Addiction Treatment Clients’ Reactions to Graphic Warning Labels on Cigarette Packs

• DOI: 10.1177/0022042617699196
• Date: 01 July 2017
• Author: Joseph Guydish,Noah Gubner,Anna Pagano,Catherine Henderson,Barbara Tajima,Deborah Yip
• Published date: 01 July 2017
• Subject Matter: Articles

https://doi.org/10.1177/0022042617699196

Journal of Drug Issues

2017, Vol. 47(3) 433 –447

© The Author(s) 2017

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DOI: 10.1177/0022042617699196

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Article

Addiction Treatment Clients’

Reactions to Graphic Warning

Labels on Cigarette Packs

Anna Pagano1, Noah Gubner2, Barbara Tajima2, Deborah Yip2,

Catherine Henderson2, and Joseph Guydish2

Abstract

Graphic warning labels (GWLs) on cigarette packs have been tested among diverse groups at

high risk for tobacco use. However, little is known about the effectiveness of GWL interventions

for persons with substance use disorders, whose smoking prevalence is 3 to 4 times that of the

general population. After a experimental study which exposed clients in residential addiction

treatment to GWLs for 30 days, we conducted five focus groups with trial participants (N =

33) to explore how exposure to the labels may have impacted their readiness to quit smoking.

Focus group interviews were analyzed thematically. Interviewees reported that GWLs were

more effective than text-based warnings for increasing quit intentions due to greater cognitive

and emotional impact. Male and female interviewees expressed gender-specific reactions to

the labels. Addiction treatment programs are a strategic site for GWL and other tobacco

interventions due to the tobacco-vulnerable populations they serve.

Keywords

addiction treatment, substance abuse, smoking cessation, graphic warning labels

Introduction

Graphic warning labels (GWLs) depicting the health risks of smoking are currently legislated for

use in over 100 countries worldwide (Campaign for Tobacco-Free Kids, 2017), but not in the

United States. Currently, U.S. cigarette packs bear only text-based warnings with messages

approved by the Surgeon General and the U.S. Food and Drug Administration (FDA). In the last

several years, the FDA has attempted to join other countries in implementing Article 11 of the

World Health Organization (WHO) Framework Convention on Tobacco Control (WHO, 2003),

which encourages the use of GWLs on tobacco products. The tobacco industry initially blocked

the FDA’s attempts, claiming that requiring them to use GWLs threatened their First Amendment

rights. In 2012, after a protracted legal battle, the U.S. Court of Appeals for the D.C. Circuit

tasked the FDA with demonstrating the effectiveness of GWLs (Public Health Law Center,

2016).

1Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA, USA

2Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA

Corresponding Author:

Anna Pagano, Research Scientist, Prevention Research Center, Pacific Institute for Research and Evaluation, 180

Grand Avenue, Suite 1200, Oakland, CA 94612, USA.

Email: apagano@prev.org

699196JODXXX10.1177/0022042617699196Journal of Drug IssuesPagano et al.

research-article2017