Miller

(Miller, Hill, Quester, & Hiller, 2011) studied an approach to assess the significance of graphic health warnings (GHW) on cigarette packets, on smoker’s beliefs and attitudes and smoking behavior and intentions. In 2006 Australia announced graphic health warnings (GHW) on cigarette packets, illustrating a range of tobacco associated pathology. This intervention, monitoring the attractiveness of a consumer product, was designed to raise consumers’ awareness of the ills of tobacco use, motivate quitting, and discourage uptake of smoking. A sample of 587 smokers were recruited and baseline data collected as a part of an annual cross-sectional survey of the South Australian population through an arbitrary representative population survey carried out in 2005, preceding the introduction of new warnings. A subset of 158 was surveyed a year later. The results indicate that GHW-related beliefs and attitudes were predicting intention to quit smoking. Intentions to quit were, in turn, predictive of quitting behavior as measured in the follow up period. The new GHW warnings smokers were exposed to, were also linked with changes in beliefs over time. Approximately, one in five of the participants quit smoking between the baseline and the follow-up surveys, those with stronger intentions to quit smoking at baseline were more probable to go onto quit smoking at follow-up than other smokers. follow-up than other smokers. Taken together, these findings affirm the relevance of Fishbein and Ajzen’s (2010) model in predicting quitting intentions and behavior, generally, and the importance of smokers’ attitudes in predicting quitting, via the mediator of intentions.

(Cunningham & Kyle, 1995)researched upon the plain packaging legislation being considered by governments in Canada which would require the removal of all attractive aspects of tobacco packaging and standardize the size, color, depiction in brand name, material and opening methods. Evidence was provided by four empirical studies that plain packaging would reduce the use of tobacco products. The package itself is a means of advertising; an increasingly essential form of jurisdiction such as Canada where media advertising has been banned but tobacco company sponsorships continue. Plain packaging can eliminate the positive imagery and attractiveness of the brand and can break the association between the brand and the sponsorship promotions. Although the tobacco industry has put forth counter arguments opposing plain packaging- citing everything from job losses in printing and packaging industry, infringement of trade laws, to increase in cross-border smuggling etc. However, plain packaging as yet remains an untried tobacco control tool with great potential.

(Rousu, Marette, Thrasher, & Lusk, 2014) wrote a paper estimating the value of two different health warning labels(HWL) for cigarette packages relative to the current US labeling policy. A number of countries require prominent pictorial HWLs on the front and back of cigarette packages. In the US, pictorial HWLs have been adopted, but tobacco industry litigation has delayed their implementation. This intervention could have value to smokers, if it increases their information and changes their smoking behavior. In this research 146 smokers from four cities took part and experimental auction with these smokers were held in grocery stores. The researchers focused on an approach to valuing information with a surplus measure that couples willingness-to-pay(WTP) from non-hypothetical experimental auctions with time-series revealed preference demand estimates. It was found that a pictorial HWL has a large value to smokers, and a higher value than a label that only contains text, as to changing purchase behavior. According to results, there was no significant effect on the participants from these labels. These are the participants who offer the same sum for packs of cigarettes with altered labels. This outcome should be predictable, as some smokers are knowledgeable about the dangers of smoking. Furthermore, others may simply not be apprehensive enough to change their buying behavior by seeing a pictorial label. Moreover, about 10% of smokers increased their WTP for the cigarettes with the pictorial label. One justification for this behavior may be that participants had an anti-paternalist response to the exposed information. Thus, the pictorial label actually enhanced this group of smokers’ demand for cigarettes. The outcomes of this study confirm that a pictorial label on cigarettes delivers significant value to smokers. The pictorial label on packages has an advantage as, if pictorial labels are used instead of taxes, these labels have the advantage of not financially harming the low-income smokers who would not change their cigarette consumption even when presented the additional information. It also would avoid negative side-effects of smokers switching consumption to contraband cigarettes, which are becoming more popular in states with high cigarette taxes like New York (Kress, 2013).

(Strahan, White, Fong, Fabrigar, Zanna, & R., 2002) carried out a study to outline the social psychological principles influencing the psychological and behavioral impact of tobacco warning labels so to inform the development of more effective tobacco warning labels. Tobacco warning labels represent a potentially effective method of influencing attitudes and behaviors. Research indicated that a persons attitude towards smoking is not the opposite of his attitude towards quitting. A person may have a negative attitude towards smoking and believe its unhealthy and dangerous yet continues to smoke as his attitude towards quitting is even more negative. Hence according to this research warning labels should focus more on the positives of quitting. Moreover, subjective norms and social approval within our reference groups tend to have a strong influence on health behavior. Therefore labels such as “85% of families want their loved ones to quit smoking” or “Smoking causes bad breath and yellow teeth” can be effective. Also, people with high self-efficacy who believe they can change their behavior can succeed which can be incorporated in the labels. Social psychological research has indicated benefits of assessing relevant mediators of smoking behavior and how subtle techniques can reduce the demand characteristics. Theory and research in social psychology offers a set of principles that could be used in order to develop more effective tobacco warning labels having a larger impact on smokers.
(Borland, et al., 2009) wrote a research paper to examine the impact of health warnings on smokers by comparing the impact of new warning labels in 4 counties: Australia, United States, United Kingdom and Canada. Countries vary substantially in terms of health warning mandate; for instance the US has had a small text based warning on one side of the cigarette pack since 1984. The UK introduced larger warnings in 2003 increasing the size from 6% on the front and back to 30% on the front and 40% on the back. Australia introduced new graphic warnings from March 2006. Which went from six black text on white background warnings that covered 25% of the front and 33% back of the pack to seven graphical warnings that covered 30% of the front and 90% back. Canada has had graphic warnings that cover 50% of both faces since December 2000. This research was carried out on a sample of 17,773 in the aforementioned countries annually in five waves: 2002-2006. It aimed to measure pack warning salience(reading and noticing); cognitive responses(thoughts of harm and quitting) and two behavioral responses: forgoing cigarettes and avoiding the warnings. All four factors of impact increased significantly midst Australian smokers subsequent to the introduction of graphic warnings. Researchers stimulated more cognitive responses than the UK (text only) changes, and were avoided more, did not significantly increase forgoing cigarettes but were read and noticed less. The finding also show partial wear out of both graphic and text only warnings but the Canadian warnings have more sustained effects than UK ones. Warning size increases warning effectiveness and graphic warnings may be superior to text based warnings. While there is partial wear out in the initial impact associated with all warnings, stronger warning tends to have longer lasting effects.

(Shiffman, Pillitteri, Burton, Rohay, & Gitchell, 2001) carried out a study to test the effect of three health messages focusing on vent holes, sensory impact of Light and Ultra-Light cigarettes or health concerns of smoking on beliefs and quitting intentions. The research was carried out in a random telephonic survey with a sample of 2120 participants :Regular(46%), Light (39%) and Ultra Light (15%). The respondents were made to hear one of the three messages. The effects of these messages, beliefs and quitting intent was then assessed pre and post message deliverance. Beliefs were summarized on three factors: Safety(reduced health risk), Delivery(lower tar and nicotine content) and Sensation(less harsh). The message that focused on smokers’ sensory perceptions of Light and Ultra Light cigarettes resulted in the most positive change in beliefs about safety, delivery and intent to quit and was particularly effective among those who believed the cigarettes to be less harsh. The impact was most pronounced among young adults and smoker of Light and Ultra Light brands who endorsed their sensory benefits. Addressing smokers sensory experience of Light and Ultra Light being less harsh may be a promising strategy to change their misconceptions about these cigarettes and encouraging interest in quitting. Media counter advertising campaigns focusing on sensory aspects of these cigarettes may play and essential part in tobacco control efforts.
(Hastings, Gallopel-Morvan, & Rey, 2008) highlight the significance of cigarette packaging in creating a distinctive brand image stimulating purchase and repeat purchase of the product. Large scale research in the UK shows that even after branding was banned in the 2004in UK it still continues to drive up teen smoking and the awareness of package designs is a key element in this ongoing marketing. Package designs are often made to distract attention from the health warnings. The UK government has put forth a proposal to mandate plain packaging for cigarettes which would remove all distinctive signs from the packs and include the brand name in a standard color and font and the legally mandate health warnings.

(Koval, L, Pederson, O'Hegarty, & Chan, 2005) examined the perception of young Canadian adults between 20-24 years who participating in a 10 year longitudinal study- about the graphic warning labels being used on cigarette packages in Canada and their potential to prevent smoking or encourage quitting. A sample of 1267 smokers participated from which 35.6% were males who were more likely to smoke than females (30.4%). Among the several focus groups carried out in this study one set of Canadian adolescents who smoked (16-21 years) said they did not even read the warning label of the cigarette packs but were aware of their existence. Almost all participants said the labels did not motivate them to quit. Non-smokers were in agreement with the warning labels. Moreover, the results revealed that current smokers were less probable than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting. Despite the efforts of developing the warning labels some young adults were skeptical about their effects. Modified warning labels according to target issues that are relevant to younger adults; gender differences can play an essential role. Warning labels can however offer to provide health information in the tobacco control program.

(Kees, Burton, Andrews, & Kozup, 2006) carried out three studies using smokers from United States and Canada in order to examine the impact of specific graphic visuals warnings on cigarette packs in context to United States verbal warnings. According to the WHO Public Health Treaty, warning information on cigarette packs may be presented in either text or pictures and must take up a minimum of 30% package display area. Given these changes in treaty the study focused on the impact of only text, only pictures and the combination of both on cigarette pack in the three forced exposure studies. Study 1 focused on young adults who were current smoker, and studies 2 and 3 examined adult female smokers residing in US(in which visual warnings are not used) and Canada(in which visual warnings are used). The findings indicate that the inclusion of graphic visual warnings such as those used in Canada and warning statements as used in IS can decrease the perceived attractiveness of the cigarette packs and create high levels of negative effect, fear and anxiety. The results also revealed that the addition of visual warnings to the US statements increases smokers’ perceived intentions to quit smoking compared to warning statements alone.

(Willemsen, 2005) in his study examined the self-perceived impact of newly introduced health warnings on the attractiveness of cigarettes, smokers’ motivation to quit and smoking behavior. All European Countries were required to have the new health warnings on the cigarette packs as of September, 2004. The research consisted of cross-sectional study consisting of 3937 Dutch adult smokers. The findings highlighted that 14% of the respondents became less inclined to purchase the cigarette packs because of the new warnings, 31.8% preferred to purchase the pack without the new warnings. 17.9% smokers responded that the new warnings increased their motivation to quit and 10.3% said their smoking had reduced. There was a significant does-response relationship noticed between these effects and the intention to quit. The new warning labels made the cigarette packages less attractive especially to those who already intended on quitting smoking.