Testing the impact of pictorial warning on cigarette packs on initiation of smoking and quitting intentions in a tobacco control policy void

Tobacco use is the leading cause of morbidity and mortality worldwide. In Lebanon, estimates suggest that 35% of adult women and 46% of adult men smoke cigarettes. The Framework Convention for Tobacco Control (FCTC) has set out guidelines for policy change to promote tobacco control, including the implementation of large pictorial health warnings on tobacco products. Evidence suggests that pictorial warnings are more effective than text warnings. Cultural/contextual factors within a country also influence the effectiveness of particular warnings. This research intends to test various pictorial warnings with three target populations in Lebanon. The current warning on cigarette packs in Lebanon is very small, general in nature, and on the side of the pack. Youth in schools (13-18 years) and university (19-25 years), as well as adults (26-65 years) were shown the current text warning and two other pictorial warnings one at a time and asked to complete a survey inquiring about the effectiveness of the message and its impact on tobacco use behavior. Preliminary results indicate that smokers and non smokers evaluated the effectiveness of specific warnings differently, as did different agegroups. The pictorial indicating long term effects on the lungs was perceived to be most effective by smokers of school and university age. Detailed results will be shared and comparisons of impact of different warnings made by gender, age, and smoking status. The results of this study will inform policy makers and suggest the most effective pictorial warnings to implement when Lebanon adopts a comprehensive tobacco control law.