MOVING BEYOND FEAR: EXPLORING PERCEPTIONS OF THEORY-BASED GRAPHIC WARNING LABELS AMONG LOW-INCOME, URBAN SMOKERS
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Date
2014-08-28
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Johns Hopkins University
Abstract
Background: Research supports the greater impact of graphic warning labels than text-only labels on cessation behaviors; however, few studies have looked at the effectiveness of specific content. Evidence-based communication and behavioral theories and constructs—particularly efficacy beliefs, risk perceptions, and perceived similarity to characters—in label design might enhance their persuasiveness. Moreover, few studies have explored graphic warning labels among low socioeconomic status (SES) populations in the U.S. The aim of this dissertation was to develop and explore perceptions of theory-driven graphic warning labels among low-income smokers in Baltimore, Maryland.
Methods: From January-February 2014, qualitative interviews were completed with 25 low-income smokers, who were purposively sampled from a community-based population by age group (<40 versus ≥40 years) and gender. Participants were asked about their perceptions of the labels, perceived influence on efficacy beliefs, risk perceptions, and motivation to quit, and perceived similarity to the characters. Interview transcripts were coded using a deductive and inductive approach in Atlas.ti v.7, and data were analyzed using the framework method, a thematic analysis using a matrix structure for data reduction.
Findings: Efficacy messages in which participants vicariously experienced the characters’ quit successes were reported as most influential to self-efficacy beliefs, and viewing characters as role models for quitting was also reported as motivational for quitting. High threat labels were reported as increasing perceived risk from smoking and causing fear and worry about the risks, and these high risk perceptions and negative emotional reactions to the labels were reported as being very motivational. Findings also highlighted ways in which the characters and perceived similarity to characters might enhance or diminish the influence of labels on efficacy beliefs, risk perceptions, and motivation. Labels depicting negative effects from smoking were most often reported as motivational, compared to labels depicting the benefits of quitting, with some differences in reporting by participants’ quit attempt status.
Conclusions: This research contributed to the growing literature exploring graphic warning labels in the U.S. and suggested new approaches for the design of theory-based labels to promote cessation. It also contributed valuable information on perceptions of graphic warning labels among low SES populations.
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graphic warning labels, qualitative research, health communication theories, smoking cessation, low socioeconomic status individuals