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Many emotional appeal theorists argue that negative affect and efficacy work together to promote adaptive behavioral responses to a threat, yet most research on cigarette warning label messages has not examined the intersection between negative affect, hope, and efficacy. The current study tests effects of exposure, at different points in a sequence, to an efficacy-focused warning label in the context of threat-focused warning labels. We conducted an online, between- and within-subjects experiment with 398 adult smokers, testing the effects of warning label exposure on negative affect, hope, efficacy beliefs, and intentions to quit. Exposure to the efficacy-focused "Quit" label aroused higher levels of reported hope and lower levels of reported negative affect than threat-focused labels. Negative affect increased with each additional exposure to a threat-focused warning label, regardless of the order in which respondents saw the "Quit" label. Exposure to the "Quit" label (within a larger set of three threat-focused labels) led to greater self-efficacy but did not influence response efficacy or intentions to quit. We conclude that "Quit" messaging on warning labels can inspire both hopeful feelings and efficacy beliefs. Future research should identify the optimal balance between threat-focused and hopeful quit messages. [ABSTRACT FROM AUTHOR]

This paper tests how certainty conveyed through language can be harnessed to enhance the effectiveness of health risk messages. We conducted experiments with low-income, adult smokers (n = 317) and middle schoolers (n = 321) on pictorial cigarette warning labels. We manipulated hypotheticality of risk through verb modality: present tense, may, can, and will. For adult smokers, present tense led to greater health risk beliefs, compared to hypothetical, among adult males but not females. For youth, contrary to what might seem intuitive, the hypothetical may verb was more effective than the present tense language in promoting health risk beliefs, which was associated with reduced susceptibility to use cigarettes. We discuss the findings in relation applications of construal level theory to health communication. [ABSTRACT FROM AUTHOR]

Much of the controversy surrounding the advertising of tobacco and alcohol products concerns the impact on young people. Eye tracking was used to determine how a large sample of adolescents attend to print ads for cigarettes, beer, and other products. In particular, the time spent viewing the ads, the percentages attending to mandated and voluntary warning messages, and the time spent viewing those messages were analyzed. The two cigarette ads had similar mandated warnings but produced very different results, thus demonstrating the importance of conducting warnings research in the context in which the warnings will be used. Finally, preliminary results based on eye tracking indicate that in the beer ad, the voluntary message encouraging responsible drinking had limited warning value. [ABSTRACT FROM AUTHOR]

Introduction: Although the popularity of small cigar brands that resemble cigarettes, including both little cigars (LC) and filtered cigars (FC), has been on the rise, little is known about the delivery of nicotine from these products. Our objective was to determine the nicotine yields of small cigars in comparison to cigarettes.Methods: Nicotine yields from LC, FC, and 3R4F and 1R6F research cigarettes were determined from mainstream smoke generated on a smoking machine under the International Organization of Standardization (ISO) and Canadian Intense (CI) methods. Market characteristics (price and package label) and physical features (filter ventilation, product weight and filter weight, product length, and diameter) were also determined for eight brands of small cigars.Results: Nicotine yields in small cigars averaged 1.24 and 3.49 mg/unit on ISO and CI regimens, respectively, compared with 0.73 and 2.35 mg/unit, respectively, for the research cigarettes. Nicotine yields per puff were similar between small cigars and cigarettes. We also found that FC did not differ from LC in nicotine yields. FC and LC differ from each other in many physical design features (unit weight, filter weight, and filter length), but are similar in others (unit length, diameter, and filter ventilation).Conclusions: Nicotine delivery from small cigars is similar to or greater than that from cigarettes. Thus, for future research and regulatory purposes, standard definitions need to be developed for small cigars, and FC and LC should be evaluated as separate entities.Implications: Small cigars are similar to cigarettes in their design and use. Although nicotine yields per puff were similar between products, small cigars delivered substantially higher amounts of nicotine per unit than cigarettes. These findings support the growing body of evidence to justify regulating all small cigars, including LC and FC in a similar fashion as cigarettes. [ABSTRACT FROM AUTHOR]

Background: Smoking is responsible for a large proportion of cancer, respiratory and cardiovascular deaths. Nevertheless the health risks of smoking are still underestimated in many smokers. The present study aimed to examine neurobiological responses to graphical warnings on cigarette packings in non-smokers and patients with tobacco dependence. Methods: Twenty non-smokers and twenty-four patients with tobacco dependence participated in a functional MRI study during that pictures of different categories were presented ((a) EU-warning pictures, (b) text-only warnings, (c) neutral pictures with short information). Patients contributed twice in the experiment (after 10 hours nicotine withdrawal / about 5 minutes after nicotine consumption). Results: Smokers during withdrawal demonstrated increased neuronal responses predominantly in subcortical, temporal and frontal brain regions that are associated with emotional and cognitive processes during the presentation of graphical warnings compared to neutral pictures. In smokers after smoking and non-smokers, the differences between graphical warnings and neutral pictures were increased compared to smokers during withdrawal. The comparison of the graphical warnings with text-only labels demonstrated the importance of affective brain regions especially in smokers after smoking and in non-smokers. During withdrawal, the neural responses associated with graphical warnings and text-only labels differed only marginally. Discussion and conclusion: The results suggest that emotional and cognitive reactions to graphical warnings are predominantly seen in smokers after smoking and in non-smokers. The impact of these pictures during withdrawal seems to be less pronounced; in this case, more unspecific processes seem to be important, including the projection of sensory signals to the cerebral cortex. [ABSTRACT FROM AUTHOR]

Introduction: Prior to the US Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample.Methods: Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four US geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016.Results: Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine." Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine." None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive." All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering.Conclusions: Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors.Implications: These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure warning statements, which are not currently mandated; and requirements on websites or language on packaging to help manufacturers adhere to the minimum age of purchase regulation. The data can also be used to help FDA develop additional guidance on the framing of statements on packaging that helps consumers make informed decisions about purchasing the product or protecting young people from use or unintentional exposure to the product. [ABSTRACT FROM AUTHOR]

Graphic health warning labels (HWLs) depicting bodily injury due to smoking are effective for producing changes in affect, cognition and smoking behavior in adult smokers. However, little is known about the effects of repeated presentation of graphic HWL's on the aforementioned processes. The goal of this study was to examine neural and behavioral responses to graphic HWL's and evaluate whether the repeated presentation of graphic HWL's leads to repetition suppression (RS). Smokers (N = 16) performed an event-related HWL cue task while blood oxygen level dependent (BOLD) signal was collected during a functional magnetic resonance imaging (fMRI) experimental session. Consistent with prior literature, graphic HWL's, as compared to scrambled images, elicited increased BOLD response in brain regions involved in self-referential and emotion processing. Importantly, BOLD response at sites in this network diminished during repeated presentation of the same HWL. These findings suggest that while novel graphic HWL's may have a significant effect on smokers' brain activity, repeated presentation may lead to muted responses and thus limit their potential to induce behavioral change. [ABSTRACT FROM AUTHOR]

Objectives: Smokers underestimate the health risks of smoking and overestimate their expected longevity. Warning labels on cigarette packs might help correct these misperceptions. Methods: We carried out an online study with 1200 smokers (18-62 years old), randomized to 3 conditions: text warning labels, pictorial warning labels and a control group (water bottle labels). Warning labels were based on those proposed by the US Food and Drug Administration in 2010. Participants in each condition saw 4 randomly selected labels and rated their expected longevity and chances of surviving to age 75 after exposure. Analyses of covariance controlled for cigarettes per day and self-rated health. Results: Compared to control, both text and pictorial warnings reduced participant's expected longevity (text: mean = 76.8 years, pictorial: 77.3, control 79.4) and their estimated chances of living to 75 (text: 62.0%, pictorial: 63.0%, control 66.5%). The contrast between text and pictorial labels combined and control showed significantly reduced expected longevity (p = .011) and chances of living to 75 (p = .004). Differences between text and pictorial conditions were not statistically significant. Conclusions: Large text or pictorial warnings on cigarette packs might help smokers develop a more accurate understanding of the effects of smoking on their longevity. [ABSTRACT FROM AUTHOR]

Background: Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit.Purpose: Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings.Methods: Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking. Analyses examined the effects of pictorial versus text-only warnings and self-efficacy for quitting on cigarette consumption during and 1 month after the trial as mediated by emotional and cognitive responses as well as satisfaction with smoking.Results: Stronger emotional responses to pictorial than text-only warnings predicted reduced satisfaction with smoking during the trial and lower cigarette consumption at follow-up among the majority of smokers who continued to smoke. Consistent with the efficacy-desire model, those with moderate efficacy reported the greatest reduction in consumption at follow-up. However, a small proportion of smokers (7%) who reported 7-day abstinence at follow-up did not exhibit a significant relation with self-efficacy.Conclusions: Pictorial warning labels proposed by FDA create unfavorable emotional reactions to smoking that predict reduced cigarette use compared to text alone, with even smokers low in self-efficacy exhibiting some reduction. Predictions that low self-efficacy smokers will respond unfavorably to warnings were not supported. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (e-cigarettes) are the most frequently used tobacco product among U.S. youths, and past 30-day e-cigarette use is more prevalent among high school students than among adults (1,2). E-cigarettes typically deliver nicotine, and the U.S. Surgeon General has concluded that nicotine exposure during adolescence can cause addiction and can harm the developing adolescent brain (2). Through authority granted by the Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) prohibits e-cigarette sales to minors, free samples, and vending machine sales, except in adult-only facilities (3). States, localities, territories, and tribes maintain broad authority to adopt additional or more stringent requirements regarding tobacco product use, sales, marketing, and other topics (2,4). To understand the current e-cigarette policy landscape in the United States, CDC assessed state and territorial laws that 1) prohibit e-cigarette use and conventional tobacco smoking indoors in restaurants, bars, and worksites; 2) require a retail license to sell e-cigarettes; 3) prohibit e-cigarette self-service displays (e.g., requirement that products be kept behind the counter or in a locked box); 4) establish 21 years as the minimum age of purchase for all tobacco products, including e-cigarettes (tobacco-21); and 5) apply an excise tax to e-cigarettes. As of September 30, 2017, eight states, the District of Columbia (DC), and Puerto Rico prohibited indoor e-cigarette use and smoking in indoor areas of restaurants, bars, and worksites; 16 states, DC, and the U.S. Virgin Islands required a retail license to sell e-cigarettes; 26 states prohibited e-cigarette self-service displays; five states, DC, and Guam had tobacco-21 laws; and eight states, DC, Puerto Rico, and the U.S. Virgin Islands taxed e-cigarettes. Sixteen states had none of the assessed laws. A comprehensive approach that combines state-level strategies to reduce youths' initiation of e-cigarettes and population exposure to e-cigarette aerosol, coupled with federal regulation, could help reduce health risks posed by e-cigarettes among youths (2,5). [ABSTRACT FROM AUTHOR]

Health warning labels (HWLs) on cigarette packs that use strong fear appeals may evoke defensive responses including acts of disparaging the warnings. Whether warning disparagement undermines HWL effectiveness remains unclear. We assessed correlates of one type of HWL disparagement and its association with subsequent cessation attempts. Longitudinal data (2012-14) on adult smokers from Australia, Canada, Mexico and the United States (US) were analyzed. HWL disparagement was assessed as the frequency of making fun of HWLs in the past month. Using Generalized Estimating Equation models we estimated correlates of HWL disparagement and whether HWL disparagement predicted subsequent cessation attempts. In each country, across all waves, 24-31% of smokers reported making fun of the warnings at least once in the pastmonth.More frequent disparagement was found among males, younger participants, those with higher education and greater addiction, and those who recently attempted to quit. Attention to, avoidance of and talking to others about HWLs were all positively associated with HWL disparagement. In all countries, except the US, this type of HWL disparagement was an independent predictor of subsequent cessation attempts. HWL disparagement among smokers may indicate greater warning relevance and processing and does not result in counterproductive effects on cessation efforts. [ABSTRACT FROM AUTHOR]

Objectives: We tested how variations of the warning message on e-cigarette packages influenced risk and ambiguity perceptions, and whether including a modified risk statement on the package influenced how the warning label was perceived. Method: A 4 (warning text) x 2 (modified risk statement), plus control, experiment (N = 451) was conducted. Results: Smoking status, sex, and the language used in the warning statements interacted to influence risk perceptions. For example, non-smoking women perceived e-cigarettes with the FDA text at 30% of the package as riskier than the FDA text at 12-point type. Additionally, including a modified risk statement on the package increased ambiguity among non-smokers, as did an abstract warning label. Conclusions: When evaluating the effectiveness of warning label text, it is important to consider smoking status and sex. Additionally, including modified risk statements on the package with the warning label could potentially increase ambiguity among non-smokers. [ABSTRACT FROM AUTHOR]

Introduction: The high prevalence of smoking among Aboriginal and Torres Strait Islander people in Australia (39%) contributes substantially to health inequalities. This study assesses the impact of warning labels on quitting and related thoughts and behaviors for Aboriginal and Torres Strait Islander smokers. Methods: Participants were recruited from communities served by 34 Aboriginal Community Controlled Health Services and communities in the Torres Strait, Australia, using quota sampling. A cohort of 642 daily/weekly smokers completed relevant questions at baseline (April 2012-October 2013) and follow-up (August 2013-August 2014). Results: We considered three baseline predictor variables: noticing warning labels, forgoing cigarettes due to warning labels ("forgoing") and perceiving labels to be effective. Forgoing increased significantly between surveys only for those first surveyed prior to the introduction of plain packs (19% vs. 34%); however, there were no significant interactions between forgoing cigarettes and the introduction of new and enlarged graphic warning labels on plain packaging in any model. Forgoing cigarettes predicted attempting to quit (adjusted odds ratio [AOR]: 1.45, 95% confidence interval [CI]: 1.02-2.06) and, among those who did not want to quit at baseline, wanting to quit at follow-up (AOR: 3.19, 95% CI: 1.06-9.63). Among those less worried about future health effects, all three variables predicted being very worried at follow-up. Often noticing warning labels predicted correct responses to questions about health effects that had featured on warning labels (AOR: 1.84, 95% CI: 1.20-2.82) but not for those not featured. Conclusions: Graphic warning labels appear to have a positive impact on the understanding, concerns and motivations of Aboriginal and Torres Strait Islander smokers and, through these, their quit attempts. Implications: Graphic warning labels are likely to be effective for Aboriginal and Torres Strait Islander smokers as they are for the broader Australian population. [ABSTRACT FROM AUTHOR]

The current study sought to examine the impact of strengthening cigarette pack warnings on attention, message processing, and perceived effectiveness, through a systematic review of longitudinal observational studies. The review included 22 studies (N = 81,824 participants). Strengthened warnings increased attention to warnings, recall of warnings, and thinking about the health risks of smoking. Strengthened warnings also increased several perceived effectiveness outcomes, including perceptions that warnings reduce smoking and motivate quitting. Strengthened cigarette pack warnings achieve their goal of attracting attention and enhancing motivation to act. Strengthening warning policies should be a priority for tobacco control globally. [ABSTRACT FROM AUTHOR]

Objectives. To assess the proportion of electronic cigarette (e-cigarette) products sold in the United States that contain nicotine according to retail scanner data. Methods. We obtained unit sales data from January 11, 2015, to December 12, 2015, from The Nielsen Company for convenience stores; supermarkets; mass merchandisers; drug, club, and dollar stores; and Department of Defense commissaries. The data did not include purchases from tobacco specialty shops, "vape shops," or online sources. Nicotine content was assessed by product type (disposables, rechargeables, and refills), region, andflavor status based on nicotine strength listed in the Universal Product Codes. For the 36.7% of entries lacking nicotine content information, we conducted Internet searches by brand, product, and flavor. Results. In 2015, 99.0% of e-cigarette products sold contained nicotine, including 99.0% of disposables, 99.7% of rechargeables, and 98.8% of refills. Overall, 98.7% of flavored e-cigarette products and 99.4% of nonflavored e-cigarette products contained nicotine. Conclusions. In 2015, almost all e-cigarette products sold in US convenience stores and other assessed channels contained nicotine. Public Health Implications. Findings reinforce the importance of warning labels for nicotine-containing products, ingredient reporting, and restrictions on sales to minors. [ABSTRACT FROM AUTHOR]

Consideration of designing an emotional warning pictorial on cigarette labels which will be used in public place, the effect from gender differences should be concerned. The aim of this study was to examine gender differences in emotional response from warning pictorials on cigarette labels. Sixty engineering students participated in this study. Half of them are males. Neutral affect manipulation using IAPS was conducted prior the experiments. Participants were asked to rate their emotional responses from sixty warning pictorials (positive, neutral, negative). Results revealed that both male and female participants could perceive target emotional affective warning pictorials, although there were some differences. Male participants perceived greater arousal than female participants which contradicts to previous study. Implications for affective warning pictorial design concerning gender difference. [ABSTRACT FROM AUTHOR]

Objectives: This study measures sociodemographic disparities in perceived effectiveness of pictorial health warnings on cigarette packs. Methods: A cross-sectional study in 2011 tested 20 pictorial warnings among 1517 adults across Lebanon. Participants evaluated the effectiveness of the current text-only warning, and 2 pictorial warnings. Health warnings were thematically grouped. Logistic regression models evaluated associations between the perceived effectiveness of themes and sociodemographic characteristics. Results: Perceived effectiveness of the current warning was 15.0% (95% CI 13.2%-16.9%). All pictorial warnings were perceived to be more effective than the current warning, including those about the long-term consequences of smoking (78.1%, 95% CI 74.9%-81.3%) and second-hand smoke (79.2%, 95% CI 74.3%-84.2%). Men had lower odds of perceiving warnings about dependence and second-hand smoke as being effective (AOR 0.30, 95% 0.14-0.65; AOR 0.22, 95% CI 0.10-0.50, respectively). Older respondents had lower odds of perceiving warnings about reproductive health, but higher odds of perceiving warnings about cessation, as effective (AOR 0.35, 95% CI 0.14-0.88; AOR 3.30 95% CI 1.26-8.64, respectively). Other sociodemographic disparities are described. Conclusions: Pictorial warnings are perceived to be more effective than text-only warnings in Lebanon, and should be implemented considering sociodemographic disparities. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine psychological reactance in response to graphic cigarette warning labels and to strengthen and expand on the current literature by using validated measures. Young adults (N = 435) were randomly assigned to a cigarette package featuring a graphic image or a package featuring no image. Utilizing both structural equation modeling and multivariate analyses, the results indicate that graphic warning labels are associated with freedom threat perceptions directly and reactance indirectly. In addition, exposure to graphic cigarette warning labels resulted in higher freedom threat perceptions, negative cognitions, and source domineeringness. Our results are considered with an emphasis on the theoretical and practical implications for policy makers. [ABSTRACT FROM AUTHOR]

Objectives: A hookah is used to smoke waterpipe tobacco. It is unknown what percentage of waterpipe tobacco contains nicotine, and no labeling regulations currently exist in the United States. The aim of this study was to determine nicotine and pH levels of waterpipe tobacco. Methods: Waterpipe tobacco was purchased in 2014 and 2015. Nicotine content of tobacco was analyzed using the CORESTA Recommended Method N° 62: determination of nicotine in tobacco and tobacco products by gas chromatography. Results: The nicotine content of waterpipe tobacco ranged from nicotine-free for 'herbal' products to 3.30 mg/g for products claiming to contain nicotine (mean = 1.13 mg/g; std dev = 0.65; N = 140). In products that claimed to, and contained, tobacco (N = 120), the label did not predict actual nicotine content. All waterpipe tobacco labeled as tobacco-free (N = 20) was found to be nicotine-free. Measured pH levels ranged from 3.81 to 5.84 (mean = 5.04, std dev = 0.45; N = 218). Conclusions: There is a need for standardized testing of waterpipe tobacco products for nicotine, pH, and other constituents. Erroneous waterpipe tobacco packaging and labeling is problematic for consumers and supports regulatory efforts to provide accurate constituent labeling. [ABSTRACT FROM AUTHOR]

Current warning labels on cigarette packages are generally focused on long-term losses that can be incurred if one continues smoking. This study compares the effects of these labels against warning labels that stress short-term losses of smoking as well as labels that stress short- and long-term benefits that can be obtained when one quits smoking. A 2 (message frame: gain vs. loss) × 2 (temporal context: short vs. long term) between-subjects experiment was conducted among 132 smokers, with attitude toward quitting smoking and intention to quit smoking, as well as information-seeking behavior and message recall, as the dependent variables. Findings were in line with theory regarding message framing and temporal discounting, showing enhanced effects of gain over loss frames and short-term over long-term consequences on warning labels for attitudes and intentions. In addition, an interaction between message frame and temporal context was found. Especially, gain-framed messages showed stronger effects on intentions to quit smoking than loss-framed messages when warning labels concerned short-term outcomes. Findings suggest that current warning labels, with an emphasis on long-term negative health outcomes, should be reconsidered. [ABSTRACT FROM AUTHOR]

Few studies have examined how diverse populations interpret warning labels. This study examined interpretations of 9 graphic cigarette warning labels (image plus text) proposed by the U.S. Food and Drug Administration among a convenience sample of youth (ages 13–17) and adults (18+) across the United States. Participants (N = 1,571) completed a cross-sectional survey. Participants were asked to select 1 of 3 plausible interpretations (1 preferred vs. 2 alternative) created by the research team about the particular consequence of smoking addressed in each warning label. Participants also rated each label for novelty, counterarguing, perceived effectiveness, and harm. Smokers reported their thoughts of quitting, self-efficacy, and motivation to quit. Although at least 70% of the sample chose the preferred interpretation for 7 of 9 labels, only 13% of participants chose all 9 preferred interpretations. The odds of selecting the preferred interpretation were lower among African Americans, among those with less education, and for labels perceived as being more novel. Smokers reported greater counterarguing and less perceived effectiveness and harms than nonsmokers, but results were not consistent across all labels and interpretations. The alternative interpretations of cigarette warning labels were associated with lower perceived effectiveness and lower perceived harms of smoking, both of which are important for motivating quit attempts. [ABSTRACT FROM PUBLISHER]

Introduction: In 2015, the Food and Drug Administration issued warnings to three tobacco manufacturers who label their cigarettes as "additive-free" and/or "natural" on the grounds that they make unauthorized reduced risk claims. The goal of this study was to examine US adults' perceptions of three American Spirit (AS) pack descriptors ("Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown Tobacco") to assess if they communicate reduced risk.Methods: In September 2012, three cross-sectional surveys were posted on Amazon Mechanical Turk. Adult participants evaluated the relative harm of a Marlboro Red pack versus three different AS packs with the descriptors "Made with Organic Tobacco," "100% Additive-Free," or "100% US Grown Tobacco" (Survey 1; n = 461); a Marlboro Red pack versus these AS packs modified to exclude descriptors (Survey 2; n = 857); and unmodified versus modified AS pack images (Survey 3; n = 1001).Results: The majority of Survey 1 participants rated the unmodified AS packs as less harmful than the Marlboro Red pack; 35.4%-58.8% of Survey 2 participants also rated the modified (no claims) packs as less harmful than Marlboro Red. In these surveys, prior use of AS cigarettes was associated with reduced perceptions of risk (adjusted odds ratio [AOR] 1.59-2.40). "Made with Organic Tobacco" and "100% Additive-Free" were associated with reduced perceptions of risk when comparing the modified versus the unmodified AS packs (Survey 3).Conclusions: Data suggest that these AS pack descriptors communicate reduced harm messages to consumers. Findings have implications for regulatory actions related to product labeling and packaging.Implications: These findings provide additional evidence that the "Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown" descriptors, as well as other aspects of the AS pack design, communicate reduced harm to non-, current, and former smokers. Additionally, they provide support for the importance of FDA's 2015 warning to Santa Fe Natural Tobacco Company on "100% Additive Free" as an unauthorized modified risk claim. [ABSTRACT FROM AUTHOR]

The article discusses the amount of nicotine found in various Romanian cigarette brands through thin-layered chromatographic (TLC) methodology, a method of segregating components. The segregation procedure took place on silica gel plates with required chemicals in mobile phase. The result proved to be the same as notified on the cigarette packs.

Background: Although much research on graphic cigarette warnings has focused on motivational responses, little focus has been given to how much individuals learn from these labels. Purpose: This study aims to investigate whether graphic warnings provide greater perceived new knowledge of smoking consequences compared to text-only warnings, and to test a mediational model whereby perceived new knowledge promotes discouragement from smoking through its impact on worry. Methods: In two studies, young adult smokers and nonsmokers (ages 18-25) evaluated graphic + text and corresponding text-only labels on perceived knowledge, worry about the harms addressed by the warning, and discouragement from smoking. Results: Compared to text-only labels, graphic + text labels were rated as providing better understanding, more new knowledge, and being more worrisome and discouraging. Perceived new knowledge predicted greater discouragement from smoking directly and through worry. Conclusions: Graphic warnings may be more efficacious than text-based warnings in increasing knowledge and worry about harms, and discouragement from smoking. [ABSTRACT FROM AUTHOR]

Objectives: The susceptibility to smoking index can be improved as it only identifies one third of future adult smokers. Adding curiosity to this index may increase the identification of future smokers and improve the identification of effective prevention messages. Methods: Analyses used data from the California Longitudinal Study of Smoking Transitions in Youth, for whom tobacco use behaviors, attitudes, and beliefs were assessed at 3 time points from age 12 through early adulthood. Logistic regressions were used to evaluate whether baseline curiosity about smoking was predictive of smoking during the 6-year follow-up period and whether curiosity about smoking provided evidence of incremental validity over existing measures of susceptibility to smoking. Results: Compared to those who were classified as definitely not curious about smoking, teens who were classified as probably not curious (ORadj = 1.90, 95% CI = 1.28-2.81) and those classified as definitely curious (ORadj = 2.38, 95% CI= 1.49-3.79) had an increase in the odds of becoming a young adult smoker. Adding curiosity to the original susceptibility to smoking index increased the sensitivity of the enhanced susceptibility index to 78.9% compared to 62.2% identified by the original susceptibility index. However, a loss of specificity meant there was no improvement in the positive predictive value. Conclusions: The enhanced susceptibility index significantly improves identification of teens at risk for becoming young adult smokers. Thus, this enhanced index is preferred for identifying and testing potentially effective prevention messages. [ABSTRACT FROM AUTHOR]

Theories within organizational and economic sociology that center on market categories often equate taken-for-grantedness with increased constraint on category members’ features. In contrast, we develop a novel perspective that considers how market participants’ changing category-related attributions decrease the scrutiny of category offerings, opening up strategic opportunities for firms. We further argue that whether producers should be expected to take advantage of these opportunities depends on the extent to which they are incentivized to do so. We use the case of the light cigarette category to test this thesis. We argue and find evidence that increasing taken-for-grantedness of the light cigarette category created greater opportunity for tobacco firms to strategically manipulate category features. [ABSTRACT FROM PUBLISHER]

Purpose -- The purpose of this paper is to find out whether the plain packaging format in cigarette labeling is worth adopting or not. Design/methodology/approach -- A lab experiment with a 2 (existing vs plain packaging format) X 2 (familiar vs unfamiliar brand) factorial design was conducted with Chinese subjects in Macau. Findings -- The plain packaging format in cigarette labeling reduces both smoking intent and brand likability in familiar brand condition but not unfamiliar brand condition. Social implications -- When many governments are currently deliberating about whether to follow the plain packaging initiative, this study constitutes a timely investigation of the effects of it on smoking intent and brand likability among Chinese young non-smokers. The positive effect of the plain packaging in familiar brand condition provides the justification of adopting it by the governments. Originality/value -- Studies of plain packaging have not been taking brand familiarity into consideration (the only exceptional study used the top three familiar brands and thus failed to examine the familiarity effect) but the study focussed on it. In the data analysis, if brand familiarity is not considered, wrong conclusion will be drawn. Therefore, by having brand familiarity as moderator, the authors are able to correctly conclude that plain packaging format is worth adopting. [ABSTRACT FROM AUTHOR]

There is growing evidence that self-affirmation can reduce defensive processing of threatening health messages among high risk individuals. However, how self-affirmation might influence low risk individuals is less clear. This study examined the effect of self-affirmation on daily versus occasional smokers’ reactions to graphic on-pack warning labels. Results showed a relatively consistent pattern of interaction wherein self-affirmation decreased favorable reactions to the warning labels among occasional smokers, whereas its effect on daily smokers was mostly nonsignificant. Potential explanations of these findings are offered and their practical implications are discussed. [ABSTRACT FROM PUBLISHER]

Purpose: To compare perceptions of text and pictorial warning labels on cigarette packs among Ghanaian smokers and nonsmokers and to explore their views on the introduction of pictorial warnings in Ghana. Methods: Qualitative study involving 12 focus group discussions with 50 smokers and 35 nonsmokers aged 15 years and older in Kumasi, Ghana. Semistructured discussion guides along with visual discussant aids were used to explore the perception, acceptance, and potential use of pictorial warning labels in Ghana. Results: Health warnings combining text and a picture were perceived by both smokers and nonsmokers to communicate health messages more effectively than text-only or picture-only warnings. The effect of text-only warnings was considered limited by low levels of literacy and by the common practice of single stick sales rather than sales of packs. Of the 6 health warnings tested, lung cancer, blindness, stroke, and throat/mouth cancer messages were perceived to have the most impact on smoking behavior, including uptake and quit attempts. Conclusions: Warning labels combining pictures and text have the potential to reduce smoking uptake, increase quit attempts, and reduce smoking appeal among smokers and nonsmokers in Ghana. Measures to prevent single stick sales, or to promote health messages to purchasers of single sticks, are required. [ABSTRACT FROM PUBLISHER]

In 2003, the Parliament of India passed the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA) to counter the growing societal and health burdens of tobacco in India. The major provisions (Sections 4-7) of COTPA mandate the display of pictorial health warnings on all tobacco product packets and strictly prohibit: smoking in public places, direct and indirect forms of tobacco advertisements, promotion and sponsorship of tobacco products, sale of tobacco products to a minor, and sale within 100 yards of any educational institution. However, India continues to have a high prevalence of tobacco consumption and the provisions of COTPA are routinely flouted. The purpose of the study is to analyze the trends in and the prevalence of COTPA violations in a sample test site (Haryana) to develop informed and practical tobacco control policy recommendations. Violations in five districts of the State of Haryana were observed and recorded. The data overwhelmingly show that the most fundamental provisions (Sections 4-7) of COTPA were frequently violated in each of the five districts. All districts had a high rate of noncompliance, with Sites having at least one violation of Sections 4-7 of COTPA, with rates fluctuating between nearly 70 and 90 percent. Such violations however, were unequally distributed between Sections 4-7 within the five districts with some districts having a higher frequency of Section 4 violations (Panipat and Jhajjar) and other districts with higher violation frequency of Section 5 (Mewat and Kurukshetra). However, all five districts had relatively low numbers of Section 7 violations (i.e., the required display of pictorial health warnings on all tobacco products). The study highlights the challenges of the tobacco control policy in India including: engagement of state and district level enforcement officials for effective enforcement of existing legislation, encouragement for civil society to partner and complement governmental efforts in monitoring progress and reporting violations of COTPA, and the need for supply-level controls on tobacco (e.g., pictorial health warnings and increased taxation) to reduce tobacco consumption. [ABSTRACT FROM AUTHOR]

Introduction: According to the attentional myopia model, salient cues that serve to inhibit behavior can be especially effective under conditions of limited attention. A small field study tested the implications of this model for smoking reduction. Methods: Twenty-three undergraduate smokers were exposed to a prominent health warning for 2 5-day experimental phases, with phase order counterbalanced across participants. During one phase, participants simply viewed the warning at regular intervals. During the other phase, participants viewed the warning for the same duration but also simultaneously performed a distracting cognitive load task. Results: Participants in the phase that combined a health warning with cognitive load reported smoking significantly fewer cigarettes and taking significantly fewer puffs of smoke as compared to a baseline comparison phase—a reduction in smoking not observed in the absence of cognitive load. Conclusions: Sources of attentional distraction may heighten the impact of salient smoking warnings, resulting in significant reductions in smoking. [ABSTRACT FROM PUBLISHER]

The marketing of natural cigarettes has been widely criticized by consumer advocates and public policymakers. The present research is designed to inform the ongoing policy debate by examining the effects of natural cigarette claims on adolescents' brand impressions. The authors report the results of an experiment in which high school students viewed images of cigarette packages for three different brands. Findings indicate that including natural claims on cigarette packages can weaken beliefs that the cigarettes cause diseases. Results also reveal that skepticism toward marketing claims may play an important role in undermining brand attitudes and trial intentions toward cigarette brands promoted with natural claims. Policy implications and suggestions for further research are provided. [ABSTRACT FROM PUBLISHER]

Introduction: Article 11 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC) requires countries to implement health warnings on tobacco products. The Article 11 guidelines advise countries to periodically rotate warnings to prevent “wearout” of the health warnings. This study investigates potential wearout of cigarette health warnings during a period of 9 years in 2 countries: Canada, where larger pictorial warnings were implemented approximately 1 year prior to the study, and in the United States, where small text-only warnings were in place for 17 years at the beginning of the study. Methods: Data were drawn from national samples of smokers from the International Tobacco Control (ITC) Surveys in Canada (N = 5,309), and the United States (N = 6,412) who were originally recruited by telephone with random digit dialing. Changes in 4 measures of health warning effectiveness and in a composite Labels Impact Index were examined over 8 waves of survey data (2002–2011). Analyses were conducted in 2012. Results: The health warning effectiveness measures and the Labels Impact Index indicated that the effectiveness of both the Canadian, and the U.S. warnings declined significantly over time. The Canadian warnings showed greater declines in effectiveness than the U.S. warnings, likely due to the initial novelty of the Canadian warnings. Despite the greater decline in Canada, the Canadian pictorial warnings were significantly more effective than the U.S. text-only warnings throughout the study. Conclusions: Health warnings decline in effectiveness over time. Health warnings on tobacco products should be changed periodically to maintain effectiveness. [ABSTRACT FROM PUBLISHER]

The article focuses on tobacco control strategies across the world as of April 2014. Topics discussed include overview of global tobacco industrial growth, description of smokefree laws and regulations such as cessation programs, warning labels, and bans on tobacco advertising, promotion, and sponsorship, and forecast analysis for the tobacco industry.

Introduction: Research conducted by the U.S. Food and Drug Administration to select graphic warning labels for cigarette packs has been challenged as inadequate for demonstrating effects on smokers’ beliefs about smoking. The present study tested the prediction that warnings alter risk perceptions and thoughts of quitting indirectly through a cognitive pathway (warning believability) and an affective pathway (worry about health), both of which are important for encouraging smokers to consider quitting. Methods: Using a national Internet panel, individuals who smoke were randomly assigned to view 1 of 3 types of warning labels: basic text only, graphic image with basic text, and graphic image with both basic and additional text elaborating on the reason for the health risk. Analyses were conducted to determine whether cognitive and affective reactions mediated effects on smoking-related outcomes. Results: Images influenced perceived risk, immediate desire to smoke, and feelings toward quitting indirectly through affective reactions; elaborated text influenced these outcomes through cognitive believability, with little evidence of direct effects. Believability also enhanced positive feelings toward quitting among smokers who were less worried about health risks due to smoking. Conclusions: The findings indicate that (a) many effects of warnings on smokers’ beliefs are mediated rather than direct, (b) both cognitive and affective responses are important mediators, and (c) elaborated text can help to increase effects of images through a cognitive pathway. Warning labels should be designed to maximize effects on these mediators in order to influence smoking outcomes. [ABSTRACT FROM PUBLISHER]

Introduction: Many governments around the world have banned the use of misleading cigarette descriptors such as “light” and “mild” because the cigarettes so labeled were found not to reduce smokers’ health risks. However, underlying cigarette design features, which are retained in many brands, likely contribute to ongoing belief that these cigarettes are less harmful by producing perceptions of lightness/smoothness through lighter taste and reduced harshness and irritation. Methods: Participants (N = 320) were recruited from the International Tobacco Control U.S. Survey conducted in 2009 and 2010, when they answered questions about smoking behavior, attitudes and beliefs about tobacco products, and key mediators and moderators of tobacco use behaviors. Participants also submitted an unopened pack of their usual brand of cigarettes for analysis using established methods. Results: Own-brand filter ventilation level (M 29%, range 0%–71%) was consistently associated with perceived lightness (p < .001) and smoothness (p = .005) of own brand. Those whose brand bore a light/mild label (55% of participants) were more likely to report their cigarettes were lighter [71.9% vs. 41.9%; χ2(2) = 38.1, p < .001] and smoother than other brands [75.5% vs. 68.7%; χ2(2) = 7.8, p = .020]. Conclusion: Product design features, particularly filter ventilation, influence smokers’ beliefs about product attributes such as lightness and smoothness, independent of package labels. Regulation of cigarette design features such as filter ventilation should be considered as a complement to removal of misleading terms in order to reduce smokers’ misperceptions regarding product risks. [ABSTRACT FROM PUBLISHER]

Concern over health risks is the most common motivation for quitting smoking. Health warnings on tobacco packages are among the most prominent interventions to convey the health risks of smoking. Face-to-face surveys were conducted in Mexico (n = 1,072), and a web-based survey was conducted in the US (n = 1,449) to examine the efficacy of health warning labels on health beliefs. Respondents were randomly assigned to view two sets of health warnings (each with one text-only warning and 5–6 pictorial warnings) for two different health effects. Respondents were asked whether they believed smoking caused 12 different health effects. Overall, the findings indicate high levels of health knowledge in both countries for some health effects, although significant knowledge gaps remained; for example, less than half of respondents agreed that smoking causes impotence and less than one third agreed that smoking causes gangrene. Mexican respondents endorsed a greater number of correct beliefs about the health effects of smoking than did the U.S. sample. In both countries, viewing related health warning labels increased beliefs about the health risks of smoking, particularly for less well-known health effects such as gangrene, impotence, and stroke. [ABSTRACT FROM PUBLISHER]

Background: For the past 30 years, there have been no changes in the text-only cigarette warning labels in Nepal. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of the current study was primarily to compare the differences in reactions to different types of warning labels on cigarette packages, with a specific focus on whether the new warning label adopted by WHO FCTC was better than the text only label used by Nepal. Material and Methods: This study was conducted in Gandaki Medical College Teaching Hospital (GMCTH) in 2012, in a tertiary care hospital located in the western region of Nepal. Eligible study participants included in this survey were those aged 18 years and over and those who are studying MBBS/Nursing or who were employees of GMCTH. 500 participants finished the survey. Participants were shown nine types of warning labels found on cigarette packages.They comprised one text only warning label used within Nepalese market and eight foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking. Results: On comparing the Nepalese warning label with other foreign labels with regards to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were found to be more effective. Both smokers and non-smokers thought that warning labels with text plus graphics were substantially more of a deterrent than textonly labels. Conclusion: The findings from this study support previous research that has found that text-plus graphic warning labels were more salient and potentially more effective than text-only labels. Warning labels are one of the component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger Nepalese public health educational efforts. [ABSTRACT FROM AUTHOR]

Abstract: Smoking is the leading preventable cause of death in the U.S., yet cigarette health warnings in the U.S. are among the weakest in the world. In 2011, the FDA issued regulations mandating that graphic warnings be displayed on every cigarette pack sold in the U.S. Almost immediately, the tobacco industry challenged the warnings on First Amendment grounds. In March 2013, the FDA withdrew the graphic warning mandate, choosing instead to pursue additional research and then issue requirements for a new set of warnings. These warnings almost certainly will be challenged by the tobacco industry. The current paper describes the legal standards that will be used to assess the warnings, and the empirical questions that must be answered in order to determine whether each standard has been met. The paper also identifies errors the FDA could make in choosing images to be evaluated that would cause the images to be unable to meet the standards, regardless of the scientific evidence the FDA can establish. To be on safest ground, the FDA should adopt images that depict factual health consequences of smoking and should avoid images that could be interpreted as opinions. The FDA will have a high likelihood of prevailing in legal challenges to the warnings if there is evidence demonstrating that graphic warnings are necessary to counter past industry deception or that graphic warnings affect smoking behavior better than textual warnings. Even without evidence of the impact of graphic warnings on behavior, strong evidence that they affect behavioral intent, and that intent predicts behavior, should be sufficient for the warnings to be upheld. Alternatively, evidence that graphic warnings lead to more accurate consumer assessment of smoking risks should also be sufficient. [Copyright &y& Elsevier]

According to the Surgeon General, tobacco use is the leading preventable cause of death in the United States. Smoking-related diseases kill 443, 000 Americans each year, more than are killed by HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. To address this public health threat, Congress enacted the Family Smoking Prevention and Tobacco Control Act (TCA) in 2009, which gave the federal government unprecedented power to regulate the tobacco industry. Among its provisions, the TCA requires the U.S. Food and Drug Administration to select images that depict smoking's deleterious effects and compels tobacco companies to display the images, accompanied by a textual warning, on half of the front and rear panels of every cigarette package. This new graphic format--the first alteration of cigarette package warnings in over twenty-five years--represents a significant and aggressive change in the way that the government communicates the dangers of smoking to the public. To prevent the introduction of these new labels into the marketplace, the tobacco industry has filed suit alleging that the graphic warnings infringe on its First Amendment right to refrain from speaking. The two circuit courts that have considered this issue are divided sharply over the labels' constitutionality and the appropriate framework for assessing them. This Note examines this legal fissure and argues that the warnings should be examined under the strict scrutiny standard of judicial review. Ultimately, this Note contends that the labels do not pass muster under this intense level of scrutiny and are thus unconstitutional compulsions of speech. [ABSTRACT FROM AUTHOR]

We report the results of experimental auctions with U.S. smokers, assessing the percentage of U.S. smokers whose demand for cigarettes decreases when bidding on packs with text and pictorial warnings, relative to packs with text-only warnings. We find that pictorial labels and pictorial labels accompanied by plain packaging are more effective at reducing demand for cigarettes than only a front text warning label. We also find that pictorial labels were most effective at encouraging younger smokers to reduce their demand for cigarettes, and plain packaging was most effective at reducing demand among less educated smokers. [ABSTRACT FROM AUTHOR]

Background: The cigarette text warnings are considered as one of the most effective ways to convey information on the health consequences of smoking. The aim of our study was to assess the emotional impact of cigarette text warnings used in the Czech Republic on a sample of basic schoolchildren. Method: The children's emotional response to the warnings was assessed by means of the Self-Assessment Manikin Method (SAM). The nine-point pen and paper version of SAM was used. The research sample consisted of 328 basic schoolchildren (182 boys, mean age 13.02±1.46 and 146 girls; mean age 12.95±1.48; 58 current smokers were identified). Each child completed a questionnaire where all the sentences with the SAM were presented (24 text warnings and 24 neutral sentences). Results: The majority of children assessed the warning texts as very unpleasant (valence for all warning texts 2.58±1.53) and above-average exciting (arousal 5.52±1.87). Smokers in comparison with non-smokers assessed the warning texts as less unpleasant (smokers 3.40±1.84; non-smokers 2.88±1.44; p<0.02) but equally arousing. A significant association was found between arousal and valence (smokers r=-0.50; non-smokers r=-0.34; p<0.01) and in smokers between arousal and level of nicotine dependence (r=0.31; p<0.02). Girls in comparison with boys assessed the warning texts as significantly more unpleasant (p<0.01). No gender differences were found in arousal levels. Summary: Our results showed that the existing text warnings are assessed by children and adolescents as arousing and very unpleasant; thus they could greatly support both the primary and secondary preventions of smoking. However, to intensify avoidance of smoking, the future text warnings should generate a more negative valence and arousal. [ABSTRACT FROM AUTHOR]

Introduction: Single-cigarette sales have been associated with increased cigarette accessibility to less educated, lower-income populations, and minors; lower immediate cost, and increased smoking cues. Since 1997, Guatemalan Law bans the sale of single cigarettes and packs with fewer than 20 cigarettes. In 2005, Guatemala ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC); it is therefore obliged to “prohibit sale of cigarettes individually or in small packets.” Methods: Blocks were numbered and randomly selected in Guatemala City and 3 neighboring towns. All stores in each block were surveyed. Single-cigarette and fewer than 20-cigarette pack sales were assessed by observation and purchase attempts. Cigarette brands and manufacturers (Philip Morris, PM or British American Tobacco, BAT) were also recorded. Percentages and means were used to describe data. Analyses were done using STATA 11.0. Results: Of 398 stores and street vendors surveyed, 75.6% (301) sold cigarettes. Of these, 91% (275) sold single cigarettes and none sold fewer than 20-cigarette packs. Only informal economic sectors sold singles. There was no difference on sales between Guatemala City and neighboring towns and by store type. Buying 20 single cigarettes was US$ 0.83 more expensive than buying a 20-cigarette pack. The most prevalent brands were Rubios (PM), Marlboro (PM), Payasos (BAT), and After Hours (BAT). Conclusions: Single-cigarettes sales are highly prevalent among informal economic sectors in Guatemala City and its neighboring towns. Our data should prove useful to advocate for FCTC Article 16 enforcement in Guatemala. [ABSTRACT FROM AUTHOR]

Background: The U.S. Family Smoking Prevention and Tobacco Control Act of 2009 requires updating of the existing textonly health warning labels on tobacco packaging with nine new warning statements accompanied by pictorial images. Survey and experimental research in the U.S. and other countries supports the effectiveness of pictorial health warning labels compared with text-only warnings for informing smokers about the risks of smoking and encouraging cessation. Yet very little research has examined differences in reactions to warning labels by race/ethnicity, education or income despite evidence that population subgroups may differ in their ability to process health information. The purpose of the present study was to evaluate the potential impact of pictorial warning labels compared with text-only labels among U.S. adult smokers from diverse racial/ethnic and socioeconomic subgroups. Methods/Findings: Participants were adult smokers recruited from two online research panels (n = 3,371) into a web-based experimental study to view either the new pictorial warnings or text-only warnings. Participants viewed the labels and reported their reactions. Adjusted regression models demonstrated significantly stronger reactions for the pictorial condition for each outcome salience (b = 0.62, p,.001); perceived impact (b = 0.44, p,.001); credibility (OR = 1.41, 95% CI = 1.2221.62), and intention to quit (OR = 1.30, 95% CI = 1.1021.53). No significant results were found for interactions between condition and race/ethnicity, education, or income. The only exception concerned the intention to quit outcome, where the condition-by-education interaction was nearly significant (p = 0.057). Conclusions: Findings suggest that the greater impact of the pictorial warning label compared to the text-only warning is consistent across diverse racial/ethnic and socioeconomic populations. Given their great reach, pictorial health warning labels may be one of the few tobacco control policies that have the potential to reduce communication inequalities across groups. Policies that establish strong pictorial warning labels on tobacco packaging may be instrumental in reducing the toll of the tobacco epidemic, particularly within vulnerable communities. [ABSTRACT FROM AUTHOR]

The authors perform an exploratory survey that examines the smoking behavior, perceptions, and quitting intentions of 579 college students, an important segment because of their large numbers, their education, and the fact that many of them begin smoking during college. Unlike findings from prior studies of adults, most college students in the sample did not perceive that light cigarettes are safer than regular cigarettes or that ultralight cigarettes are safer than light cigarettes, but rather they perceived lights to provide sensory benefits (e.g., milder, lighter taste) over regular cigarettes. This was especially true for former and current smokers. The majority of smokers were nondaily smokers, many of whom have no thoughts of quitting. This is a concern because these nondaily smokers may not consider their smoking behavior risky. In addition, nondaily college student smokers who are primarily social smokers constitute a large group of young adults for which there is little research into the health risks from smoking. [ABSTRACT FROM AUTHOR]

The authors question Smith, Stutts, and Zank's (2012) conclusion that young adult smokers interpret 'light' and 'mild' as taste attributes on several grounds. First, the current study examines evidence from industry documents that reveal strategies to use light and mild variants to reassure smokers. Second, the authors explore the multiple meanings of terms such as 'light' and 'mild' and illustrate how 'light' is commonly used to imply a reduction, particularly in food and alcohol products. Third, they review the extensive consumer evidence documenting smokers' belief that light cigarette variants will deliver less tar and nicotine and reduce the risk of harms arising from smoking. Finally, they review Smith, Stutts, and Zank's findings and suggest that their sample, predominantly social smokers, has important cognitive biases. The authors identify limitations in the measures of risk used, suggest that these elicit only superficial risk understanding, and conclude that Smith, Stutts, and Zank's findings reveal a considerable potential for harm. As a result, they conclude that Smith, Stutts, and Zank's study has consolidated prior findings by revealing high levels of deception, even among college students, who might be expected to be better educated and more discerning. [ABSTRACT FROM AUTHOR]