Health warnings on plain packs do not promote quitting intention: results from two EMA studies

Abstract

Background. Fear-inducing warning labels on tobacco products are widely used, despite theory and experimental evidence suggesting that fear appeals are ineffective and may even cause denial, disengagement, or maladaptive behavior. Purpose. To examine effects of plain packaging health warnings on quitting intentions and its predictors in smokers’ everyday life. Methods. Two Ecological Momentary Assessment studies tested whether smokers report higher risk appraisals, self-efficacy, and quitting intentions immediately after seeing a warning compared to random times of the day (Study 1, n=33), and whether smoking from plain packs results in higher quitting intentions, risk appraisal, and self-efficacy than smoking from branded packs (Study 2, n=62). Findings. Encountering health warnings did not increase self-efficacy, risk appraisal or intention, however, self-efficacy and risk appraisal were predictors of intention. Discussion. Health warnings on plain packs seem inefficient in increasing quitting intentions, better messages focusing on self-efficacy are needed to make the most of plain packaging.