The effect of specific and rotating health warnings on smoking risk perception and quitting intentions: Evidence from China

Abstract

INTRODUCTION This study aims to investigate whether non-rotating, specific health risk messages on cigarette packaging could be a practical alternative to rotating health warnings to improve smokers' health risk perceptions and intentions to quit smoking. METHODS The study employs a cross-sectional randomized survey experiment conducted among 1700 adult smokers (aged ≥18 years) in China, with data collected using a snowball sampling method. Participants were randomly assigned to one of three groups: the control group (viewed standard packaging with a general health warning), the rotating health risk text group (exposed to four rotating disease-related warnings), and the reproductive health risk text group (focused on smoking’s impact on sexual health). After viewing the corresponding health warnings, participants reported their health risk perceptions and intentions to quit smoking, and responses to additional control variables. RESULTS Rotating health risk text warnings on cigarette packaging significantly increased participants' perceptions of cardiovascular (β=0.20; 95% CI: 0.05–0.35), digestive (β=0.22; 95% CI: 0.07–0.37), respiratory (β=0.17; 95% CI: 0.07–0.26), and reproductive system risks (β=0.21; 95% CI: 0.06–0.37), while the non-rotating reproductive health risk text warnings only significantly improved perceptions of reproductive system risks (β=0.18; 95% CI: 0.10–0.25). Both types of text warnings significantly increased smokers’ intentions to quit smoking (p≤0.001), indicating that non-rotating specific health risk warnings can be equally effective in promoting quitting intentions. CONCLUSIONS This study demonstrates that rotating health risk text on cigarette packaging offers comprehensive advantages in enhancing health risk perceptions. However, its effects on intentions to quit smoking are similar to those of non-rotating reproductive health risk warnings. These findings suggest that in contexts where implementing rotating warnings is challenging, non-rotating, specific health risk messages can serve as a feasible alternative to support the effective implementation of tobacco health warning policies.