The role of theory-driven graphic warning labels in motivation to quit: a qualitative study on perceptions from low-income, urban smokers
Creators: name: Mead, Erin L.
name: Cohen, Joanna E.
name: Kennedy, Caitlin E.
name: Gallo, Joseph
name: Latkin, Carl A.
Publisher: name: Digital Repository at the University of Maryland
Year: 2015
Subjects: Graphic warning labels
Health communication
Behavioral theories
Smoking cessation
Motivation
Low-income adults
Qualitative research

description: Background: Use of communication theories in the development of pictorial health warning labels (graphic
warning labels) for cigarette packaging might enhance labels’ impact on motivation to quit, but research has been
limited, particularly among low socioeconomic status (SES) populations in the U.S. This qualitative study explored
perceptions of theory-based graphic warning labels and their role in motivation to quit among low-income
smokers.
Methods: A cross-sectional qualitative study was conducted with 25 low-income adult smokers in Baltimore,
Maryland, who were purposively sampled from a community-based source population. Semi-structured, in-depth
interviews were conducted from January to February 2014. Participants were asked about the motivational impact
of 12 labels falling into four content categories: negative depictions of the health effects of smoking to smokers
and others, and positive depictions of the benefits of quitting to smokers and others. Data were coded using a
combined inductive/deductive approach and analyzed thematically through framework analysis.
Results: Labels depicting negative health effects to smokers were identified as most motivational, followed by
labels depicting negative health effects to others. Reasons included perceived severity of and susceptibility to the
effects, negative emotional reactions (such as fear), and concern for children. Labels about the benefits of quitting
were described as motivational because of their hopefulness, characters as role models, and desire to improve
family health. Reasons why labels were described as not motivational included lack of impact on perceived
severity/susceptibility, low credibility, and fatalistic attitudes regarding the inevitability of disease.
Conclusions: Labels designed to increase risk perceptions from smoking might be significant sources of motivation
for low SES smokers. Findings suggest innovative theory-driven approaches for the design of labels, such as using
former smokers as role models, contrasting healthy and unhealthy characters, and socially-oriented labels, might
motivate low SES smokers to quit.
description: The data collection was supported by the National Institute on Drug Abuse at
the National Institutes of Health and the Food and Drug Administration Center
for Tobacco Products (grant numbers R01DA032217-04 and R01DA032217-04S);
and by the National Institute of Allergy And Infectious Diseases at the National
Institutes of Health, The Johns Hopkins Center for AIDS Research (grant number
1P30 AI094189). The agencies were not involved in any technical aspect of the
study. Funding for Open Access provided by the UMD Libraries Open Access
Publishing Fund.