Evidence map›Paper›PMID 25948713›Full record

SynthesisTobacco control2016

Pictorial cigarette pack warnings: a meta-analysis of experimental studies.

Seth M Noar, Marissa G Hall, Diane B Francis, Kurt M Ribisl, Jessica K Pepper, Noel T Brewer

Registry-linked trialAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Tobacco control, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06308081 (SMART), which is not on this map. Cited by 364 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
364citing papers in PubMed, 7 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06308081 nacompletednot on this mapstarted 2024, after this paper: background citation

SMART: Social Media Anti-Vaping Messages to Reduce ENDS Use Among Sexual and Gender Minority Teens

TypeinterventionalSponsorAbramson Cancer Center at Penn MedicineRan2024 to 2025Enrolled1,155ConditionsVaping, Adolescent Behavior, Communication ResearchArmsTailored
3 · Its place in the literature

Who cites it

364 citing papers in PubMed, 7 syntheses or guidelines pooled it.

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  16. Relative Efficacy of Cigarillo Warning Statements in Text and Pictorial Formats: An Experimental Study Among a Sample of US Young Adults.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025
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304 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Seth M NoarSchool of Journalism and Mass Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Marissa G HallDepartment of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Diane B FrancisSchool of Journalism and Mass Communication, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Kurt M RibislLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Jessica K PepperLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Noel T BrewerLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Funding

Virology Research Program (Program 4)P30CA016086 · NCI · UNIV OF NORTH CAROLINA CHAPEL HILL · PI Deborah F. Tate · 1985 to 2026
$201.5M
ACL HHS U48DP001944NCI NIH HHS P30 CA016086PHS HHS P3OCAO1 6086-3832
6 · The paper itself

Abstract

objectiveTo inform international research and policy, we conducted a meta-analysis of the experimental literature on pictorial cigarette pack warnings. DATA SOURCES: We systematically searched 7 computerised databases in April 2013 using several search terms. We also searched reference lists of relevant articles. STUDY SELECTION: We included studies that used an experimental protocol to test cigarette pack warnings and reported data on both pictorial and text-only conditions. 37 studies with data on 48 independent samples (N=33,613) met criteria. DATA EXTRACTION AND SYNTHESIS: Two independent coders coded all study characteristics. Effect sizes were computed from data extracted from study reports and were combined using random effects meta-analytic procedures.

resultsPictorial warnings were more effective than text-only warnings for 12 of 17 effectiveness outcomes (all p<0.05). Relative to text-only warnings, pictorial warnings (1) attracted and held attention better; (2) garnered stronger cognitive and emotional reactions; (3) elicited more negative pack attitudes and negative smoking attitudes and (4) more effectively increased intentions to not start smoking and to quit smoking. Participants also perceived pictorial warnings as being more effective than text-only warnings across all 8 perceived effectiveness outcomes.

conclusionsThe evidence from this international body of literature supports pictorial cigarette pack warnings as more effective than text-only warnings. Gaps in the literature include a lack of assessment of smoking behaviour and a dearth of theory-based research on how warnings exert their effects.

Indexed as

Health BehaviorPhotographyProduct LabelingSmoking PreventionAttentionCognitionHealth EducationHealth Knowledge, Attitudes, PracticeHumansMotivationRisk AssessmentRisk FactorsSmokingSmoking CessationTobacco ProductsVisual PerceptionGlobal healthPackaging and LabellingPublic policy

Identifiers

PMID25948713
PMCPMC4636492

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.