Cigarette Plain Packaging Perceptions on Intent to Abstain ... Narumon_ Nithat… · Narumon Auemaneekul * Dusit Sujirarat Pimpan Silpasuwan Pratana Satitvipawee* Chukiat Viwatwongkasem***

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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)

J Public Health 2019; 49(2): 155-169

Article info: Received August 10, 2018; Revised April 1, 2019; Accepted April 4, 2019.

Correspondence:NarumonAuemaneekul.DepartmentofPublicHealthNursing,FacultyofPublicHealth,

MahidolUniversity.Bangkok10400,THAILAND.E-mail:[email protected]

* DepartmentofPublicHealthNursing,FacultyofPublicHealth,MahidolUniversity

** DepartmentofEpidemiology,FacultyofPublicHealth,MahidolUniversity

*** DepartmentofBiostatistics,FacultyofPublicHealth,MahidolUniversity

**** DepartmentofHealthEducationandBehavioralSciences,FacultyofPublicHealth,MahidolUniversity

*****DepartmentofPublicHealthAdministration,FacultyofPublicHealth,MahidolUniversity

Cigarette Plain Packaging Perceptions on Intent to Abstain

from Smoking among Thai Female Youth

Narumon Auemaneekul* Dusit Sujirarat** Pimpan Silpasuwan* Pratana Satitvipawee***

Chukiat Viwatwongkasem*** Malinee Sompopcharoen**** Nithat Sirichotiratana*****

ABSTRACTThisstudyexaminedtheetiologicalmodelof

cigaretteplainpackagingperceptiononintentiontoabstain fromsmokingamongThai female youth.Thetestedhypothesisproposedthattheconstructsof perception on plain packaging, perceived susceptibilityandseverityofsmokingconsequencesandfeararousalfromsalienthealthwarningswillpredictintenttoabstainfromsmoking.Structuralequationmodeling(SEM)wasusedtoanalyzethedataandvariableswereassessedusingself-reportquestionnaires.MultistagestratifiedrandomsamplingwasusedtoselectsubjectsfrombothhighschoolsandvocationalschoolsinBangkok.Randomsamplingof15-to24-year-oldfemaleswasusedtorecruitatotalof438subjects.Thesamplesizeincludednonsmokers(86.3%),formersmokers(5.48%)andsmokers(8.22%).TheSEMshowedagoodfittothedata(χ2=1.060,df=2,P-value=0.589,CFI=0.999,TLI=0.999andRMSEA<0.001,SRMR=0.005).Inthe

SEMshowedthatsmokersandformersmokerhadsignificantly negative associations with intent toabstain(β=-0.49and-0.087,p<0.001and0.026)whileperceivedseverityandfearappealweresignificantlypositiveassociationwithintenttoabstain(β=0.237and0.124,p<0.001and0.003).Nonetheless,SEMrevealed that the effect of perception on plainpackaging,perceivedseverityandageofsmokerandformersmokersubjectsonintenttoabstainwaspartlymediatedbyfeararousalfromsalienthealthwarnings.Inaddition,theeffectofsmokersonintenttoabstainwasalsopartlymediatedbyperceivedseverity. Thisinformationcouldbeusefulin designing interventions to promote abstinencefromsmokingamongfemaleyouthandadvocatingand implementing the plain packaging policy inThailand.

Keywords:cigarette plain packaging, smoking abstinence,femaleyouths,perception

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Journal of Public Health Vol.49 No.2 (May-Aug 2019)

IntroductionA strong health warning graphic on

tobaccopackagesisasignificantsourceof

healthinformationforsmokersandnonsmokers.

TheWorldHealthOrganization(WHO)and

FrameworkConventiononTobaccoControl

(FCTC)indicatedthatplainpackagingpolicy

ismost likely tobe effective in removing

brandimages,reducingappealtotheproduct

andmakinghealthwarningsmoreprominent.1

Moreover, communication theory suggests

thatpacksdeprivedofcolororplaincigarette

packswillincreasetheprominenceofHealth

Warning Labels (HWLs) and decrease the

attractivenessofbrandimages.2Supportfor

plainpackagingderivesfromthebeliefthat

tobaccoproductssoldinplainpackscould

reduce appeal and so aremore likely to

deteryouthandnonsmokers,fromstarting

tobacco use and more likely to motivate

smokerstoquitandstayquit.

Thailandhasareputationasacountry

thathassuccessfullyimplementedcontroland

monitoringpoliciesandmeasurescontinuously

directedatpreventingsmokingdangers.Under

the conditions of a total advertising ban,

packagingdesignsserveasenormouscrucial

communication tools to restrict promotion of

brandimage,althoughonlycolorfulpackages

are available in the market in Thailand.

However, Thailand began to use pictorial

healthwarningssince2005andsixwarning

pictureswererotatedoncigarettepackages.

Fromthenon,Thailandhasupdatedhealth

warningsregularly.In2009,thelastrotation

withanewrotationof tenhealthwarning

picturesincludedababyexposedtosmoke,

smoke home ban, disapproving look of

smokingsmellfromgirls,heartattack,lung

cancer, mouth cancer, pulmonary disease,

laryngealcancer,strokeandcausingdeath.3

Globally around 40% ofmen smoke

compared with around 9% of woman.

However,theepidemicoftobaccouseamong

woman is increasing. More research is

needed to understand trends in tobacco use

amongwomen.WHOconductedasurveyof

smokingtrendsamongyouth,andtheresults

showedthatonehalfof151countriessurveyed

indicatedsimilarnumbersofboysandgirls

whosmoked.Evidencesuggestedthatmost

ofthesegirlsandboyswillcontinuetosmoke

untiladulthood.Therefore,studyingintention

nottosmokeisprivileged.Manygirlsbelieve

thatsmokingcouldcontrolweight;moreover,

lowself-esteemisdeemedonefactorrelated

to smoking among girls. In addition, the

tobaccoindustrymarketingcampaigntowards

womenfalselylinkstobaccousetotheconcept

ofbeauty,prestige,andfreedom.Alarming

reportsfromWHOshowedthateveryyear,

1.5millionwomendiefromtobaccouseand

notedanincreasedwoman’sriskforcancer

of the cervix. Unless prompt actions are

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taken,tobaccousedcouldkillupto2.5million

womeneveryyearby2030.4

The Global Youth Tobacco Survey2

reportedthatThaiyouthsmokersstartsmoking

at11yearsoldandthefemaleyouthsmoker

ratehasbeenincreasing.Presently,Thailand’s

MinistryofPublicHealth(MOPH)istaking

plainpackagingintoaccount.Acurrentdraft

of the Tobacco Consumption Control Act

(TTCA)issettorecommendmorerestrictions,

includingthegovernmentimposingthedesign

oftobaccoproductpackagingandfacilitating

theintroductionofplainpackaginginThailand

to raise health concerns from tobacco use

amongsmokersandnonsmokersespecially

amongfemaleyouthsmokersasnewtarget

consumers.6Femaleyouthsmokingprevention

and cessation continues to be an important

highlight for public health and consumer

welfare.Featuressuchastype,pictureand

HWLsontobaccopackagesareimportant

indirectandindirectoutcomesofcounter-

persuasiveefforts.Onerecentstudyhasshown

thatplainpackagingwouldservetoboost

theallureofsmokingamongyouth,asitcould

clearlypresenthealthwarningpicturesand

warningsonthepackage.7However,littleis

knownabouthowfemaleyouthinterpretHWLs

withplainpackaging.Therefore,understanding

femaleyouthperceptionsonplainpackaging

would be important and useful to further

drivepolicyinThailand.

Inthisstudy,innovativecigaretteplain

packageproductionwasintroducedtofemale

youthparticipants.Itincludedfourcolorson

covers:plaingreen,darkbrown,blackand

off-whitebox.Theselectedpicturescomprised

lungcancer,mouthcancer,laryngealcancer,

facialcancer, footgangreneandapicture

ofababyexposetosmoke.

Literature5 showed that health and

disease-basedanti-smokingimagesevoked

feelingsofdisgustandsympathyamongyouth

subjects,whichappearedtobesufficientto

reducefuturesmokingintentions.Empirical

studiesregardingsocialandhealthpsychology

theorieshavealsoindicatedthat“fearappeals”

areeffectiveinmotivatingchangeofhealth

behavior,e.g.,quitting,becausefearisinfluenced

bynegativehealthbeliefsofpeopleabout

smokingwhichisultimatelyincreasingthoughts

ofquitting.

Therefore,self-administeredquestionnaires

wereemployedtoaskquestionsrelatedto

packaging with the aim of examining the

etiologicalmodelofcigaretteplainpackaging

perceptionconcerningtheeffectonintention

toabstainfromsmokingamongThaifemale

youth.Thetestedhypothesisproposedthat

theconstructsofperceptiononplainpackaging,

perceivedsusceptibility,perceivedseverityof

disease or consequences of smoking and

feararousalofsalienthealthwarningswill

predictsmokingabstinenceintention.

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MethodResearch DesignThestudyemployed

apredictivedesignwherecorrelationsand

Structural Equation Modeling (SEM) were

employedtodeterminecorrelationsbetween

measuresandintenttoabstainfromsmoking.

The population:Thestudywasconducted

inschoolsandcollegesinBangkoktogether

with four provinces from four regions of

Thailand,fromJulytoAugust2012.

The participants: Subjectsfromallsettings

wererecruitedandvoluntarilyparticipatedin

the program by criteria measurement of

secondaryschoolandcollegepopulations.

Thesubjectswererecruitedusingmultistage

stratifiedrandomsamplingfromfourprovinces

representingfourregionsofThailand(north,

northeast,centralandsouth).Later,twoschools

ineachregionwereselectedbysimplerandom

sampling.Ineachschool,oneclasswiththe

sampleage15-to24-year-oldfemaleyouths

wasselected.Atotalof438femaleyouths

were recruited using the criteria of one

variableper30subjects.Thesamplesize

included those who nonsmokers 86.3%,

smokers8.22%andformersmokingfemales,

5.48%.

Research instrument: The innovative

cigaretteplainpackproduction(mock-ups)

includedfourcolorsoncovers:plaingreen,

darkbrown,blackandoff-white.Fiftypercent

ofhealthwarningpicturescoveredbothsides

of the pack. Six of the selected health

warningpictureswerelocatedonthefront.

Eachcigarettepackwastypedinastandard

fontwithoutlogoorbrand.Thecontentsand

cigarette plain pack designs used as a

stimulus agent were identical (Figure 1).

Self-administeredquestionnaires,developed

byresearchers,comprisingsevenparts,were

used to collect data. The questionnaires

includeddemographiccharacteristics,smoking

status,perceptiononplainpackaging,perceived

susceptibilityandperceivedseverityofdisease,

fear arousal and intention to abstain from

smoking.Eachquestionwasassignedmultiple-

choice responses and the participants were

asked to select one single response. All

responsesweremeasuredonathree-point

scalerangingfrom1(yes),2(unsure)to3

(untrue).Regardingtheintentiontoabstain

from smoking, the scaled responseswere

scored from 1 to 10 on a continuum with 1

“notatallhavingconfidencetoabstain”to

10“fullyhavingconfidencetoabstain”.The

validityofquestionnaireswasexaminedby

threeexpertsandinstrumentreliability(intention

toabstainfromsmoking)wastestedamong

20studentsresultinginanalphaCronbach

coefficientof.80.

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Figure 1 Cigaretteplainpackagingmock-ups

Data collection: The research was

reviewedandapprovedbytheEthicsReview

CommitteeforHumanResearch,Facultyof

PublicHealth,MahidolUniversity,No.MUPH

2012-180.Allparticipantsandtheirparents

werefullyinformedandsignedconsentwas

obtained before participation.

Data analysisData Analysis and Statistics Used in

the Research

Data was analyzed using SPSS for

Windows,Version18.0.

Statistics used in the analysis are

described below.

1.Descriptivestatisticsandrelationship

wereemployedbetweenmeasuresandintent

to abstain.

2.SEMwasconductedafterallassump-

tionsweremet toexamineandverify the

etiologicalmodelofcigaretteplainpackaging

perceptionconcerningtheeffectonintentto

abstainfromsmokingamongThaifemaleyouth.

The tested hypothesis proposed that the

constructsofperceptiononplainpackaging,

perceivedsusceptibility,perceivedseverityof

disease or consequences of smoking and

feararousalofsalienthealthwarningswould

predictintenttoabstainfromsmoking.

ResultsTheresultshowedthatthemajorityof

female youth were aged from 15 to 17,

followedby18to20yearsold.Onaverage,

thesubjects’agewasapproximately17years.

Theoldestwas23andtheyoungestwas

13(Table1).

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Eventhoughnonsmokingfemaleyouth

werefoundtocomprisethemajorityrateof

86%,thestudyrevealedaformersmoking

rateof6%andsmokingrateof8%(Table1).

Theserateswerenearlyequaltothesurvey

conducted by the Global Youth Tobacco

revealingthefemaleyouthsmokingrateof

10%washigherthantheGYTSinThailand

indicatingonly2.3%.

Table 1Generalcharacteristicsofparticipants(n=438)

Variable Number PercentageAge

<1515-1718-20>20

Mean=16.58yearsoldSD=2.00ป

822221259

Min-max=13-23yearsold

18.750.728.52.1

SmokingstatusNonsmokersSmokers

Formersmokers

3783624

86.38.225.48

FearLow

ModerateHigh

Mean=7.82SD=2.02106145187

Min-max=1-1024.2033.1142.69

SeverityLow

ModerateHigh

Mean=28.94SD=3.521642376

Min-max=12-333.699.6886.64

Susceptibility(n=435)Low

ModerateHigh

Mean=15.45SD=2.353272331

Min-max=7-187.3616.5576.09

PerceptiontopackageLow

ModerateHigh

Mean=28.97SD=5.15106145187

Min-max=14-3824.2033.1142.69

IntentionsofabstainingLow(1-8)High(9-10)

Mean=9.29SD=1.7653385

Min-max=1-1012.1087.90

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TheSEMresultsshowedagoodfitof

data revealing that former smokers and

smokersweresignificantlynegativeassociation

withintenttoabstainwhileperceivedseverity

andfeararousalfromplainpackagingwere

significantlypositiveassociationwithintent

toabstain.However,theSEMresultsrevealed

thattheeffectofperceptiononplainpackaging,

perceivedseverity,age,smokersandformer

smokerwerepartlymediatedbyfeararousal.

Inaddition,theeffectonsmokerswasalso

partlymediatedbyperceivedseverity and

fear arousal concerning intent to abstain

(Figure2andTable2).

Figure 2Structural EquationModeling (SEM) of intent to abstain from smoking among

femaleyouth

Note:eversmk=Formersmokers,c-m=currentsmokersorSmokers,

sum_sus=susceptibility,int_nosm=intenttoabstainfromsmoking

Fitstatistics:chi-square=1.060df=2p=0.589,RMSEA<0.001;CFI=0.999;TLI=0.999;

SRMR=0.005

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Table 2Resultofdirecteffects(DE),indirecteffects(IE)andtotaleffects(TE)ofintention

toabstainfromsmoking

DV IV

DE IE TE

β P-value β P-value β P-value

Susceptibility

Severity

Perception

Age

Smokers

Formersmokers

0.421

0.099

0.059

-0.067

-0.101

<0.001

0.044

0.198

0.147

0.036

-

0.124

0.004

-0.022

-0.135

-

<0.001

0.871

0.353

<0.001

0.421

0.224

0.063

-0.089

-0.236

<0.001

<0.001

0.221

0.085

<0.001

Intentto

abstain

Susceptibility

Fear arousal

Severity

Perception

Age

Smokers

Formersmokers

0.074

0.124

0.237

-

-

-0.087

-0.493

0.098

0.003

<0.001

-

-

0.026

<0.001

0.002

-

0.046

0.125

-0.009

-0.032

-0.114

0.810

-

<0.001

<0.001

0.610

0.075

<0.001

0.076

0.124

0.282

0.125

-0.009

-0.119

-0.607

0.094

0.003

<0.001

<0.001

0.610

0.005

<0.001

Fear arousal

Susceptibility

Severity

Perception

Age

Smokers

Formersmokers

0.013

0.110

0.275

-0.148

-0.110

-0.172

0.810

0.053

<0.001

0.002

0.022

0.001

-

0.006

0.035

-0.017

-0.024

-0.092

-

<0.001

<0.001

0.356

0.179

<0.001

0.013

0.115

0.310

-0.165

-0.134

-0.264

0.810

0.042

<0.001

0.001

0.008

<0.001

Severity

Perception

Age

Smokers

Formersmokers

0.296

0.049

-0.017

-0.206

<0.001

0.322

0.737

<0.001

-

-0.022

-0.020

-0.063

-

0.166

0.200

0.001

0.296

0.027

-0.037

-0.269

<0.001

0.602

0.476

<0.001

Perception

Age

Smokers

Formersmokers

-0.074

-0.068

-0.214

0.154

0.190

<0.001

-

-

-

-

-

-

-0.074

-0.068

-0.214

0.154

0.190

<0.001

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DiscussionThisresearchofferedevidenceofhow

femaleyouthareappraisingandinterpreting

HWLsonplainorregularpacksandexplored

howdominantappraisalsmayaffectHWLs,

playingacrucialroleinyouths’perceptions

offeararousalandintenttoquitsmoking.

The HWLs on plain packaging stimulated

increasedintentionnottosmokeamongfemale

youth. Irrespective of smoking experience,

pack image perceptions became more

negativeovertimewithplainpacksenhancing

HWLspicturestobemoreobviousthanon

company-brandedpacks.However,thisstudy

revealed that former smoker and smoker

female youth were significantly negative

associationwithintenttoabstain,meaning

theHWLspicturesonplainpackagingcould

notevokefearconcerningthenegativehealth

consequences among female youth who

smokedorformersmoking.Thismighthave

beenbecausethosesubjectswerealready

familiarwithHWLspictures than thoseof

nonsmokers.Theyfeltnofearregardingthe

HWLspicturesastheyperceivedtheyhad

noeffectonthem.Thisresultwassupported

byNymanetal.4reportingthathealth-based

warningmessagesdidnotnecessarilyevoke

fearofexperiencingnegativehealtheffects

withadeterrenteffectonyouth.However,

healthanddisease-basedanti-smokingimages

mayelicitfeelingsofdisgustandempathy

amongasampleofnonsmokerfemaleyouth,

which could be sufficient to lower future

smokingintentions.8

However,theresultofthisstudyrevealed

perceived severity and fear arousal were

significantlypositiveassociationwithintentto

abstain.Nonetheless,theeffectofperception

onplainpackaging,perceivedseverity,age,

smokersand formersmokerson intent to

abstainwaspartlymediatedbyfeararousal

fromsalienthealthwarnings.Inaddition,the

effectofsmokersonintenttoabstainwas

alsopartlymediatedbyperceivedseverity.

Thus,itcouldbeinferredfromtheresultsthat

HWLsonplainpackagingcouldeffectively

motivatethebeliefsoffemaleyouthtoregard

smokingasapotentialhealthrisk.HWLscould

activateemotionalreactionssuchasfearor

worrybyfemaleyouthbecausetheyperceived

seriousadversehealthconsequences from

cigarettesmokingandthatguidedthemto

protectivebehaviorssuchascurbingorquitting

smoking.Thiswascongruentwith“Health

BehavioralModels”ofhealthbehavioralchange

thatsetindicatorssuchassmokingstatus,

perceptiononhealthwarning,perceiveddisease

susceptibility,perceiveddiseaseseverityand

feararousal,combinedinapredictiveequation

to explain behavioral intent and change.

Therefore, thisstudyconfirmedthathealth

warningpicturesoncigarettepackageswere

strongly associated with intent to abstain

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amongfemaleyouth.

Fear has been shown to be the most

compelling emotional persuader in relation

tobehavioralresponsestoaphysicalthreat.9

This effect is likely heightened when the

behavior is performed by the individual

observingtheHWLsonplainpackaging,that

is,personalvulnerabilitytoathreatbasedon

smokingbehaviorsleadstogreaterpersuasion

toavoidsmoking.10ThemodelinFigure2

suggestedthattheeffectofperceptionon

plain packaging, perceived severity, age,

smokersand formersmokerson intent to

abstainwerepartlymediatedbyfeararousal

fromsalienthealthwarningsamongfemale

youth.Inaddition,theeffectofsmokerson

intenttoabstainwasalsopartlymediated

by perceived severity and fear arousal to

intenttoabstainforfemaleyouth.HWLsmay

notdirectlyaffectintenttoquitsmokingbut

had an indirect effect through fear. The

proposedindirectandtotaleffectofsmoker

statusthroughemotionalresponsetoperceived

susceptibleriskswassupportedbytheHealth

BeliefModelTheoryandfindingsrelatedto

theunderlyingmechanismsofhowHWLson

plainpackaginginfluencessmokers’intentions

toquit.11,12,13Therefore,feararousalfrom

HWLs on plain packs could be effective

messagestoconvincefemaleyouthtorefrain

fromsmoking.Fearisthedominantmediator

resulting in changed behavior in quitting

smoking,includingempiricalandtheoretical

support that intent to quit brings about

realaction.Thiswasalso in linewiththe

semiotictheoryexplainingthatHWLsonplain

packagingcoulddirectlyandindirectlypresent

adverseeffectsof tobaccouse, especially

indirectlyappliedtoyouths’perceptionand

emotional response.14,15,16,17Inaddition,youth

have sometimes interpreted HWLs images

asmythsregardingtheadverseeffectsof

tobaccousebasedontheirexperiencesor

social norms.18Particularly,theseincludethe

beliefsormythsofsignificantothersandclose

friends,thatthefirstsmokecouldnotcause

addiction.Moreover,themythofmasculine

associationmotivatessmokingamongfemale

youthstoshowgenderequivalenceandappear

fashionable.Moreover,youthingeneraltend

to think that negative consequences of

smokingwouldnotoccursoonbutatan

olderage.

Asubstantialandsignificantassociation

wasfoundbetweenfeararousalandsmoking

cessationafterobservingHWLsamongfemale

youth.Thiswasespeciallytrueconcerningplain

packversuscompany-brandedpacksfeaturing

warningpictures,thoughthemediationwas

incomplete.Thestudymodelresultshelpto

understandinghighfeararousalthataffects

femaleyouthsmokers’ intent toquit.This

studycouldnotinfercausality.However,the

modeldevelopedfromitdescribedpossible

165


mechanismsofsusceptibilityincreasingpositive

andnegativereinforcementexpectancyfrom

feararousalandhigherreinforcementexpec-

tancyfosteringintenttoabstain.19

Thisresearchofferedevidenceonhow

female youths evaluated and interpreted

graphicwarninglabelsonplainpackaging.

Moreover,thestudyexploredhowdominant

factorsmayaffecttherolegraphicwarning

labelsplay. Thesesignificant roles include

their smoking status, perceived disease

susceptibility,perceiveddiseaseseverity,fear

arousalonpreventingsmokingandintentto

abstainamongfemaleyouth.Cigaretteplain

packagingcouldenhancethesalienceand

impactofgraphicwarninglabels.Inaddition,

itcouldpotentiallyincreasethepowerofthe

messagethatcigarettesmokingisharmful,

especially using plain green, dark brown,

blackandoffwhitecovers.

Implication for best practicesGraphicwarninglabelsonplaincigarette

packsarenoticedbythemajorityoffemale

youth.Asaresult,increasedfemaleyouths’

perception on these messages has the

potentialtoreducecigarettesmokingamong

Thaifemaleyouth.Influencingfactorsinclude

perceived disease susceptibility, perceived

diseaseseverityandfeararousal,whichaffect

intenttoabstainfromsmokingamongfemale

youth.

Warninglabelsonplaingreen,darkbrown,

blackandoff-whiteboxplaincoverswere

consideredmoreseriousthansimilarwarnings

onregularpackaging.Thus,perceivedhealth

risk and fear arousal motivated them to

reduceorquitsmokingmorethanregular

packaging.

Thailand has yet to launch a plain

packagingpolicyashasbeenimplementedin

manycountries.Manystudieshavecompared

regular packagingwithplainpackaging to

confirmthestrongassociationwithsmoking

tendency.Plaincigarettepackageisperceived

tobemoreeffectiveinwarningcustomers

ofhealthrisksfromsmokingasithighlights

thehealthwarningpictures.

Thisstudyconfirmedhowfemaleyouth

interpretedandrespondedtographichealth

warning labels of newly designed plain

packagingofcigarettes.Hence,plainpackaging

couldbeseenasapracticalstrategytodeter

smoking among teenagers. These visuals

stimulatedtheirperceptionsofhealthrisks

causedbycigarettesmoking,andreduced

theappealofcigarettesmoking.

Therefore, this information could be

usefulforallhealthcareproviderstoprevent

smokingamongfemaleyouth.Abstinencefrom

smokingcouldbepromotedamongfemale

youth by advocating the plain packaging

policyinThailand

166


ConclusionAfterenactingtheThaiTobaccoRegulation

in2014,thetobaccocontrolpolicyproposed

HWLstobeusedinplainpackaging.Our

findingsrevealedthatHWLsonplaincigarette

packs presented amore explicitmessage

aboutthenegativehealthandimagerisks

relatedtocigarettesmoking.HWLsonplain

cigarettepackswereassociatedwithheightened

perceived severity, susceptibility and fear

arousalregardinghealthrisksfromcigarette

smoking.Theplainpackagingandnegative

imagefacilitatedfemaleyouthawarenessof

susceptible health risk from smoking. In

addition,itcouldevokefeararousalregarding

tobaccouseleadingtoabstainingorrefraining

fromsmoking.Thestudyshowedthatplain

packagingexplainedasubstantialportionof

andmoremodestbutsignificantamountof

varianceinactualintenttorefrainfromsmoking

amongfemaleyouth.Therefore,atobacco

controlpolicyfocusingonHWLsisimportant,

actionableandaneffectivestrategyforyouth,

especiallyamongfemaleyouth.

AcknowledgementFunding for this research was fully

supportedbytheTobaccoControlResearch

KnowledgeManagementCenter(TRC),Mahidol

University&ThaiHealthPromotionFoundation

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การรบรฉลากคำาเตอนบนซองบหรแบบเรยบตอความตงใจในการไมสบบหร

ของวยรนหญงไทย

นฤมล เออมณกล* ดสต สจรารตน ** พมพพรรณ ศลปสวรรณ* ปรารถนา สถตยวภาว ***

ชเกยรต ววฒนวงศเกษม*** มลน สมภพเจรญ**** นทศน ศรโชตรตน *****

บทคดยอการศกษาทดสอบรปแบบเชงสาเหตของการรบร

ฉลากคำาเตอนบนซองบหรแบบเรยบตอความตงใจ

ไมสบของวยรนหญงไทยสมมตฐานคอการรบรฉลาก

คำาเตอนการรบรความเสยงและความรนแรงรวมถง

ความกลวจากภาพคำาเตอนสามารถทำานายความตงใจ

ไมสบไดใชสถตStructuralEquationModeling

วเคราะห เกบขอมลใชแบบสอบถาม สมตวอยาง

แบบชนภมจากโรงเรยนมธยมศกษาตอนปลายและ

อาชวศกษาในกรงเทพอาย15-24ปจำานวน438คน

ไมสบ86.3%เคยสบ5.48%และผสบปจจบน8.22%

ผลการวเคราะหโมเดลมความเหมาะสมสอดคลองกบ

ขอมลเชงประจกษ โดยใหคา χ2= 1.060, df=2,

p=0.589,CFI=0.999,TLI=0.999และRMSEA<0.001,

SRMR=0.005 โดยคนทสบและคนทเคยสบมความ

สมพนธเชงลบตอความตงใจไมสบ (β=0.237 และ

0.124,p<0.001และ0.003)การรบรความรนแรง

และความกลวมความสมพนธทางบวกตอความตงใจ

ไมสบ(β=0.237และ0.124,p<0.001และ0.003)

อยางไรกตามการรบรฉลากคำาเตอนบนซองบหร

แบบเรยบการรบรความรนแรงอายของคนสบและ

คนเคยสบตอความตงใจไมสบจะผานตวแปรความกลว

จากภาพคำาเตอนบนซองบหรแบบเรยบ นอกจากน

ผสบกบความตงใจไมสบสวนหนงผานตวแปรการรบร

ความเสยงผลการวจยจะเปนประโยชนในการออกแบบ

กจกรรมสงเสรมการไมสบบหรในวยรนหญงและใช

ผลกดนนโยบายซองบหรแบบเรยบสำาหรบไทย

คำ�สำ�คญ:ซองบหรแบบเรยบ,การไมสบบหร,

วยรนหญง

วารสารสาธารณสขศาสตร 2562; 49(2): 155-169

* ภาควชาการพยาบาลสาธารณสขคณะสาธารณสขศาสตรมหาวทยาลยมหดล** ภาควชาระบาดวทยาคณะสาธารณสขศาสตรมหาวทยาลยมหดล*** ภาควชาชวสถตคณะสาธารณสขศาสตรมหาวทยาลยมหดล**** ภาควชาสขศกษาและพฤตกรรมศาสตรคณะสาธารณสขศาสตรมหาวทยาลยมหดล*****ภาควชาบรหารงานสาธารณสขคณะสาธารณสขศาสตรมหาวทยาลยมหดล

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Cigarette Plain Packaging Perceptions on Intent to Abstain ... Narumon_ Nithat… · Narumon Auemaneekul * Dusit Sujirarat** Pimpan Silpasuwan Pratana Satitvipawee*** Chukiat Viwatwongkasem***

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