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Table 7 Perceived harm outcomes

From: The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions

No. Author(s), publication year Group Perceived risk OR or Beta Measures
Pre Post
1 Anshari et al., 2018 Australia 0.22 (0.03 to 0.40) 0.36 (0.09 to 0.63) NA Negative affect: “How much does this warning make you feel worried about the health risks of smoking?”
Canada 0.06 (−0.08 to 0.20) 0.03 (−0.23 to 0.28) NA
Mexico 0.00 (−0.14 to 0.15) −0.25 (−0.47 to 0.02) NA
2 Borland et al., 2009* Australia 1.68 2.04 NA Cognitive responses combined two questions: “Extent to which the warnings both made the respondent think about the health risks of smoking” and “made them more likely to quit smoking”
UK 1.95 1.81 NA
Canada 1.93 1.84 NA
3 Brewer et al., 2016 NA 3.3 (0.9) 3.4 (0.9) NA Combined three perceived harm questions: “What is the chance that you will one day get cancer if you continue to smoke cigarettes?”, “What is the chance that you will one day get heart disease if you continue to smoke cigarettes?” and “What is the chance that you will one day get a permanent breathing problem if you continue to smoke cigarettes?”
4 Brewer et al., 2019 NA 0.04 (−0.04, 0.13) 0.03 (−0.05, 0.11) NA Perceived likelihood of harm from smoking combined 3 questions: “What is the chance that you will one day get cancer if you continue to smoke cigarettes?”, “What is the chance that you will one day get heart disease if you continue to smoke cigarettes?” and “What is the chance that you will one day get a permanent breathing problem if you continue to smoke cigarettes?”
5 Cho et al., 2018 Australia 1.14 1.22 NA “Indicate which illnesses, if any, are caused by smoking cigarettes (emphysema, heart attacks, bladder cancer, blindness, impotence in male smokers, gangrene, hepatitis, and diseases that lead to amputation)” and ‘Their own chance of getting the disease in the future to the chance of a nonsmoker if they continue to smoke the amount that they currently do’
Canada 1 1.22 NA
Mexico 1.25 1.26 NA
7 Elton-Marshall et al., 2015 NA 6.90% 11.80% NA “To what extent, if at all, do the health warnings on cigarette packs make you more likely to think about the health risks (health danger) of smoking?”
8 Fathelrahman et al., 2010 NA 8 (11.6%) 20 (29.0%) NA “To what extent, if at all, do the health warnings on the cigarette pack designs make you more likely to quit smoking”
9 Fathelrahman et al., 2013 NA 3.6 (1.9) 3.8 (2.0) NA Cognitive reactions combined two measures: “thinking about health risk because of them (think-harm)” and thinking about quitting because of them (think-quit)”
10 Glock & Kneer, 2009 NA 5.50 (2.05) 4.67 (1.63) NA Pre health warning viewing: Six smoking-related and six non-smoking-related diseases were rated between 0 (no risk of developing disease) and 9 (highest risk of developing disease). Post health warning viewing: rated another 12 diseases under the same conditions
11 Gravely et al., 2016a NA 31.5% 43.3% OR: 1.66 “To what extent do the health warnings make you think about the dangers from smoking?”
12 Gravely et al., 2016b NA 15.0 (95% CI 11.9; 18.8) 17.5 (95% CI 12.1; 24.6) NA Cognitive reactions two questions: “To what extent, if at all, do the warning labels on smokeless tobacco packages make you more likely to think about the health risks (health danger) of using it?” and “To what extent, if at all, do the warning labels on smokeless tobacco packages make you more likely to quit using it?”
13 Green et al., 2014 NA 24.50% 41.80% OR: 2.47 (95% CI = 1.87–3.26) “To what extent, if at all, do the warning labels make you think about the health risks of smoking”
14 Green et al., 2019 Blindness 14.70% 36.70% NA “based on what you know or believe, does smoking cause (stroke, impotence, bladder cancer and blindness)” Note: blindness, bladder cancer and addiction were chosen because they were the new messages added to health warning labels
Bladder Cancer 26.80% 44.00% NA
Addiction 90.50% 89.60% NA
15 Hall et al., 2018 NA 3.3 (0.9) 3.55 (0.63) NA Perceived likelihood of harm combined 3 questions: “What is the chance that you will one day get heart disease if you continue to smoke cigarettes?”, “What is the chance that you will one day get cancer if you continue to smoke cigarettes?” and “What is the chance that you will one day get a permanent breathing problem if you continue to smoke cigarettes?”
16 Hitchman et al., 2014* NA NA NA Log OR: −0.320 (×2 = 5.45) “To what extent, if at all, do the warning labels make you think about the health risks of smoking”
17 Kasza et al., 2017 Canada NA NA OR: 1 (CI 1.00 to 1.01) Concern/ risk reasons: “concern for personal health”, “setting example for children” and “concern for health of others”
Australia NA NA OR: 1.01 (CI 1.00 to 1.01)
18 Kennedy et al., 2012 Australia (Waves 1–7) 50.1 69.5 NA ‘I am going to read you a list of health effects and diseases that may or may not be caused by smoking cigarettes. Based on what you know or believe.’ This statement was followed by possible health effects, including, ‘does smoking cause blindness?’
Australia (Wave 8) 69.5 57.5
19 Li et al., 2015 NA 2.1 1.9 NA Cognitive response combined 3 questions: “made them think about the health risks of smoking”, “made them more likely to quit smoking” and “if ‘warning labels on cigarette packages’ motivated them to think about quitting in the past 6 months”
20 Li et al., 2016 Thailand 0.49 (0.06) 0.61 (0.06) NA Cognitive response combined 2 questions: “made them think about the health risks of smoking” and “made them more likely to quit smoking”
Malaysia (Waves 2–4) 0.07 (0.06) 1.01 (0.06) NA
Malaysia (Waves 4–6) 1.01 (0.06) 0.47 (0.06) NA
21 Mannocci et al., 2019 NA 11.6 (2.5) 14.6 (1.8) NA “Identify tobacco related illnesses (from a list of 20 diseases)”
22 Mays et al., 2014 NA 2.2 (1.1) 3.5 (1.3) NA Perceptions of warnings “warnings convey risks”
23 McQueen et al., 2015 NA 146 (79%) 158 (86%) NA “Made them think about the health risks of smoking”
24 Nagelhout et al., 2016 UK NA NA OR: 1.34 Cognitive responses combined 3 questions: “To what extent, if at all, do the warning labels make you think about the health risks of smoking?”, “To what extent, if at all, do the warning labels on cigarette packs make you more likely to quit smoking?” and “In the past 6 months, have warning labels on cigarette packages led you to think about quitting?”
France NA NA OR: 0.7
25 Ngan et al., 2016 NA 12.7 18.8 NA “Do you worry about the health consequences of smoking?”
26 Nicholson et al., 2017 NA 35 38 NA “Very worried that smoking will damage your health in future”
27 Osman et al., 2016 NA NA NA b = 0.23, SE = 0.03, p < .001 “To what extent, if at all, do the health warnings make you think about the health risks of smoking?”
28 Parada et al., 2017* NA 3.2 (mean) 3.1 NA two questions: “In the last week, how often did you think about the harm your smoking might be doing to you?” and “In the last week, how often did you think about the harm your smoking might be doing to other people?.”
29 Partos et al., 2013* Australia (Waves 4–6) 1.89 2.42 NA “To what extent, if at all, do the warning labels make you think about the health risks of smoking”
Canada (Waves 2–6) 2.46 2.4 NA
UK (Waves 2–6) 2.49 2.07 NA
30 Popova & Ling, 2014 NA 6.86 7.57 NA Two questions: ‘In your opinion, how harmful is … (moist snuff, snus, e-cigarettes) to general health?’ and ‘In your opinion, to what extent does … cause cancer?’
31 Schneider et al., 2012 NA NA NA 18.59 (6.31) Motivation to quit was assessed with four items: What extent the warnings induced them to: “consider ceasing their cigarette consumption”, “consider reducing their cigarette consumption”, “think about the health risks associated with smoking” and “refrain from smoking a cigarette at the moment”
32 Swayampakala et al., 2014 Australia 62.83 65.5 NA “To the best of your knowledge, indicate which illness (emphysema, heart attacks, bladder cancer, blindness, impotence in male smokers, gangrene and hepatitis (non-smoking related disease), if any, are caused by smoking cigarettes?” Note: percentages of the six risks were averaged for pre and post result
Canada 56.5 61 NA
Mexico 55.5 55.3 NA
33 White et al., 2008 Experimental smoker 69.6 79 NA Agreed or disagreed that smoking caused a number of different illnesses or harms (disease in toes and fingers, mouth cancer, clogs arteries, emphysema, leading cause of death). Note: percentages of the five risks were averaged for pre and post result
Established smoker 67.4 78.4 NA
34 Yong et al., 2013 NA 30.9 (2.14) 48.3 (2.16) NA “To what extent, if at all, do the health warnings make you think about the health risks (health danger) of smoking?”
35 Yong et al., 2016 NA 1.82 1.95 NA Cognitive reactions combined 3 questions: “To what extent, if at all, do the warning labels make you think about the health risks of smoking?”; “To what extent, if at all, do the warning labels on cigarette packs make you more likely to quit smoking?”; “In the past 6 months, have warning labels on cigarette packages led you to think about quitting?”.
  1. *Results generated online from web plot digitize