Towards optimal effectiveness of tobacco packaging communications: determinants and beliefs predicting smoking initiation and cessation

Abstract

Background: Although threatening health communications have been found to be ineffective or even backfire, they remain popular. Identifying alternatives to warning labels on tobacco packaging requires first identifying the determinants and beliefs that predict whether people start to smoke or successfully quit. The current literature synthesis provides this starting point for developing effective tobacco packaging communications. Methods: A query was entered into PsycINFO and MedLine. Hits were screened by two independent screeners in two rounds, and 114 hits were retained for extraction. Qualitative and quantitative results were extracted and integrated qualitatively or, where appropriate, meta-analysed with the R metafor package using random-effects models. Findings: Quantitatively, in addition to risk perception, a number of other predictors emerged, including self-efficacy, attitude, and subjective norm. In addition to quantitative evidence, a large number of beliefs that potentially predict smoking initiation and cessation were identified. Discussion: On the basis of the identified determinants and beliefs, tentative recommendations are made regarding specific theory- and evidence based communications on tobacco packaging. In addition, a list of beliefs requiring quantitative verification is presented to guide future research.