media campaign in Mexico.

Methods Cross-sectional data were collected from a population-based sample of 1756 adult smokers, aged 18–55 years, during the initial implementation of pictorial HWLs, which some smokers had seen on cigarette packages while others had seen only the text-based HWLs. Exposure to the campaign and pictorial HWLs was assessed with aided recall methods, and other questions addressed attention and cognitive impact of HWLs, knowledge related to HWL and campaign content, and quit-related thoughts and behaviours. Logistic and linear regression models were estimated to determine associations between key outcomes and intervention exposure.

Results In bivariate and multivariate adjusted models, recall of pictorial HWLs and of the campaign were positively associated with greater attention to and cognitive impact of HWLs, whereas only pictorial HWL exposure was associated with having refrained from smoking due to HWLs. Both recall of pictorial HWLs and of the campaign were independently associated with greater knowledge of secondhand smoke harms and toxic tobacco constituents. Smokers who recalled only the pictorial HWLs were more likely to try to quit than smokers who recalled neither the pictorial HWLs nor the campaign (17% vs 6%, p<0.001).

Conclusions Consistent with other studies, adult smokers' exposure to new pictorial HWLs in Mexico was associated with psychosocial and behavioural responses related to quit behaviour. Exposure to the complementary media campaign was associated with independent additive effects on campaign-related knowledge, and it enhanced psychosocial responses to pictorial HWLs.

  • Tobacco
  • labelling
  • communication
  • media campaign
  • public policy
  • health communication
  • media campaigns
  • qualitative study
  • public opinion polls
  • advertising and promotion
  • low/middle-income country
  • media
  • social marketing
  • global health
  • advocacy

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  • Funding This work was supported by the Bloomberg Global Initiative to Reduce Tobacco Use through a grant from the Union against Tuberculosis and Lung Disease, grant number Mexico 2-02, and by the World Lung Foundation. JT's time was partially funded by the US National Cancer Institute, grant number P01 CA138389.

  • Competing interests None.

  • Ethics approval Ethics Committee, National Institute of Public Health, Mexico.

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

  • Data sharing statement No data from this study are currently available for public sharing; however, researchers interested in analysing the data should contact JT or NM.