Objective This paper examines whether there are possible wear-out effects associated with repeated exposure to pictorial health warnings on tobacco products. Wear-out effects can be general, that is, people get used to the presence of pictorial warnings in general, or specific to the content of the warnings (ie, the images used). Distinguishing between these two types of wear-out is important for understanding how to maintain the effectiveness of health warnings over time.
Methods This study used data from two surveys carried out in 10 European countries. Participants (n=12 600) were exposed in a random order to a series of health warnings and assessed the salience of the warnings as well as their effects on smoking intentions. Using these data and country variations in health warning legislation, we tested whether warning pictures are subject to general and/or specific wear-out effects.
Results Responses were stronger to combined text+picture warnings than to text-only warnings. This effect was lower for smokers living in countries where combined warnings were already in place at the time of the data collection, compared with smokers residing in countries where text-only warnings were in use. This result, observed for combined warnings with new pictures, is in line with the presence of general wear-out effects. Combined warnings with an unknown pictorial content were more effective than those including pictorial warnings already in use, suggesting that specific wear-out effects are also at play.
Conclusions These findings strengthen the evidence that pictorial health warnings are an effective tool for tobacco control policies and suggest that, even in the presence of a general wear-out effect among smokers, periodically introducing new pictures helps to maintain warning effectiveness over time.
- packaging and labelling
- global health
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Contributors EW and Bd’H jointly conceived the study, analysed the data and wrote the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval London School of Economics Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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