Mannheim Institute of Public Health, Social and Preventive Medicine (MIPH), Mannheim Medical School, Heidelberg University, Mannheim, Germany.
Patient Educ Couns. 2012 Jan;86(1):77-83. doi: 10.1016/j.pec.2011.03.005. Epub 2011 Apr 8.
Placing a combination of a written warning and a graphic image on cigarette packaging (so called "pictorial warnings") is one of the WHO Framework Convention on Tobacco Control's most controversial recommendations. Our randomized controlled trial investigated if pictorial warnings lead to significantly higher motivation to quit, as compared to written warnings alone.
Four pictorial warnings were selected from the EU Commission's official image catalogue. Study arm 1 (44 adult smokers) viewed only the written warnings while study arm 2 (44 adult smokers) viewed the corresponding pictorial warnings. Self-affirmation was a second randomly manipulated factor, and nicotine dependence a quasi-experimental third factor. The main outcome measured was the motivation to quit, with fear intensity as one of the secondary outcomes.
Pictorial warnings were associated with a significantly higher motivation to quit. A pictorial warning was also associated with higher fear intensity. The effect of warnings appears to be independent of nicotine dependence and self-affirmation.
Nationwide implementation of pictorial warnings may be effective in increasing heavy smokers' motivation to quit.
Due to the fact that perceived vulnerability, response and self-efficacy are not more strongly affected by pictorial warnings this effect may turn out to be short-term.
在香烟包装上放置组合的书面警告和图形图像（所谓的“图片警告”）是世界卫生组织烟草控制框架公约的最具争议性的建议之一。我们的随机对照试验研究了图片警告是否会比单独的书面警告更能显著提高戒烟的动机。
从欧盟委员会的官方图像目录中选择了四个图片警告。研究臂 1（44 名成年吸烟者）仅查看书面警告，而研究臂 2（44 名成年吸烟者）则查看相应的图片警告。自我肯定是第二个随机操纵的因素，尼古丁依赖是准实验的第三个因素。主要测量的结果是戒烟的动机，恐惧强度是次要结果之一。
图片警告与更高的戒烟动机相关。图片警告也与更高的恐惧强度相关。警告的效果似乎独立于尼古丁依赖和自我肯定。
全国范围内实施图片警告可能会有效地提高重度吸烟者戒烟的动机。
由于感知脆弱性、反应和自我效能感没有受到图片警告的更大影响，这种效果可能是短期的。
