%0 Journal Article
%T Does Adding Information on Toxic Constituents to Cigarette Pack Warnings Increase Smokers¡¯ Perceptions About the Health Risks of Smoking? A Longitudinal Study in Australia, Canada, Mexico, and the United States
%A David Hammond
%A Hua-Hie Yong
%A Isaac Lipkus
%A James F. Thrasher
%A James W. Hardin
%A Kamala Swayampakala
%A Kenneth Michael Cummings
%A Ron Borland
%A Yoo Jin Cho
%J Health Education & Behavior
%@ 1552-6127
%D 2018
%R 10.1177/1090198117709884
%X Background. Health warning labels (HWLs) on cigarette packs in Australia, Canada, Mexico, and the United States include varying information about toxic cigarette smoke constituents and smoking-related health risks. HWL information changed more recently in Australia, Canada, and Mexico than in the United States. Aims. To investigate whether smokers¡¯ knowledge of toxic constituents and perceived smoking-related risks increased after adding this information to HWLs and how knowledge of toxic constituents is associated with perceptions of smoking-related risks. Methods. Data come from a longitudinal, online cohort of 4,621 adult smokers surveyed every 4 months from September 2012 (Wave 1) to January 2014 (Wave 5) in Australia, Canada, and Mexico, with the United States being surveyed from Waves 2 to 5. Generalized estimating equation models estimated the association between perceived smoking-related risk at follow-up and prior wave knowledge of toxic constituents, adjusting for attention to HWLs, sociodemographics, and smoking-related characteristics. Results. Between 2012 and 2014, knowledge of toxic constituents increased in Australia, Canada, and Mexico (p < .001), but not in the United States. Higher levels of both attention to HWLs and knowledge of toxic constituents were associated with a higher perceived risk of smoking-related conditions at follow-up across all countries except for the United States. Conclusions. Our results suggest that information about toxic constituents on prominent HWLs not only increases smoker¡¯s knowledge of toxic constituents, but that it may also reinforce the effects of HWL messages about specific, smoking-related health outcomes
%K global health
%K health behavior
%K health communications
%K health promotion
%K smoking and tobacco use
%K tobacco control and policy
%U https://journals.sagepub.com/doi/full/10.1177/1090198117709884