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Introduction Methods Results Discussions and Conclusions As part of several measures to inform consumers about the health risks of alcohol, the Irish Government signed into law the Public Health (Alcohol) Act 2018, with Section 13 requiring the implementation of multiple health warnings in all alcohol ads. Although health warnings on product labels have been subject to intensive political discussion and academic research, health warnings in alcohol ads have received little attention.A between‐subject factorial survey experiment was conducted with a convenience sample of adults in Ireland (n = 932) to compare single‐text, multiple‐text and shocking image‐and‐text health warnings displayed on two types of static alcohol ads—an ad with social imagery featuring people drinking alcohol and an ad featuring only the alcohol product. Believability of health warnings, negative emotions, perceived risks of alcohol use and self‐efficacy to drink less were measured after viewing each alcohol ad with or without health warnings.Single‐text health warnings, with and without shocking imagery, were more effective in increasing negative emotions than multiple‐text health warnings (p ≤ 0.001), whereas multiple‐text warnings were found to be more believable than single‐text warnings (p ≤ 0.001). No significant effects were found on perceived risks of alcohol use and self‐efficacy to drink less (p > 0.05). The warnings did not differ across demographic groups and the type of alcohol ads on all outcomes (p > 0.05).A single health warning emphasising cancer risk could be a useful starting point for policymakers when implementing health warnings in alcohol ads. [ABSTRACT FROM AUTHOR]

Findings on the effects of alcohol warning labels (AWLs) as a harm reduction tool have been mixed. This systematic review synthesized extant literature on the impact of AWLs on proxies of alcohol use. PsycINFO, Web of Science, PubMED, and MEDLINE databases and reference lists of eligible articles. Following PRISMA guidelines, 1,589 articles published prior to July 2020 were retrieved via database and 45 were via reference lists (961 following duplicate removal). Article titles and abstracts were screened, leaving the full text of 96 for review. The full-text review identified 77 articles meeting inclusion/exclusion criteria which are included here. Risk of bias among included studies was examined using the Evidence Project risk of bias tool. Findings fell into five categories of alcohol use proxies including knowledge/awareness, perceptions, attention, recall/recognition, attitudes/beliefs, and intentions/behavior. Real-world studies highlighted an increase in AWL awareness, alcohol-related risk perceptions (limited findings), and AWL recall/recognition post-AWL implementation; these findings have decreased over time. Conversely, findings from experimental studies were mixed. AWL content/formatting and participant sociodemographic factors also appear to influence the effectiveness of AWLs. Findings suggest conclusions differ based on the study methodology used, favoring real-world versus experimental studies. Future research should consider AWL content/formatting and participant sociodemographic factors as moderators. AWLs appear to be a promising approach for supporting more informed alcohol consumption and should be considered as one component in a comprehensive alcohol control strategy. [ABSTRACT FROM AUTHOR]

Background: Statutory options for restricting alcohol advertising include limiting it to product‐orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). Methods: We conducted a 2 × 2 online between‐group experiment with adults (18+) (n = 2421) recruited from a non‐probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. "drink responsibly"). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol‐related information and support. The "drink responsibly" control reflected the self‐regulatory messages commonly used by alcohol companies. Participants rated the advert on 7‐point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. Results: Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: −1.57 [makes drinking alcohol seem enjoyable] to −0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: −0.55 [advert attractiveness] to −0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. Conclusions: Restricting content and including a multiple text health warning (compared to a "drink responsibly" message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups. [ABSTRACT FROM AUTHOR]

Abstract Background Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app. Methods Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol. Results Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products. Conclusions The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.

Background: Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app. Methods: Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol. Results: Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products. Conclusions: The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol. [ABSTRACT FROM AUTHOR]

The microbial compositions, quality characteristics, and structural changes in fresh brown rice noodles (FBRN) during storage were investigated. Total plate count and mold and yeast counts increased while the pH decreased during storage. Metagenomic sequencing revealed that the microbial composition of FBRN changed throughout storage. A comprehensive investigation of the variation in lipid content demonstrated that hydrolytic rancidity was responsible for lipid deterioration. LF-NMR showed an increase in the proportion of bound water and a decrease in the proportion of free water in FBRN. Moreover, significant changes in edible qualities were observed. The cooking loss increased three-fold and noodles hardness reduced by approximately 23%. Further, the high initial aldehyde content of FBRN diminished almost completely, while that of alcohols and esters increased, leading to significant flavor deterioration. The correlation and factor analysis suggested that the TPC and MY counts could be used as key indicators of FBRN deterioration.

Introduction: There is an ongoing policy debate in the European Union regarding the best method of providing information to consumers on the health risks of alcohol use. One of the proposed channels is via the provision of QR codes. This study tested the usage rate of QR codes placed on point‐of‐sale signs in a supermarket in Barcelona, Catalonia over a 1‐week period. Methods: Nine banners with beverage‐specific health warnings in large text were prominently displayed in the alcohol section of a supermarket. Each banner provided a QR code of relatively large image size that linked to a government website providing further information on alcohol‐related harms. A comparison was made between the number of visits to the website and the number of customers in the supermarket (number of unique sales receipts) in a single week. Results: Only 6 out of 7079 customers scanned the QR code during the week, corresponding to a usage rate of 0.085%, less than 1 per 1000. The usage rate was 2.6 per 1000 among those who purchased alcohol. Discussion and Conclusions: Despite the availability of prominently displayed QR codes, the overwhelming majority of customers did not make use of the QR codes to obtain further information on alcohol‐related harms. This corroborates the results from other studies investigating customers' use of QR codes to obtain additional product information. Based on the current evidence, providing online access to information through QR codes will likely not reach a significant portion of consumers. [ABSTRACT FROM AUTHOR]

BackgroundThe US lags behind >120 countries in implementing graphic warning labels (GWLs) on cigarette packs. US courts prevented implementation of FDA's 2012 rule requiring GWLs citing the need for more evidence on effectiveness. After more research, in 2020, the FDA proposed a revised rule mandating GWLs. This trial will test how the introduction of GWLs influence cognitions and behavior in US smokers.MethodTo investigate the "real-world" impact of GWLs in US smokers, we are conducting a randomized trial involving a 3-month intervention and 8-month follow-up. The study recruited California smokers between September 2016 through December 2019 and randomly assigned them into 3 groups (1) Blank Pack devoid of any cigarette branding; (2) GWL Pack featuring 1 of 3 rotating images added to blank pack; or (3) their usual Standard US Pack. Throughout the 3-month intervention, participants purchased study-packaged cigarettes and reported daily cognitions and behavior through ecological momentary assessments. We will validate self-reported tobacco use with saliva cotinine concentrations following the 3-month intervention and 8-month follow-up.ResultsThe trial enrolled 359 participants (average age 39 years; average cigarette consumption half a pack/day). The 3 study groups were balanced on age, gender, race-ethnicity, education and income (17% low income) as well as on smoking related variables.ConclusionsThis 3-month real-world randomized trial will test the effect of repackaging cigarettes from standard US packs to GWL plain packs on smokers' perceptions of the risks of smoking, their perception of the appeal of their cigarettes, and on their smoking behavior.

Alcohol marketing provides a high-reach opportunity to communicate consumer protection messages (e.g. health warnings), but there are concerns about the efficacy of self-regulatory practice. Through the Public Health (Alcohol) Act, Ireland will mandate the presence of such information. To understand the potential impact of the Act, we examined: (1) the presence of self-regulated consumer protection messages in alcohol marketing on Twitter; and (2) the presence of warnings (about alcohol, drinking when pregnant, and cancers) and signposts to websites with information about alcohol, which will be required under the Act. Data come from a content analysis of Tweets (n = 554) from a purposive non-probabilistic sample of 13 alcohol companies either based in Ireland or, for multinational companies, where marketing was targeted at Ireland. A third of Tweets (36.3%) had a self-regulated message, with 'Get the facts. Be DRINKAWARE' featured most (20.0%). No Tweets signposted independent health websites, 20.6% signposted an industry-funded website (drinkaware.ie), and 6.7% signposted industry-controlled websites. No Tweets featured warnings about the dangers of alcohol or link to cancers. Only one brand (0.5% Tweets) referenced drinking during pregnancy, but only through incidental exposure to warnings on packaging. Ireland's legislation will fundamentally improve communication of warnings in alcohol marketing on Twitter. [ABSTRACT FROM AUTHOR]

• Health warnings about alcohol could discourage alcohol consumption. • Health warnings – regardless of topic – are perceived as more effective at discouraging alcohol consumption than control statements. • Among the 16 warning topics tested, liver disease, cancer, dementia, and hypertension were perceived as most effective. • None of these topics are included in the current US alcohol warning. Health warnings about alcohol consumption could inform consumers and discourage alcohol consumption, but little is known about what topics these warnings should address. We sought to identify promising topics for alcohol warnings. In January 2024, we recruited a convenience sample of 2,522 US adults ages ≥ 21 years. In an online within-subjects experiment, participants viewed messages about 6 topics (5 warning topics selected from a pool of 16 topics [e.g., liver disease, liver cancer] and 1 control topic [i.e., recycling or reselling products]) shown in random order. For each topic, participants viewed and rated 2 statements about that topic on perceived message effectiveness (primary outcome) and reactance (secondary outcome). The 16 warning topics elicited higher perceived message effectiveness than the control topic (p s < 0.001). Among the warning topics, liver disease, most cancer types, dementia or mental decline, and hypertension elicited the highest perceived message effectiveness, while breast cancer, sleep, and drinking guidelines elicited the lowest. Fourteen of the 16 warning topics (all except for fetal harms and impaired driving) elicited more reactance than the control topic (p s < 0.001). Warning topics that elicited high perceived message effectiveness generally elicited high reactance, except for messages about liver disease and liver cancer, which elicited high perceived message effectiveness but only moderate reactance. Warning messages about a variety of topics hold promise for discouraging alcohol consumption. Messages about liver disease, most cancer types, dementia or mental decline, and hypertension are perceived as especially effective; however, none of these topics are included in the current US alcohol warning. [ABSTRACT FROM AUTHOR]

One way of tackling hazardous alcohol consumption is introducing warning labels on alcohol products. This research explores three under‐researched message content areas in relation to alcohol warning labels: negative/positive framing of the message; use of signal words and qualifiers and type of information used in the message (qualitative or quantitative), across message themes that depict social or health consequences. A qualitative and exploratory approach was undertaken using five focus groups of UK undergraduate students followed by 15 semi‐structured interviews with UK adults. Discussions centred around responses to the alcohol warning labels that varied in message content characteristics. The students also created their own warning label designs based on what they believed would be useful for encouraging students to keep to low‐risk drinking guidelines. Findings across both samples revealed a preference for negatively (loss) framed health messages that elicit fear and use evidence‐based reasoning and statistics. The avoidance of signal words (e.g. 'government warning') and qualifiers (e.g. may cause) would likely make the messages more persuasive. Our findings contribute to understanding the influence of message content on consumer responses to alcohol warning labels. However, such message content characteristics are inherent in the design of many product warnings and our findings may apply to other contexts. [ABSTRACT FROM AUTHOR]

Introduction: According to the literature, quitting tobacco before the age of 30 years would mitigate almost all tobacco-related hazards. In this respect, understanding behavioral patterns associated with the process of individual change to a healthier behavior is likely to contribute to tobacco control and avoidance of the related health risks, as well as to promote healthier behaviors, especially during adolescence., Methods: This study is a secondary dataset analysis utilizing the 2016 Global Youth Tobacco Survey (GYTS) data for Morocco. Initially, a descriptive analysis is conducted to outline smoking prevalence and related behaviors among Moroccan youth, with a focus on gender differences, employing chi-squared tests for comparison. This is followed by bivariate and multivariate logistic regression analyses, which were adjusted for potential confounders to identify the determinants of intended smoking cessation., Results: The survey was based on a sample of 3883 adolescents, of whom 11.07% have already tried smoking cigarettes at least once during childhood and adolescence, and 1.39% are current smokers. As for those close to the surveyed subjects, 22.2% had at least one smoking parent, and 24.1% had friends who smoked. Self-efficacy (AOR=15.54; 95% CI: 3.05-79.03) and noticing health warnings on cigarette packages (AOR=5.41; 95% CI: 2.54-11.52) were found to be important determinants of the intent to quit tobacco., Conclusions: This study is a focused analysis of self-efficacy and health warnings as predictors of smoking cessation intent among Moroccan adolescents. The study elucidates the role of self-efficacy and exposure to health warnings in shaping the intent to quit smoking among Moroccan adolescents. These findings provide evidence for developing targeted interventions that support self-efficacy and impactful health warnings to promote healthier choices and reduce tobacco use among young Moroccans., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2024 Loukili H. et al.)

Aims: To measure how cigarette packaging (standardised packaging and branded packaging) and health warning size affect visual attention and pack preferences among Colombian smokers and non‐smokers. Design To explore visual attention, we used an eye‐tracking experiment where non‐smokers, weekly smokers and daily smokers were shown cigarette packs varying in warning size (30%‐pictorial on top of the text, 30%‐pictorial and text side‐by‐side, 50%, 70%) and packaging (standardised packaging, branded packaging). We used a discrete choice experiment (DCE) to examine the impact of warning size, packaging and brand name on preferences to try, taste perceptions and perceptions of harm. Setting: Eye‐tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia. Participants: Participants (n = 175) were 18 to 40 years old. Measurements For the eye‐tracking experiment, our primary outcome measure was the number of fixations toward the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions. Findings We observed greater visual attention to warning labels on standardised versus branded packages (F[3,167] = 22.87, P < 0.001) and when warnings were larger (F[9,161] = 147.17, P < 0.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F[9,161] = 4.44, P < 0.001). Non‐smokers visually attended toward the warnings more than smokers, but as warning size increased these differences decreased (F[6,334] = 2.92, P = 0.009). For the DCE, conditional trials showed that increasing the warning size from 30% to 70% reduced preferences to try (odds ratio [OR] = 0.48, 95% CI = [0.42,0.54], P < 0.001), taste perceptions (OR = 0.61, 95% CI = [0.54,0.68], P < 0.001); and increased harm perceptions (OR = 0.78, 95% CI = [0.76,0.80], P < 0.001). Compared with branded packaging, standardised packaging reduced our DCE outcome measures with ORs ranging from OR = 0.25 (95% CI = [0.17,0.38], P < 0.001) to OR = 0.79 (95% CI = [0.67,0.93], P < 0.001) across two brands. These effects were more pronounced among non‐smokers, males and younger participants. Unconditional trials showed similar results. Conclusions: Standardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia. [ABSTRACT FROM AUTHOR]

Warning labels are an important source of health information. This study examined awareness of health warnings on cannabis packages over time in Canada—where large rotating messages are mandated—versus US states with legal adult-use cannabis, which have less comprehensive regulations. Repeat cross-sectional data were collected from the International Cannabis Policy Study online surveys among past 12-month cannabis consumers in Canada and the US (n = 38,448). Free recall of warning messages was assessed in 2018–2020, followed by a prompted recognition task (2020 only). Adjusted logistic regression models tested differences in free recall and recognition of warnings between Canada and US states with and without legal adult-use cannabis ("legal" and "illegal" states, respectively). Free recall of ≥1 warning increased to a greater extent in Canada from 2018 (5%; pre-legalization) to 2019 (13%; post-legalization) compared to US "legal" (AOR = 1.93, p < 0.001) and "illegal" states (AOR = 1.80, p = 0.007), and from 2018 to 2020 (5% vs. 15%) compared to US "legal" states (AOR = 2.23, p = 0.027). In all jurisdictions, free recall of warnings was higher among more frequent consumers (p < 0.001) and those who purchased products from legal retail stores/websites (p < 0.001). With few exceptions, when a specific message was mandated (e.g., impaired driving), consumers were more likely to both freely recall and recognize that message (all p < 0.05). Cannabis legalization is associated with greater recall of health warning messages. Awareness of specific warning messages was higher in jurisdictions where the associated warning was mandated on packages, suggesting that warning labels may improve knowledge of cannabis-related health risks. Supplemental data for this article is available online at [ABSTRACT FROM AUTHOR]

INTRODUCTION Noticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco. METHODS We analyzed data from the 2017 Zambia WHO STEPS survey (STEPwise approach to surveillance) for noncommunicable disease risk factors. Descriptive analyses and logistic regression were performed to assess the association of select sociodemographic characteristics with awareness of health warnings and thinking about quitting because of health warnings. RESULTS Adults who currently smoked tobacco who were aged 30–44 years, of Chewa ethnicity, or with a formal education, were more likely to be aware of health warnings than those aged 18–29 years (adjusted prevalence ratio, APR=1.26; 95% CI: 1.02–1.54), of Bemba ethnicity (APR=1.43; 95% CI: 1.17–1.74), or with no formal education (APR: 2.61–5.95). Among all adults who currently smoked, those of Chewa ethnicity (APR=1.55; 95% CI: 1.03–2.35), or with a formal education (APR:1.80–4.38), were more likely to report thinking about quitting because of health warnings than those who were of Bemba ethnicity or with less than primary school education level. Women who currently smoked were 49% less likely (APR=0.51; 95% CI: 0.23–0.84) to report thinking about quitting than men. Among a subset of adults who currently smoked who were aware of health warning labels, no sociodemographic characteristics were significantly associated with thinking about quitting in unadjusted or adjusted models. CONCLUSIONS Sociodemographic characteristics such as sex, ethnicity, and education level were significantly associated with awareness of cigarette health warnings. Among cigarette smokers aware of health warnings, no sociodemographic differences in thinking about quitting were found. Tobacco control campaigns may need to target people of ethnicities with the highest smoking prevalence in the country. [ABSTRACT FROM AUTHOR]

The present world is passing a great pandemic where Bangladesh facing an unavoidable challenge to cope up with COVID-19. The government and other health organizations haveannounced somehealth warnings to prevent COVID-19 and make people aware. The study aims to explore the health warnings status (knowledge and practicesof health warnings) among low socio-economic people in Bangladesh. This cross-sectional study was conducted with 400 participants (low socio-economic people) by using the purposive sampling and semi-structured questionnaire survey over six months. This study illustrates that 60% of respondents noticed they and their family members are very aware and knowledgeable about COVID-19where 36.5% are conscious to make their family aware about corona virus. About 32% of respondents use mask when they go to outside during corona period where 25% use hand sanitizer. It is found that there is a significant association between occupation, age and perception on people’s awareness about COVID-19 at 1% level of significance where (p<0.002), (p<0.001) respectively. Along with, educational qualification is also significantly associated at 10% level of significance where (p<0.08).Most of the respondents have moderate level of knowledge and awareness about COVID-19 health warnings. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol packaging can communicate alcohol-related health information, messaging and warnings. However, there is a dearth of research exploring awareness of, and engagement with, health information and messaging on alcohol packaging, and response to novel alcohol warnings. Methods: Eight focus groups were conducted in Glasgow (Scotland) with current drinkers (n=50), segmented by age (18-24, 25-35), gender (female, male) and social grade (ABC1, C2DE), to explore awareness and use of health information and messaging on existing packaging, and perceptions of novel front-of-package warnings differing in size (small, large), form (text-only, text and image) and message content (general, specific). Results: Unaided recall of some health information and messaging was high (e.g. units, pregnancy symbols); however, most participants did not attend to or meaningfully engage with these, viewing them as unnoticeable, obscure and ineffective. Participants were skeptical of alcohol companies' motivations with respect to health messaging on products. They were surprised to see the novel warnings on alcohol products but generally supported their inclusion. Most thought that these warnings could increase awareness of alcohol-related harms, particularly for younger or potential drinkers. Large, combined (text and image) warnings with specific messages on the front of packaging were considered most engaging and potentially effective. Conclusions: The health-related information and messaging on alcohol packaging in Scotland is failing to inform consumers about the potential risks associated with alcohol use. Prominent warnings on alcohol packaging could help to capture attention, increase awareness of alcohol-related harms, and may support a reduction in consumption and alcohol-related harms. [ABSTRACT FROM AUTHOR]

Objective: In February 2020, San Francisco proposed mandatory health warnings for sugar-sweetened beverage (SSB) advertisements. Industry legal challenges stated that the warning would detract from advertisers' ability to convey their intended message and mislead consumers into believing that SSB cause weight gain regardless of consumption amount, lifestyle or intake of other energy-dense foods.Design: Online between-group experiments tested the impact of SSB warnings on advertising outcomes and consumer perceptions. Respondents were randomised to view six SSB print advertisements with or without a health warning ('Warning' and 'No Warning' condition, respectively). Linear and binary logistic regression models tested differences between groups, including ad recall, brand perceptions and beliefs about SSB health effects.Setting: Panelists from the US Nielsen Global Panel.Participants: Sixteen to 65-year-old respondents (n 1064).Results: Overall, 69·2 % of participants in the 'Warning' condition recalled seeing warnings on SSB ads. Compared with the 'No Warning' condition, participants in the 'Warning' condition who reported noticing the warnings were equally likely to recall the brands featured in the SSB ads and to recall specific attributes of the final ad they viewed. Similarly, no differences were observed between groups in perceptions of SSB, such as perceived taste, or in the prevalence of false beliefs regarding the health effects of SSB and intake of other sugary foods on weight gain.Conclusions: Overall, there was no evidence that SSB health warnings detracted from attention to promotional elements in advertisements or that the warnings misled consumers into false beliefs about SSB as the exclusive cause of weight gain. [ABSTRACT FROM AUTHOR]

Introduction: Product labelling and health warnings are important components of regulatory frameworks for consumer products such as tobacco, alcohol and food. However, evidence in the cannabis domain is limited. This study aimed to examine the reach of mandated health warnings on cannabis products using a natural experimental design. Methods: Data are from the online International Cannabis Policy Study 2018 and 2019 surveys. Respondents were men and women aged 16 to 65 years in Canada and US states with illegal and legal nonmedical cannabis ("illegal" and "legal" states, respectively) (n = 72 549). Regression models tested differences in noticing health warnings on cannabis packages pre- and post-legalization in Canada, with comparisons to US states, adjusting for cannabis use, cannabis source and sociodemographics. Results: Respondents in Canada showed a greater increase in noticing warnings (+8.9%) in 2019 (14.7%) versus 2018 (5.8%) than respondents in US "illegal" states (+2.8%) and "legal" states (+3.2%). In 2019, consumers residing in jurisdictions with legal recreational cannabis who purchased from legal retail sources were more likely to report noticing warnings than consumers who obtained cannabis from illegal/unstated sources (Canada: 40.4% vs. 15.3%; US "legal" states: 35.3% vs. 17.0%). Regular cannabis consumers were more likely to notice warnings than less frequent consumers. Conclusion: Mandating warning labels on cannabis products may increase exposure to messages communicating the health risks of cannabis, especially among frequent consumers and those who access the legal market. [ABSTRACT FROM AUTHOR]

As cannabis policy trends toward liberalization, assessing cannabis health warning effects becomes increasingly important. This study investigated underlying mechanisms accounting for the effectiveness of cannabis health warnings on protective health intentions. A sample of 1,095 adults (21+) living in legal recreational US states who reported using cannabis in the past 12 months participated in an online experiment. Participants were randomly assigned to view cannabis health warnings that described risks of impaired driving, mental health, and smoke exposure and varied pictures and text (vs. text-only) attributes in warnings. Outcomes were message reactions (cognitive elaboration, fear, and hope), attitudes and beliefs (perceived severity of cannabis harms and perceived susceptibility to cannabis harms, and perceived response and self-efficacy to prevent cannabis harms), and protective health intentions (information-seeking about cannabis health effects and having interpersonal discussions about cannabis harms with family, friends, and medical professionals). MANCOVA results showed no significant differences between text-only vs. pictorial attributes on protective health intentions; thus, warning conditions were controlled and analyzed using structural equation modeling (SEM). SEM results showed that attention to cannabis health warnings (text-only or pictorial) elicited higher cognitive elaboration, fear, and hope—an emotion associated with coping actions that motivate positive expectations of future events. These outcomes, in turn, were associated with greater perceived severity and susceptibility and greater perceived response efficacy, respectively. Hope, perceived severity, and perceived response and self-efficacy were independently associated with greater intentions to seek information about cannabis health effects and to discuss cannabis health harms. Attention to warnings impacted emotions, attitudes, and protective health intentions. Fear is commonly associated with health warning effects, and our results suggest that hope is also an important factor. This research contributes to understanding the effects of cannabis health warnings and can inform regulatory agencies that mandate warnings on cannabis products. [ABSTRACT FROM AUTHOR]

Abstract Background Sugar taxes and front-of-package (FOP) nutrition labelling systems are strategies to address diet-related non-communicable diseases. However, there is relatively little experimental data on how these strategies influence consumer behavior and how they may interact. This study examined the relative impact of different sugar taxes and FOP labelling systems on beverage and snack food purchases. Methods A total of 3584 Canadians 13 years and older participated in an experimental marketplace study using a 5 (FOP label condition) × 8 (tax condition) between-within group experiment. Participants received $5 and were presented with images of 20 beverages and 20 snack foods available for purchase. Participants were randomized to one of five FOP label conditions (no label; ‘high in’ warning; multiple traffic light; health star rating; nutrition grade) and completed eight within-subject purchasing tasks with different taxation conditions (beverages: no tax, 20% tax on sugar-sweetened beverages (SSBs), 20% tax on sugary drinks, tiered tax on SSBs, tiered tax on sugary drinks; snack foods: no tax, 20% tax on high-sugar foods, tiered tax on high-sugar foods). Upon conclusion, one of eight selections was randomly chosen for purchase, and participants received the product and any change. Results Compared to those who saw no FOP label, participants who viewed the ‘high in’ symbol purchased less sugar (− 2.5 g), saturated fat (− 0.09 g), and calories (− 12.6 kcal) in the beverage purchasing tasks, and less sodium (− 13.5 mg) and calories (− 8.9 kcal) in the food tasks. All taxes resulted in substantial reductions in mean sugars (− 1.4 to − 4.7 g) and calories (− 5.3 to − 19.8 kcal) purchased, and in some cases, reductions in sodium (− 2.5 to − 6.6 mg) and saturated fat (− 0.03 to − 0.08 g). Taxes that included 100% fruit juice (‘sugary drink’ taxes) produced greater reductions in sugars and calories than those that did not. Conclusions This study expands the evidence indicating the effectiveness of sugar taxation and FOP labelling strategies in promoting healthy food and beverage choices. The results emphasize the importance of applying taxes to 100% fruit juice to maximize policy impact, and suggest that nutrient-specific FOP ‘high in’ labels may be more effective than other common labelling systems at reducing consumption of targeted nutrients.

Two-thirds of adolescent and young adult smokers become lifetime smokers, and one-half of those lifetime smokers will die from this habit. The authors examine alternative persuasive pathways to thoughts of quitting taken by adolescent and young adult smokers when exposed to graphic visual health warnings on cigarette packages. For adolescent smokers, the authors find that graphic warnings and smoking frequency affect fear, and fear influences negative health beliefs about smoking, ultimately increasing thoughts of quitting. They also find that the graphic warning and a graphic warning ¥ smoking frequency interaction have incremental effects on quit thoughts beyond the effects of fear and negative health beliefs. Using a longitudinal design with a sample of young adult smokers, the authors find support for many of the adolescent smoker findings, particularly the incremental effects of graphicness and its interaction with smoking frequency. These similar results from diverse samples support the use of graphic visual warnings but suggest that effects are attenuated for those who smoke the most. The authors offer implications for countermarketing programs and public health policy. [ABSTRACT FROM AUTHOR]

Abstract Background There is strong evidence that plain cigarette packaging and health warning labels (HWLs) reduce brand appeal and increase health knowledge. There is limited evidence examining this population-level public health approach for cannabis packaging. This issue is of particular importance in light of the recent legalization of recreational cannabis in Canada. The current study examined perceptions of plain packaging and HWLs for cannabis packages among young adults. Methods An online experimental study was conducted with a sample of university students in Alberta, Canada (n = 656). Respondents were randomly assigned to view cannabis packages in one of four conditions: Condition 1: branded pack, Condition 2: plain pack (uniform color, brand imagery removed, standardized font), Condition 3: branded pack with a HWL, and Condition 4: plain pack with a HWL. Respondents in Conditions 3 and 4 viewed five text-based HWLs, each corresponding to a health effect associated with cannabis use: (1) brain development, (2) mental health issues, (3) impaired driving, (4) nonlethal overdose, and (5) addiction. After viewing packs, respondents rated packs and health warnings on various measures. Results Branded packages without HWLs were rated as most appealing compared to all other packs (p

Abstract Background Packaging and labelling tobacco products has emerged as an effective policy to reduce the global health burden of tobacco use. The main purpose of this study was to explore Austrian smokers’ and ex-smokers’ responses to both the textual and pictorial cigarette pack health warnings (CPHWs) recently implemented. Methods We analysed self-reported data (N=500) from an Austrian cross-sectional survey that was conducted after the implementation of the new pictorial CPHWs in 2016. Results The results showed only weak effects of the CPHWs on the decision to quit or reduce smoking, and the level of impact of the CPHWs remained limited particularly because of smokers denying the ill-effects of tobacco use. Conclusions Although the CPHWs seem to have the potential to promote a change in smoking behaviour, the warnings reached only a rather small group of smokers, while the majority of smokers appeared to remain unaffected by this intervention. Public health policies are challenged to increase the salience of CPHWs and to overcome smokers’ denial of detrimental health effects.

Abstract Background Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them. Methods We examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease. Results A 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs. Conclusion Our findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or ‘grotesque’ HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.

INTRODUCTION Through packaging and marketing, the tobacco industry (TI) is able to increase the appeal of its products and reduce the effectiveness of health warning labels (HWLs). Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control (FCTC), ANVISA, the Brazilian surveillance and regulatory agency, conducted a process to implement new regulations at the point-of-sale (POS), including a display ban, and new parameters to HWLs. In order to prevent the regulation from entering into force, the TI strategically used several approaches. The objective of this study was to analyze the approaches used by the TI to prevent the implementation of a tobacco display ban and new requirements to HWLs. METHODS In order to identify and describe TI's approaches, we reviewed several sources of documentation, including published articles, reports, legislation, TI documents, and media stories. RESULTS Well-known, reported approaches were used by the TI in order to prevent the implementation of new regulations. These approaches included political interference, litigation, and funding studies to question tobacco control measures as previously reported in Brazil and other countries. CONCLUSIONS Using established approaches, the TI successfully stopped the implementation of a tobacco display ban and new parameters to HWLs in Brazil. [ABSTRACT FROM AUTHOR]

Background and Aims: Standardized tobacco packaging was introduced in the United Kingdom in May 2016, together with larger graphic warnings. This study explored young Scottish people's awareness of and perceptions about standardized tobacco packaging in the United Kingdom. Design Qualitative study using 16 focus groups conducted February–March 2017. Setting: Four schools in Scotland based in areas of differing socio‐economic status (high versus medium/low) and two levels of urbanity (large urban versus small town/other urban). Participants: Eighty‐two S2 (13–14 years) and S4 (15–16 years) students who were smokers or at‐risk non‐smokers. Measurements Focus groups explored perceptions of standardized packaging and health warnings. The qualitative data underwent thematic analysis. Findings Views about standardized packaging were generally negative. Packs were described as being unattractive, drab and less appealing than non‐standardized versions. The new health warnings generated negative affective, often aversive, responses. These varied depending on the image's perceived 'gruesomeness' and authenticity. Most participants thought that the impact would be greatest on young non/occasional smokers. There were divergent views about whether established smokers would be affected. Conclusions: The introduction of standardized tobacco packaging and new larger graphic health warnings in the United Kingdom seems have reduced the perceived attractiveness of cigarette packs among young people in the United Kingdom who smoke or are at elevated risk of becoming smokers, disrupting positive brand imagery (the brand heuristic), increasing the salience of health warnings and contributing to denormalizing smoking. [ABSTRACT FROM AUTHOR]

Background: To reduce diet-related chronic disease, policymakers have proposed requiring health warnings on sugar-sweetened beverages (SSBs). Health warnings reduced purchases of these products by 22% in our recent randomized controlled trial, but the mechanisms remain unclear.Purpose: We sought to identify the psychological mechanisms that explain why SSB health warnings affect purchase behavior.Methods: In 2018, we recruited 400 adult SSB consumers to complete a shopping task in a naturalistic convenience store laboratory in North Carolina, USA. We randomly assigned participants to either a health warning arm (all SSBs in the store displayed a text health warning) or to a control arm (SSBs displayed a control label). Participants selected items to purchase with cash.Results: Compared to control labels, health warnings elicited more attention, negative affect, anticipated social interactions, and thinking about harms (range of ds = 0.63-1.34; all p < .001). Health warnings also led to higher injunctive norms about limiting SSB consumption (d = 0.27, p = .008). Except for attention, all of these constructs mediated the effect of health warnings on SSB purchases (all p < .05). In contrast, health warnings did not influence other attitudes or beliefs about SSBs or SSB consumption (e.g., healthfulness, outcome expectations, and response efficacy).Conclusions: Health warnings on sugar-sweetened beverages affected purchase behavior by eliciting negative emotions, increasing anticipated social interactions, keeping SSBs' harms at top of mind, and shifting norms about beverage consumption. Results are consistent with recent studies of why tobacco warnings influence quitting behavior, pointing toward a general framework for understanding how health warnings affect behavior.Clinical Trials Registration: NCT #03511937. [ABSTRACT FROM AUTHOR]

Background Alcohol packaging can be used to communicate product-related information, health messages and health warnings to consumers. We examined awareness and recall of such information and messaging among adolescents in the United Kingdom. Method A cross-sectional survey was conducted with 11–19 year olds in the United Kingdom (n = 3399), with participants asked if they had seen any information, health messages or warnings on alcohol packaging in the past month (Yes/No) and, if so, what they recalled. We also assessed higher-risk drinking among current drinkers (≥5 Alcohol Use Disorders Identification Test-Consumption) and susceptibility to consume among never-drinkers. Results One-third (32%) of participants had seen information, health messages or warnings on alcohol packaging. Chi-Square tests showed awareness was greater for current drinkers than non-drinkers (46% vs. 19%; P < 0.001), higher-risk drinkers than lower-risk drinkers (55% vs. 39%; P < 0.001), and susceptible never-drinkers than non-susceptible never-drinkers (21% vs. 16%; P = 0.01). Ten messages were recalled, with drinking responsibly (18%) and not drinking during pregnancy (13%) most recalled. Conclusion Most young drinkers, including almost half of higher-risk drinkers, did not recall seeing any information, health messages or warnings on alcohol packaging in the past month, suggesting that current labelling is failing to reach this key audience. [ABSTRACT FROM AUTHOR]

Introduction: While most countries require health warnings on cigarette packs, the Scottish and Canadian Governments are considering requiring health warnings on cigarette sticks. Methods: Twenty focus groups were conducted in Glasgow and Edinburgh (Scotland) with smokers (n = 120) segmented by age (16–17, 18–24, 25–35, 36–50, >50), gender and social grade, to explore perceptions of cigarettes displaying the warning 'Smoking kills' on the cigarette paper and any demographic differences in how smokers responded to these. Results: A warning on each cigarette was thought to prolong the health message, as it would be visible when a cigarette was taken from a pack, lit, left in an ashtray, and with each draw, and make avoidant behavior more difficult. That it would be visible to others was perceived as off-putting for some. It was felt that a warning on each cigarette would create a negative image and be embarrassing. Within several female groups they were viewed as depressing, worrying and frightening, with it suggested that people would not feel good smoking cigarettes displaying a warning. Within every group there was mention of warnings on cigarettes potentially having an impact on themselves, others or both. Some, mostly younger groups, mentioned stubbing cigarettes out early, reducing consumption or quitting. The consensus was that they would be off-putting for young people, nonsmokers and those starting to smoke. Conclusions: Including a warning on each cigarette stick is a viable policy option and one which would, for the first time, extend health messaging to the consumption experience. [ABSTRACT FROM AUTHOR]

The use of e-cigarettes, otherwise known as 'vaping', has been increasing at alarming rates among youth and young adults. Although the long-term harms of vaping are still unclear, emerging evidence brings to light potential risks associated with vaping, especially for youth and non-smokers. This paper discusses nine viable policy measures that could limit the appeal of vaping products to youth and young adults and, in turn, reduce the potential harms of vaping. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the effects of two types of health warnings on cigarette packages: 'narrative visual warnings', showing an image portraying people plus a corresponding slogan that could evoke a story-like interpretation, and 'non-narrative visual warnings' with non-narrative content (i.e. body parts). Moreover, the mechanisms underlying the effects of these health warnings were explored. Design: A within-participants experiment was conducted comparing narrative and non-narrative visual warnings. Path analyses were performed to investigate the relationship between the narrative concepts transportation and identification, the emotions evoked by the health warning and the perceived effectiveness of the message. Method: Participants (N = 200) were presented with one narrative warning and one non-narrative warning. After each warning, they answered questions on narrative perception, transportation, identification, emotions and perceived effectiveness. Results: The narrative warnings were seen as more story-like than the non-narrative warnings. There was a statistical trend for narrative warnings to be perceived as more effective than the non-narratives. The narrative warnings caused more transportation, fear, sadness, compassion and anger; the non-narrative warnings evoked more disgust and surprise. For the narrative warnings, both narrative concepts of transportation and identification were directly related to perceived effectiveness, and also indirectly via sadness. For the non-narrative warnings, transportation was related to perceived effectiveness, both directly and indirectly via disgust. Conclusion: Seeing a story in a still picture with a slogan helps to increase the effectiveness of the antismoking message. Both narrative and non-narrative visual warnings may persuade receivers directly, but also by the evoking of emotions, although the specific emotions responsible for the persuasive effects may differ. [ABSTRACT FROM AUTHOR]

Nelly Layoun,1,2 Pascal Salameh,2,3 Mirna Waked,4 Z Aoun Bacha,5 Rony M Zeenny,6 Eric El Hitti,4 Isabelle Godin,1 Michèle Dramaix1 1Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, UniversitéLibre de Bruxelles, Brussels, Belgium; 2Doctoral School of Sciences and Technologies, Lebanese University, Beirut, Lebanon; 3Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; 4Department of Pulmonology, St George Hospital University Medical Center; Faculty of Medicine, Balamand University, Beirut, Lebanon; 5Department of Pulmonary and Critical Care Medicine, Hotel-Dieu de France, Beirut, Lebanon; 6Pharmacy Practice Department, School of Pharmacy, Lebanese American University, Byblos, Lebanon Introduction: Health warnings on tobacco packages have been considered an essential pillar in filling the gap of knowledge and communicating the health risks of tobacco use to consumers. Our primary objective was to report the perception of smokers on the textual health warnings already appearing on tobacco packages in Lebanon versus shocking pictures about the health-related smoking consequences and to evaluate their impact on smoking behaviors and motivation. Methods: A pilot cross-sectional study was undertaken between 2013 and 2015 in five hospitals in Lebanon. Participants answered a questionnaire inquiring about sociodemographic characteristics, chronic respiratory symptoms, smoking behavior and motivation to quit smoking. Only-text warning versus shocking pictures was shown to the smokers during the interview. Results: Exactly 66% of the participants reported that they thought shocking pictorial warnings would hypothetically be more effective tools to reduce/quit tobacco consumption compared to only textual warnings. Also, 31.9% of the smokers who were motivated to stop smoking reported that they actually had stopped smoking for at least 1 month secondary to the textual warnings effects. A higher motivation to quit cigarette smoking was seen among the following groups of smokers: males (odds ratio [OR] =1.8, P=0.02), who had stopped smoking for at least 1 month during the last year due to textual warning (OR =2.79, P

Abstract Background Alcohol warning labels have a limited effect on drinking behavior, potentially because people devote minimal attention to them. We report findings from two studies in which we measured the extent to which alcohol consumers attend to warning labels on alcohol packaging, and aimed to identify if increased attention to warning labels is associated with motivation to change drinking behavior. Methods Study 1 (N = 60) was an exploratory cross-sectional study in which we used eye-tracking to measure visual attention to brand and health information on alcohol and soda containers. In study 2 (N = 120) we manipulated motivation to reduce drinking using an alcohol brief intervention (vs control intervention) and measured heavy drinkers’ attention to branding and warning labels with the same eye-tracking paradigm as in study 1. Then, in a separate task we experimentally manipulated attention by drawing a brightly colored border around health (or brand) information before measuring participants’ self-reported drinking intentions for the subsequent week. Results Study 1 showed that participants paid minimal attention to warning labels (7% of viewing time). Participants who were motivated to reduce drinking paid less attention to alcohol branding and alcohol warning labels. Results from study 2 showed that the alcohol brief intervention decreased attention to branding compared to the control condition, but it did not affect attention to warning labels. Furthermore, the experimental manipulation of attention to health or brand information did not influence drinking intentions for the subsequent week. Conclusions Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions. The lack of attention to warning labels, even among people who actively want to cut down, suggests that there is room for improvement in the content of health warnings on alcohol packaging.

Introduction The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. Material and Methods This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. Results We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. Conclusions Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low.

Background and Aims: The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country. Design Cross‐sectional survey. Setting: Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN. Participants: A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re‐contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US. Measurements Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content. Findings Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs [odds ratio (OR) = 1.58, P = 0.02], whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non‐daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P < 0.001). There were no significant differences in reports of noticing HWLs when comparing concurrent smokers and vapers with daily (OR = 1.62, P = 0.91) or non‐daily (OR = 1.15, P = 1.00) vapers. There were no significant differences by country in reporting that HWLs made them concerned about using NVPs. Daily vapers were less likely to report feeling concerned than concurrent users (OR = 0.11, P = 0.017). Among those who reported reading HWLs (n = 688), there was little evidence of differences in recall of the HWL content. Conclusions: Respondents in England, where health warning labels on nicotine vaping products are mandatory, were not significantly more likely to report having noticed such warnings than those in Australia, Canada and the United States where warnings are not mandatory. [ABSTRACT FROM AUTHOR]

• Health warnings with graphic images perceived as more effective than text-only health warnings. • Negatively framed warnings perceived as more effective than positively framed warnings. • Negatively framed warnings produced stronger negative emotions than positively framed warnings. • Positive message framing improved motivation to be healthy more than negative framing. Food product health warnings may be a valuable intervention strategy for helping reduce obesity rates and the negative health outcomes associated with consuming an unhealthy diet. Research into the efficacy of food product health warnings has shown promising effects on consumers' beliefs and behaviour, but existing research has typically featured a single or limited number of simple, text-only warnings. Two studies are presented that tested the influence of text-only and text-and-graphic, positively and negatively framed health warnings on perceived efficacy, negative affect and motivation to change behaviour. Using a between-subjects design, Study 1 found that negatively framed health warnings and text-and-graphic health warnings produced more negative emotional responses than positively framed and text-only health warnings. Study 2 then featured the highest rated message topics from Study 1. Using a within-subjects design, Study 2 found that participants rated text-and-graphic health warnings as more effective than text-only warnings, and negatively framed warnings as more effective than positively framed warnings, though all warning groups scored above the scale mid-point on perceived efficacy. Negatively framed warnings produced stronger negative emotional responses, while positively framed warnings produced stronger feelings of motivation to change behaviour. Results indicate that food product health warnings were perceived as capable of effectively promoting behavioural change. While negatively framed warnings were seen as most effective, positively framed warnings may also be effective, possibly through a different persuasive pathway. [ABSTRACT FROM AUTHOR]

INTRODUCTION The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. METHODS This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. RESULTS We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. CONCLUSIONS Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low. [ABSTRACT FROM AUTHOR]

Health warnings are a promising strategy for reducing consumption of sugar-sweetened beverages (SSBs), but uncertainty remains about how to design warnings to maximize their impact. Warnings already implemented in Latin America use nutrient disclosures, while proposed U.S. warnings would describe the health effects of consuming SSBs. We sought to determine whether warning characteristics influence consumers' reactions to SSB health warnings. A national convenience sample of U.S. adults (n = 1360) completed an online survey in 2018. In a factorial design, we randomly assigned participants to view SSB health warnings that differed in: 1) inclusion of health effects ("Drinking beverages with added sugar contributes to obesity, diabetes, and tooth decay"); 2) inclusion of a nutrient disclosure ("High in added sugar"); 3) inclusion of the marker word "WARNING;" and 4) shape (octagon vs. rectangle). The primary outcome was perceived message effectiveness (PME, range 1-5). PME was higher for warnings that included health effects (average differential effect [ADE] = 0.63, p < 0.001) or nutrient disclosures (ADE = 0.32, p < 0.001) compared to warnings without this information. However, adding a nutrient disclosure to a warning that already included health effects did not lead to higher PME compared to warnings with health effects alone. The marker "WARNING" (ADE = 0.21) and the octagon shape (ADE = 0.08) also led to higher PME compared to warnings without these characteristics (ps < 0.001). The same pattern of results held for the secondary outcomes, fear and thinking about harms. SSB health warnings may have more impact if they describe health effects, use the marker "WARNING," and are octagon-shaped. [ABSTRACT FROM AUTHOR]

Introduction: In 2016 the UK introduced standardised pack design regulations, limiting branding and aiming to increase the salience of health warnings. Existing evidence suggests that the effectiveness of pack design in focusing a smoker's attention toward warnings may depend on how much they smoke. Our study aimed to directly compare attention to branding and warnings between the pre-regulation and post-regulation packs in smokers, and to determine whether this was affected by the amount smoked, to assess the effectiveness of the new policies.Method: 47 adult smokers were recruited, including daily and non-daily smokers to ensure a wide range in cigarettes smoked per week. Eye movement data were recorded while images of cigarette packs were displayed sequentially on screen. Each trial presented one of two types of cigarette pack; pre-regulation packs with a text health warning, or post-regulation packs compliant with governmental guidance introduced in 2016, with plain branding and a combined pictorial and text health warning. Eye movement data were compared between packs, covarying the number of cigarettes smoked per week.Results: Eye movement analysis revealed that smokers attended more to health warnings and less to branding when looking at post-regulation packs compared with pre-regulation packs. These effects did not relate to number of cigarettes smoked per week.Conclusion: Standardised regulations for cigarette packs successfully direct smokers' attention away from branding, and towards health warnings, with no association with cigarettes smoked per week. This study adds to the growing body of evidence advocating broader uptake of similar packaging regulations. [ABSTRACT FROM AUTHOR]

Abstract Objectives: To assess the impact of plain packaging with larger graphic health warnings on perceptions of risk and prestige related to different cigarette brands among Aboriginal and Torres Strait Islander people in the Australian Capital Territory. We hypothesised that the changes would decrease perceptions that ‘some cigarette brands are more harmful than others’, and that ‘some brands are more prestigious than others’, and this would be stronger among participants aged ≤35 years, and among smokers compared with non‐smokers. Methods: Participants completed the survey prior to packaging changes, and were followed up 12 months later (n=98). Repeated measures ANCOVAs assessed perception changes. Results: Following plain packaging implementation, there was a significant reduction in perceptions that ‘some cigarette brands are more harmful than others’. There was no overall change in perceptions of prestige. However, there was a significant interaction for age. Analyses indicated a reduction in perceptions that ‘some cigarette brands are more prestigious than others’ among younger participants (p=0.05), but no change among older participants (p>0.20). There was no interaction for smoking status for perceptions of prestige, indicating smokers' and non‐smokers' perceptions did not differ on this measure. Conclusions: These findings provide support for the packaging changes.

The Labels Impact Index (LII) score is a tool to evaluate the impact of health warnings of tobacco products. This score was tested in France, Germany, the Netherlands and UK to measure the effectiveness of the text-only health warnings. The present study aims to propose an Italian version of this tool to support future researches on the health warning and to facilitate the comparison using the same questions. Four items are translated in Italian: salience, harm, quitting and forgo. The questionnaire includes one question for each item and a multiple-choice answer, to correspond a four/five-point scales, is available for each question. The LII score can vary from 0 to 28. An international standardized tool, as the LII score, is fundamental to compare the impact of health warnings in different countries and to enforce policies to oppose the tobacco epidemic.

Background Graphic health warning labels (HWLs) on tobacco product packaging have been identified by the World Health Organization (WHO) as a cost-effective policy intervention to warn consumers about the health risks of tobacco. Compliance with HWLs shields young individuals from tobacco marketing influences and exposes users to health warnings. Assessing compliance with health warning labels would provide insights into the state of law implementation. The study assessed health warning labels on tobacco packages as per the Cigarettes and Other Tobacco Products (COTPA) (Packaging and Labelling) Amendment Rules of 2020, specifically assessing their availability around educational institutions in Bhubaneswar, Odisha, India. Materials and methods From August 2022 to January 2023, a protocol was employed to collect information on the sale of tobacco products around educational institutions including packages of cigarettes, beedis, and smokeless tobacco (SLT) from Bhubaneswar City. Using multistage random sampling 18 schools were selected in Bhubaneswar City. Areas within 100 yards (91.44 meters) of each school were mapped using a map tool. All prospective tobacco vendors within 100 yards of each school were included in the study. The data on compliance with HWLs were summarized using descriptive statistics. The health warnings compliance assessment of the tobacco products available with the vendors was conducted using three major indicators, including analysis of the font content, size and element of the graphics, and textual health warnings. In addition, the surface area occupied by these warnings was measured using a calibrated ruler. Results Within 100 yards of 18 schools in Bhubaneswar city, 57 vendors were found selling tobacco. About 48 distinct brands and 791 unbranded tobacco products were identified from 2135 packets collected from 57 vendors. Out of the 48 branded product packets examined, 25 brands were for smoking (cigarettes, bidis), while 23 were for SLT products such as khaini, gutkha, and pan masala containing tobacco. Only six brands out of 17 cigarette packs complied with HWL provisions. None of the eight unique bidi packs and 302 unbranded bidi packs were compliant with any HWL compliance indicators. Other compliance-related issues included incomplete health warning labels, out-of-rotation pictorial health warnings, distorted printing (blurry, heavy tint, and faded), and split warnings. Conclusion Tobacco products were sold within 100 yards of educational institutions in clear violation of the COTPA Section 6 provisions. Furthermore, the tobacco products sold were also not in compliance with the health warning label laws under section 7 of COTPA. There is an urgent need for strict enforcement of the provisions relating to the ban on sale within 100 yards of educational institutions and health warning label rules in Bhubaneshwar., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Satpathy et al.)

The purpose of this compendium of recent research in this themed issue is to heighten awareness of eye-tracking methodology and its application in tobacco regulatory science to advance knowledge of consumer understanding of the diversity of advertising, marketing, and other communications about tobacco products. Eye-tracking provides an objective and direct measure of attention that cannot be obtained through self-reported measures. The 7 papers selected for this special issue contribute to scientific knowledge and this editorial provides a synthesis to help guide readers and offer insights for future eye-tracking research. These elegantly designed studies apply eye-tracking methods to 3 major topics related to tobacco products: health warnings, advertising, and constituent information. The application of eye tracking methodology to tobacco regulatory science research has the potential to increase understanding of the impact of tobacco communication and marketing on consumers. [ABSTRACT FROM AUTHOR]

Background: Conventionally, involuntary attentional capture by tobacco cues in smokers are seen as an implicit bias, operating independently of current search goals. Prominent attention research, however, has suggested that search goals can induce an involuntary attentional capture. In the current investigation, we tested whether appetitive and aversive smoking images affected attention through such a mechanism and whether there were group differences based on nicotine dependence.Methods: We instructed non-smokers (NS), occasional smokers (OS; low dependence), and nicotine-dependent smokers (NDS; moderate-high dependence), to hold search goals for either an aversive or appetitive smoking category, or a category of non-smoking images. These images were presented in a stream of briefly appearing filler images, while task-irrelevant distractors were presented outside the stream. Distractors could be aversive or appetitive smoking images or a category of non-smoking images. Therefore, in some conditions, the distractors matched the current category being searched for, while in others it was incongruent.Results: Task-irrelevant smoking distractors reduced target detection, compared to the non-smoking distractors, only when they were congruent with the specific category being searched for. There was no effect of either aversive or appetitive smoking distractors on performance when participants were searching for the non-smoking targets. Distractor interference did not differ between smokers and non-smokers.Conclusions: The results support a goal-driven mechanism underpinning involuntary attentional capture by smoking cues. These findings can be used to inform models of addiction and attention, and the display of health warnings. [ABSTRACT FROM AUTHOR]

Food product health warnings have been proposed as a potential obesity prevention strategy. This study examined the effects of text-only and text-and-graphic, negatively and positively framed health warnings on dietary choice behavior. In a 2 × 5 mixed experimental design, 96 participants completed a dietary self-control task. After providing health and taste ratings of snack foods, participants completed a baseline measure of dietary self-control, operationalized as participants' frequency of choosing healthy but not tasty items and rejecting unhealthy yet tasty items to consume at the end of the experiment. Participants were then randomly assigned to one of five health warning groups and presented with 10 health warnings of a given form: text-based, negative framing; graphic, negative framing; text, positive framing; graphic, positive framing; or a no warning control. Participants then completed a second dietary decision making session to determine whether health warnings influenced dietary self-control. Linear mixed effects modeling revealed a significant interaction between health warning group and decision stage (pre- and post-health warning presentation) on dietary self-control. Negatively framed graphic health warnings promoted greater dietary self-control than other health warnings. Negatively framed text health warnings and positively framed graphic health warnings promoted greater dietary self-control than positively framed text health warnings and control images, which did not increase dietary self-control. Overall, HWs primed healthier dietary decision making behavior, with negatively framed graphic HWs being most effective. Health warnings have potential to become an important element of obesity prevention. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the prevalence of smoking status (i.e., current, former and never) between the United States and Turkey in terms of age and gender, and examine how smoking rules and health warnings are associated with smoking status within and between the two countries. Methods: The study used data from the 2012-2013 National Adult Tobacco Survey (U.S. sample, N = 60,196) and the 2012 Global Adult Tobacco Survey (Turkey sample, N = 9,581). SAS PROC SURVEYLOGISTIC with a weighted variable was used to examine the associations between demographics (age, gender and education), smoking rules, health warnings, and smoking status within and between the two countries. Results: There was an 18% current smoking prevalence among U.S. sample, compared to 27% of the Turkey sample. The U.S. sample had a higher rate of former smoking compared to the Turkey sample (25% vs. 22%). In both countries, being older and male gender predicted former smoking while being younger and female gender predicted never smoking. Having seen a health warning, and not allowing smoking in the vehicle and home positively predicted former and never smoking status. Higher education predicted both smoking statuses in the U.S. only. Conclusions: It is important to work with partners particularly in low- and middle-income countries (e.g., Turkey) to combat the global tobacco epidemic. In both counties, cessation endeavors should emphasize a comprehensive understanding of smoking status in terms of smoking rules in personal spaces and health warnings. [ABSTRACT FROM AUTHOR]