Plain packaging- can we do better than grisly images? : Effects of plain packaging and efficacy beliefs on smoking behavior and cognitions amongst individuals with high and low levels of education

This study sought to assess whether including efficacy messages alongside graphic health warning labels on cigarette packaging would reduce smoking behavior or increase the cognitive mediators of smoking (risk perceptions, self-efficacy and intentions to quit). This was based on the Extended Parallel Process Model, which states both risk perceptions and efficacy beliefs must be heightened in order to encourage behavior change (Witte, 1992). It was also assessed whether these effects would differ by level of education, as those with lower education often report lower self-efficacy in quitting (Siahpush et al., 2006). Using a randomized controlled trial with forty-six current smokers who had no initial intention to quit smoking, participants either smoked from the current packaging or the modified packaging for a period of three weeks. 2x3 ANOVAs were conducted on each of the hypotheses and found that the modified labels were capable of evoking risk perceptions but not self-efficacy. However, when education was included as a factor (in a 2x2x3 ANOVA) self-efficacy was heightened, but only for individuals with higher levels of education. This suggests that these particular labels may need further modification to be considered relevant for those with lower levels of education (Mead et al., 2016).