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The effects of tobacco-related health-warning images on intention to quit smoking among urban Chinese smokers

Objective: The purpose of this study was to explore the effects of different tobacco health-warning images on intention to quit smoking among urban Chinese smokers. The different tobacco health-warning images utilised in this study addressed the five variables of age, gender, cultural-appropriateness, abstractness and explicitness. Design: Participants were administered a questionnaire that contained 10 graphic anti-smoking images. Of the 10 images, two each represented the independent variables of age, gender, cultural-appropriateness, abstractness and explicitness. The dependent variable in this study was intention to quit smoking. Setting: A cross-sectional survey was conducted using face-to-face interviews with 699 residents of Hangzhou, China. The study focused on 202 of those residents who self-reported as smokers. Method: Data were collected using a multi-stage sampling design. A Likert-type scale was used to measure quitting intentions after viewing graphic health-warning images. Data analysis was conducted using SAS version 9.3, and paired Chi-square tests were performed to analyse the effect of different graphic tobacco health-warning images on intention to quit smoking among current smokers. Results: More than 50% of smokers studied reported they were interested in quitting smoking after viewing the graphic images. Images featuring children and women, real pictures of damaged lungs and pictures that were more explicit produced higher intentions to quit smoking than abstract, male-dominated or less explicit images. Conclusion: When designing tobacco-related health-warning images for mass media campaigns, utilising more explicit photos and photographs involving women and children is potentially most effective. These findings provide evidence that the Chinese government should consider when initiating future anti-smoking campaigns utilising such images. Furthermore, these images should appear on all cigarette packages replacing the current text-only warnings.