Disease familiarity and believability inform pictorial health warning ineffectiveness, among rural male smokers in the Philippines
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Ateneo de Manila University, Quezon, Philippines
Kaye Bernice Siao   

Ateneo de Manila University, Quezon, Philippines
Publication date: 2019-10-12
Tob. Induc. Dis. 2019;17(Suppl 1):A49
The Philippines continues to have one of the highest tobacco burdens in Asia and Southeast Asia. Only in the last decade were substantial tobacco control policy reforms implemented to address this public health issue, such as the enactment of the Graphic Health Warnings (GHW) Act in 2014 that requires at least 50% GHWs in tobacco product packages through 12 discrete pictograms changed biennially. However, despite a 5-year implementation, no systematic study has been conducted regarding GHWs and local contexts to inform pictorial selection or evidence-based policy amendment. This qualitative study examined why smokers continued to smoke despite the presence of GHWs using the Fear Appeals Theory. Explanation-building and thematic analysis were utilized after semi-structured interviews of qualified respondents. Adult males with at most a high school education, from barangay Urdaneta, Magallanes, Cavite (population = 2,092) were selected by chain-referral sampling and interviewed until data saturation (n = 44). Respondents found GHWs “ineffective” because of their “inability to go against their impulse to smoke” and their “disbelief” on GHWs. Respondents viewed GHWs as “a hoax meant to scare them”, “unrealistic,” and “untrue” because they did not personally observe or know about the GHW disease state depicted. This is more pronounced for unfamiliar diseases such as gangrene and emphysema. “More familiar” diseases like those involving the heart and lungs elicited better responses on GHW believability. This study highlighted the importance of integrating a cognitive dimension to GHW policy to counteract nicotine addictiveness and increase its role in smoking cessation support, especially among similar cohorts. This serves as an early evidence that depicting “more familiar” diseases, in contrast to exclusively “shocking” images, could improve the health literacy goal of GHWs.