TY - JOUR
T1 - How the New European Union's (Pictorial) Tobacco Health Warnings Influence Quit Attempts and Smoking Cessation
T2 - Findings from the 2016-2017 International Tobacco Control (ITC) Netherlands Surveys
AU - van Mourik, Dirk-Jan A.
AU - Candel, Math J. J. M.
AU - Nagelhout, Gera E.
AU - Willemsen, Marc C.
AU - Yong, Hua-Hie
AU - van den Putte, Bas
AU - Fong, Geoffrey T.
AU - de Vries, Hein
N1 - Funding Information:
Funding: This work was supported by the Dutch Cancer Society (KWF Kankerbestrijding; grant number UM 2014–7210). Additional support was provided to Geoffrey T. Fong from a Senior Investigator Award from the Ontario Institute for Cancer Research and a Prevention Scientist Award from the Canadian Cancer Society Research Institute. The funders had no role in the design, analysis, preparation, or decision to publish the manuscript.
Publisher Copyright:
© 2019 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - In 2016, the Netherlands was required to introduce new European Union (EU)'s (pictorial) tobacco health warnings. Our objective was to describe the pathways through which the new EU tobacco health warnings may influence quit attempts and smoking cessation among Dutch smokers. Longitudinal data from 2016 and 2017 from the International Tobacco Control (ITC) Netherlands Survey were used. Smokers who participated in both surveys were included (N = 1017). Structural equation modeling was applied to examine the hypothesized pathways. Health warning salience was positively associated with more health worries (beta = 0.301, p <0.001) and a more positive attitude towards quitting (beta = 0.180, p <0.001), which, in turn, were associated with a stronger quit intention (health worries: beta = 0.304, p <0.001; attitude: beta = 0.340, p <0.001). Quit intention was a strong predictor of quit attempts (beta = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (beta = 0.166, p <0.001), which directly predicted quit attempts (beta = 0.141, p = 0.048). Quit attempts were positively associated with smoking cessation (beta = 0.453, p = 0.043). Based on these findings, we posit that the effect of the EU's tobacco health warnings on quit attempts and smoking cessation is mediated by increased health worries and a more positive attitude and perceived social norms towards quitting. Making tobacco health warnings more salient (e.g., by using plain packaging) may increase their potential to stimulate quitting among smokers.
AB - In 2016, the Netherlands was required to introduce new European Union (EU)'s (pictorial) tobacco health warnings. Our objective was to describe the pathways through which the new EU tobacco health warnings may influence quit attempts and smoking cessation among Dutch smokers. Longitudinal data from 2016 and 2017 from the International Tobacco Control (ITC) Netherlands Survey were used. Smokers who participated in both surveys were included (N = 1017). Structural equation modeling was applied to examine the hypothesized pathways. Health warning salience was positively associated with more health worries (beta = 0.301, p <0.001) and a more positive attitude towards quitting (beta = 0.180, p <0.001), which, in turn, were associated with a stronger quit intention (health worries: beta = 0.304, p <0.001; attitude: beta = 0.340, p <0.001). Quit intention was a strong predictor of quit attempts (beta = 0.336, p = 0.001). Health warning salience was also associated with stronger perceived social norms towards quitting (beta = 0.166, p <0.001), which directly predicted quit attempts (beta = 0.141, p = 0.048). Quit attempts were positively associated with smoking cessation (beta = 0.453, p = 0.043). Based on these findings, we posit that the effect of the EU's tobacco health warnings on quit attempts and smoking cessation is mediated by increased health worries and a more positive attitude and perceived social norms towards quitting. Making tobacco health warnings more salient (e.g., by using plain packaging) may increase their potential to stimulate quitting among smokers.
KW - pictorial health warnings
KW - smokers
KW - quit attempts
KW - smoking cessation
KW - structural equation modeling
KW - CIGARETTE
KW - LABELS
KW - IMPACT
KW - PREDICTORS
KW - BEHAVIOR
U2 - 10.3390/ijerph16214260
DO - 10.3390/ijerph16214260
M3 - Article
C2 - 31684033
SN - 1660-4601
VL - 16
JO - International Journal of Environmental Research and Public Health
JF - International Journal of Environmental Research and Public Health
IS - 21
M1 - 4260
ER -