Jebai Rime, Asfar Taghrid, Cano Miguel Ángel, Nakkash Rima, Schmidt Michael, Wu Wensong, Bursac Zoran, Maziak Wasim
Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.
Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA.
Nicotine Tob Res. 2024 May 22;26(6):764-770. doi: 10.1093/ntr/ntad223.
Pictorial health warning labels (HWLs) on waterpipe (WP) tobacco packages represent a better strategy for communicating the health risks associated with WP use and promoting quit intention than text-only. However, the mechanism by which these warnings lead to higher intentions to quit remains unknown.
This study explores how pictorial warnings versus text-only induces higher quit intention among a sample of young adult WP smokers in Lebanon. An online randomized cross-over experimental study was conducted in August 2021 among 276 young adult WP smokers who were exposed to two conditions: pictorial HWLs and text-only warnings on WP tobacco packages in random order. After each image, participants completed post-exposure assessments of health communication outcomes (eg, attention and negative affect). Using serial and parallel mediation analysis, we examined the role of attention, negative affect, cognitive elaboration, and perceived harm in mediating the relationship between exposure to HWLs and intention to quit.
Using serial mediation, exposure to pictorial warnings versus text-only was found to affect intention to quit through the following pathways: attention and negative affect, which accounted for 17.28% of the total effect, and through negative affect and cognitive elaboration, which accounted for 21.53% of the total effect. Results of parallel mediation showed that the indirect effect pathways via negative affect (β = 0.063; [95% bootstrap CI = 0.004 to 0.149]) and cognitive elaboration (0.047; [0.001 to 0.114]) were statistically significant.
The findings call on designing and implementing attention-grabbing, emotionally evocative, and cognitively persuasive pictorial warnings in Lebanon and other countries to curb WP tobacco smoking.
This is among the first experimental studies looking at multiple mediators underlying the effect of exposure to pictorial HWLs on intention to quit in a sample of current WP smokers in Lebanon. The findings showed that using attention-grabbing, emotionally evocative, and persuasive pictures with a clear textual warning is crucial to maximizing the impact of implementing WP-HWLs regulations in Lebanon and other countries to curb WP tobacco smoking.
水烟袋烟草包装上的图片健康警示标签（HWLs），相较于纯文字标签，是一种更好的传达水烟使用相关健康风险及促进戒烟意愿的策略。然而，这些警示导致更高戒烟意愿的机制仍不明确。
本研究探讨在黎巴嫩的年轻成年水烟吸烟者样本中，图片警示与纯文字警示相比，如何引发更高的戒烟意愿。2021年8月，对276名年轻成年水烟吸烟者进行了一项在线随机交叉实验研究，他们被随机分为两种情况：水烟袋烟草包装上的图片HWLs和纯文字警示。在每次展示图片后，参与者完成对健康传播效果（如注意力和负面影响）的暴露后评估。通过序列和并行中介分析，我们检验了注意力、负面影响、认知加工和感知危害在介导接触HWLs与戒烟意愿之间关系中的作用。
通过序列中介分析发现，接触图片警示与纯文字警示相比，通过以下途径影响戒烟意愿：注意力和负面影响，占总效应的17.28%；以及负面影响和认知加工，占总效应的21.53%。并行中介分析结果表明，通过负面影响（β = 0.063；[95%自抽样置信区间 = 0.004至0.149]）和认知加工（0.047；[0.001至0.114]）的间接效应路径具有统计学意义。
研究结果呼吁在黎巴嫩和其他国家设计并实施引人注意、唤起情感且具有认知说服力的图片警示，以遏制水烟袋烟草吸烟。
这是首批研究接触图片HWLs对黎巴嫩当前水烟吸烟者样本戒烟意愿影响背后多种中介因素的实验研究之一。研究结果表明，使用引人注意、唤起情感且具有说服力的图片并配以清晰的文字警示，对于在黎巴嫩和其他国家实施水烟袋HWLs法规以遏制水烟袋烟草吸烟的影响最大化至关重要。
