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Abstract
Objective The Framework Convention on Tobacco Control recommends health warning labels (HWLs) include an attribution source. Little is known regarding the perceived credibility and effectiveness of different message sources. This study examined perceptions of four HWL attribution sources among adults in China – the world’s largest consumer of cigarettes.
Design Cross-sectional experimental survey design.
Participants Data were collected in 2017 from a convenience sample of 1999 adults across four cities in China; 80% of the sample were current smokers.
Main outcome measures Participants viewed four versions of the same HWL, each with a different attribution source: the China Center for Disease Control (ref. group); the regulatory arm of China’s domestic tobacco company (STMA); Liyuan Peng, China’s first lady; and the WHO. Respondents indicated which HWL was the most: (1) credible, (2) effective at making people quit and (3) effective at preventing youth initiation.
Results Multinomial logistic regression models estimated adjusted relative risk ratios (aRRRs) of the three outcomes. Controlling for demographics and smoking status, HWLs attributed to STMA and Liyuan Peng, respectively, were perceived as significantly less credible (aRRR=0.81, p<0.001; aRRR=0.31, p<0.001), less effective at making people quit (aRRR=0.46, p<0.001; aRRR=0.24, p<0.001) and less effective at preventing young smoking (aRRR=0.52, p<0.001; aRRR=0.39, p<0.001) than the China CDC HWL. There were no significant differences in perceived effectiveness of between the WHO and China CDC HWLs. Participants viewed the WHO HWL as significantly more credible (aRRR=1.21, p<0.001) than the China CDC HWL.
Conclusion Results suggest the unique role of health organisations in conveying smoking-related messages that appear credible and effective at motivating others to quit smoking or never start smoking in China. Findings can inform global recommendations regarding HWL attribution sources.
- Health warning labels
- tobacco
- cigarettes
- China
- health communication
Data availability statement
Data are available on reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available on reasonable request.
Footnotes
Contributors JH and RDK initiated the project. LC performed all statistical analyses. LC had the main responsibility for writing the article. JH, EC, TY and RDK all made substantial contributions to the interpretation of the analyses, the structure and content of the manuscript and have read and approved of the final draft. LC is responsible for the overall content as guarantor and accepts full responsibility for the finished work. LC had access to the data as the guarantor and controlled the decision to publish.
Funding This study was supported with funding from Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use (grant number not applicable).
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.