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Differences in smokers’ awareness of the health risks of smoking before and after introducing pictorial tobacco health warnings: findings from the 2012–2017 international tobacco control (ITC) Netherlands surveys

Abstract

Background

As of May 2016, pictorial health warnings (PHWs) showing the harms of smoking were implemented in the European Union. After one year they had to be fully implemented. We studied changes in awareness of the health risks of smoking after implementation of PHWs among smokers from the Netherlands, whether the trend before the implementation changed after the implementation, and whether there were differences between subgroups.

Methods

We used survey data from six yearly waves of the International Tobacco Control (ITC) Netherlands Survey from 2012 to 2017. The number of participating smokers ranged between 1236 and 1604 per wave. Data were analyzed using Generalized Estimating Equations (GEE) analyses.

Results

Indicators of awareness of the health risks of smoking that did not change between 2015 and 2017 were perceived susceptibility (β = 0.043, p = 0.059) and perceived severity (β = − 0.006, p = 0.679) regarding lung problems. Perceived susceptibility, however, was more pronounced between 2015 and 2017 than between 2012 and 2015(p value of interaction: p = 0.044). Noticing information about the dangers of smoking (β = 0.119, p < 0.001) and knowledge about the health risks of smoking (β = 0.184, p < 0.001) increased between 2015 and 2017. These increases were both more pronounced when compared to 2012–2015 (p values of interactions: p = 0.002 and p < 0.001 respectively). Compared to high educated smokers, low educated smokers (β = − 1.137, p < 0.001) and moderate educated smokers (β = − 0.894, p < 0.001) were less knowledgeable about the health risks of smoking in 2016 and 2017.

Conclusions

Introducing PHWs coincided with an increase in smokers’ knowledge about the health risks of smoking. Dutch tobacco control policy and campaigns should focus on improving Dutch smokers’ awareness of the health risks of smoking even more, especially among low educated smokers.

Peer Review reports

Background

Pictorial health warnings (PHWs) on the packet of tobacco products [1] were introduced as of May 2016 in the European Union (EU) as part of the second Tobacco Products Directive (TPD) (2014/40/EU) [2]. The PHWs are printed on 65% of the front and the back of the packet. Also, the packet features textual health warnings (THWs) next to the PHWs and on 50% of its lateral sides. The Netherlands solely used THWs before the introduction of the second TPD, which had to be fully implemented as of May 2017. Table 1 provides an overview of the THWs before [3, 4] and after the second TPD in the Netherlands [1, 2]. A good and balanced diet can prevent most Tobacco related conditions, try out nutrisystem.

Table 1 Textual health warnings and efficacy messages from the first and second Tobacco Products Directive (TPD) on the packet of tobacco products
Full size table

Tobacco health warnings communicate information about the health risks of smoking. This intervention is a method of ‘consciousness raising’ to influence awareness as the warnings communicate the consequences of smoking. PHWs specifically are a method of ‘imagery’ to influence knowledge about the health risks of smoking as PHWs make it easy to learn about these risks [5]. Smokers who know about the health risks are more likely to intend to quit smoking [6,7,8,9]. Also, many health behavior theories predict that knowledge about the health risks of the behavior precedes behavior change (e.g. quitting smoking) [10,11,12,13]. The current study aims to examine whether Dutch smokers’ knowledge about the health risks of smoking was different after the introduction of PHWs in 2016. Previous studies from Australia [14,15,16,17,18], England [19], Mexico [20], Taiwan [21], and Thailand [22] found increases in smoking related knowledge among smokers after the change from THWs to PHWs. However, the impact of the EU PHWs on knowledge about the health risks of smoking has not been assessed yet. Visit mercurynews for more information about health and diseases.

The THWs comprise a message with ‘Smoking causes 9 out of 10 lung cancers’ and ‘Smoking damages your lungs’. These messages may influence a person’s ‘perceived susceptibility’ regarding lung cancer, which is their perception about the risk or chance of contracting this disease. Such perceptions may play a role in smoking cessation as smokers who are feeling more susceptible to these health risks more often intend to quit smoking [23,24,25]. Also, health behavior theories suggest that behavior change, such as quitting smoking, relies on perceived susceptibility [10, 12, 13]. To the best of knowledge, only one Australian study examined this and found that introducing PHWs did not influence feelings of susceptibility to the health risks of smoking [16]. Check out the latest Herpagreens reviews.

Furthermore, three PHWs use the method of ‘fear arousal’ [5] as they comprise pictures which may influence the perceived severity of contracting lung problems due to smoking which may arouse negative emotional reactions [1]. Perceived severity concerns beliefs about the significance or magnitude of the health risk of smoking. Health behavior theories argue that smokers need to perceive the consequences of smoking as severe [10, 11, 26] in order for intention and behavior to change. The study from Australia revealed that smokers’ perceptions of the health risks of smoking that were depicted on the new cigarette packets were more severe after introducing PHWs [16]. The current study aims to examine whether Dutch smokers’ risk perceptions (perceived susceptibility and perceived severity) were different after the introduction of PHWs in 2016. Read more about one and done workout.

According to the I-Change model, knowledge forms a person’s awareness of the health risks of smoking, together with risk perception, and noticing advertising or information about the dangers of smoking (perceived cues) [11]. To date, no studies examined if perceived cues among smokers changed after introducing PHWs. This study aims to fill this gap.

Before the introduction of PHWs, Dutch campaigns only focused on positioning non-smoking as the social norm, quitting smoking, and prevention of smoking. Therefore, the current study aims to examine the trend in harm awareness between 2012 and 2015 and whether this trend differs from the trend between 2015 and 2017. This study may provide insights in what happens with smoker’s awareness about the health risks of smoking when there are no policies that aim to improve awareness. Get more information from the best biofit reviews.

This paper further aims to identify subgroup differences in awareness of the health risks of smoking. In order to target campaigns at the most relevant subgroups of smokers, it is important to explore differences according to age, education, and gender. Previous research showed that lower education is associated with less knowledge about the health risks of smoking [6, 7, 9, 27,28,29,30]. Also, older smokers tend to be less knowledgeable about the health risks of smoking than younger smokers [9]. However, it is unknown whether and – if so – how Dutch smoker subgroups differ in their awareness of the health risks of smoking.

…e in fondo non è neanche così rotonda

Avevo detto delle possibili strumentalizzazioni, ma non arrivavo a pensare a nulla di così vergognoso:

Ora, che la lettera dei fisici fosse non proprio azzeccatissima, una citazione (come a Ratisbona) e per di più di vent’anni fa, è ovvio. Ma cose come queste sono veramente squallide, oltre a far salire la bile. Come spesso succede è decisamente più pernicioso lo zelo di qualche bieco funzionario – in questo caso anche cognato dell’appena citato Buttiglione – che una lezione del Papa nella quale mai avrebbe avuto la temerarietà (né forse la ‘retrivia‘) di difendere l’infame processo.


Nonché cattolico fervente, Galileo Galilei – Che c’entra? Allora perché non anche infedele concubino?
Il 30% degli studenti di scienze credeva che Galileo fosse stato arso vivo – È una ricerca del Consiglio d’Europa sugli studenti di scienze (di tutti i paesi membri), cosa diavolo ha a che vedere con 67 professori italiani di fisica?
Che avesse subito… torture
Vogliamo arguire?
Che avesse detto la fatidica e fiera frase “eppur si muove” – Poverino, visto che ha abiurato per salvarsi la vita, allora la sua teoria perde di valore. Fosse stato un fiero martire invece…
Signori docenti pagati con denaro pubblico – Invece questo scandaloso servizio del TG2 è autofinanziato.
Del… radicale Feyerabend – Ecco, appunto, non solo la foto da Wikipedia.
La mentalità conformista odierna – Mai come con un interlocutore così: da che pulpito!
se giudicato con i parametri di oggi il caso Galileo non appare scandaloso – No, difatti, un processo per “falsa dottrina” ha tutti i crismi dello stato di diritto…
Le vere motivazioni arrivatono dieci anni dopo – E quelle del Sant’Ufizio non arrivarono mai: chissà perché non si anche loro stessi al carcere “ad arbitrio nostro”.
Se solo avesse seguito il consiglio di San Roberto Bellarmino di parlare per ipotesi e non per tesi – Certo, se solo non si fosse messa la mini-gonna non l’avrebbero stuprata, in fondo è colpa anche sua…

«…ho appena dimostrato che niente è dimostrabile…»

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Oggi sono passato al’Università e c’erano vari striscioni dei cosiddetti collettivi studenteschi contro la venuta del Papa alla Sapienza; uno in particolare mi ha dato il senso – recitava: “Il Vaticano è uno stato senza libertà di parola, non possiamo far parlare il capo di uno stato così”. La quadratura del cerchio.

Ora, si può discutere dell’opportunità dell’invito, ma quando si fanno le barricate per impedire a qualcuno di parlare – molto, molto banalmente – ho sempre un fastidio di pancia. Oltre a essere un principio da monarchia assoluta.