Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
PLoS One. 2013 Aug 7;8(8):e65533. doi: 10.1371/journal.pone.0065533. eCollection 2013.
The U.S. Food and Drug Administration (FDA) is working to introduce new graphic warning labels for cigarette packages, the first change in cigarette warnings in more than 25 years. We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age.
A national sample of 386 non-smoking American males ages 11-17 participated in an online experiment during fall 2010. We randomly assigned participants to view warnings using a 2 × 2 between-subjects design. The warnings described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette package warnings. Analyses tested whether age moderated the warnings' impact on risk perceptions and smoking motivations.
The warnings discouraged most adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings did (60% vs. 34% were "very much" discouraged, p<.001). Including an image had no effect on discouragement. The warnings affected several beliefs about the harms from smoking, and age moderated these effects. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They also believed that their true likelihood of experiencing any harm was lower than what an expert would say.
Our findings suggest that warnings focusing on lung cancer, rather than addiction, are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking. Including images on warnings had little effect on non-smoking male adolescents' discouragement or beliefs, though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels.
美国食品和药物管理局（FDA）正致力于为香烟包装引入新的图形警示标签，这是 25 年来首次对香烟警示语进行更改。我们试图研究这些警示语是否会降低参与者吸烟的意愿，并改变青少年男性对吸烟危害的认知，以及这些警示效果是否因年龄而异。
2010 年秋季，我们在全美范围内招募了 386 名 11-17 岁的不吸烟男性青少年，让他们参与一项在线实验。我们采用 2×2 的被试间设计，随机分配参与者观看仅使用文字或同时使用文字和欧洲香烟包装警示语中使用的图像描述吸烟危害（成瘾或肺癌）的警示语。分析检验了年龄是否会调节警示语对风险认知和吸烟动机的影响。
警示语劝阻了大多数青少年吸烟的意愿，但肺癌警示语比成瘾警示语更能劝阻他们（60%的人非常想戒烟，而 34%的人非常想戒烟，p<.001）。添加图像对劝阻效果没有影响。警示语影响了青少年对吸烟危害的几种看法，而年龄则调节了这些影响。青少年认为，吸烟成瘾比肺癌更容易想象，也更有可能发生在自己身上。他们还认为，自己实际遭受任何伤害的可能性低于专家所说的。
我们的研究结果表明，针对肺癌的警示语，而不是针对成瘾的警示语，更有可能劝阻青少年男性吸烟，并增强他们想象吸烟危害后果的能力。在 FDA 继续开发新的图形标签时，还需要对这一高危人群的图像警示语效果进行更多研究，因为目前警示语添加图像对不吸烟的男性青少年的劝阻效果或信念影响不大。
