The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study
Abstract
:1. Introduction
2. Methods
2.1. Sample and Recruitment
2.2. Health Warning Label Design
2.3. Rating the Effectiveness of HWLs
2.4. Religiosity Level
2.5. Smoking Behavior and Intentions
2.6. Statistical Analysis
2.7. Ethics Approval
3. Results
3.1. Sociodemographic Characteristics of Participants by Religiosity Level
3.2. Rating Scores of Religious and Nonreligious HWLs
3.3. The Association between CRS Score and HWL Rating Scores
4. Discussion
5. Conclusions
Author Contributors
Funding
Conflicts of Interest
References
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Gender | n | % |
Male | 644 | 78.8 |
Female | 173 | 21.2 |
Age (Year) | ||
18–24 | 421 | 51.5 |
25–34 | 236 | 28.9 |
35–44 | 103 | 12.6 |
≥45 | 50 | 6.1 |
Education Level | ||
Primary/Secondary | 76 | 9.3 |
High School | 510 | 62.7 |
College | 228 | 28.0 |
Having Children | ||
No | 538 | 66.4 |
Yes | 272 | 33.6 |
Monthly Income (IDR) | ||
≤3 million IDR | 420 | 54.9 |
>3 million and ≤5 million IDR | 217 | 28.4 |
>5 million IDR | 128 | 16.7 |
Smoking Status | ||
Daily | 642 | 78.6 |
Occasionally | 46 | 5.6 |
Not at all | 129 | 15.8 |
Health Status | ||
Poor/Fair | 123 | 15.6 |
Good | 430 | 54.6 |
Very Good/Excellent | 234 | 29.7 |
Religiosity Level (n = 665) | ||
Quite a bit/very much so (4 or 5) | 706 | 86.6 |
Moderately (3) | 93 | 11.4 |
Not at all (1 or 2) | 16 | 2.0 |
Daily Practice | ||
5 or more | 497 | 60.8 |
1–4 times in a day | 280 | 34.3 |
Never | 40 | 4.9 |
Time to First Cigarette (n = 633) | ||
Within 5 min | 189 | 29.9 |
6–30 min | 253 | 40.0 |
More than 30 min | 191 | 30.2 |
Quit Attempt in the Past Year (n = 635) | ||
Yes | 324 | 51.0 |
No | 311 | 49.0 |
Plan to Quit (n = 634) | ||
Within next month | 119 | 18.8 |
Within next 6 months | 136 | 21.5 |
Beyond next 6 months | 149 | 23.5 |
Not at all | 230 | 36.3 |
Motivation to Quit (n = 635) * | ||
1–5 | 287 | 45.2 |
6–10 | 348 | 54.8 |
Motivation to Stay Smoke Free (n = 172) * | ||
1–7 | 80 | 46.5 |
8–10 | 92 | 53.5 |
Total | 817 | 100.0 |
Characteristics | Religiosity Level | p | |||
---|---|---|---|---|---|
Score 1–3 | Score 4–5 | ||||
n | % | n | % | ||
Gender | |||||
Male | 84 | 13.0 | 560 | 87.0 | 0.590 |
Female | 25 | 14.6 | 146 | 85.4 | |
Age (Year) | |||||
18–24 | 65 | 15.5 | 354 | 84.5 | 0.065 |
≥25 | 44 | 11.1 | 352 | 88.9 | |
Education Level | |||||
Primary/Secondary | 16 | 21.1 | 60 | 78.9 | 0.049 |
High School | 69 | 13.6 | 440 | 86.4 | |
College | 23 | 10.1 | 205 | 89.9 | |
Having Children | |||||
No | 74 | 13.8 | 462 | 86.2 | 0.606 |
Yes | 34 | 12.5 | 238 | 87.5 | |
Monthly Income (IDR) | |||||
≤3 million | 67 | 16.0 | 352 | 84.0 | 0.040 |
>3 million and ≤5 million | 19 | 8.8 | 198 | 91.2 | |
>5 million | 17 | 13.3 | 111 | 86.7 | |
Smoking Status | |||||
Daily | 97 | 15.2 | 543 | 84.8 | 0.004 |
Occasionally/Not at all | 12 | 6.9 | 163 | 93.1 | |
Health Status | |||||
Poor/Fair | 29 | 23.6 | 94 | 76.4 | 0.001 |
Good | 48 | 11.2 | 380 | 88.8 | |
Very Good/Excellent | 26 | 11.1 | 208 | 88.9 | |
Total | 109 | 13.4 | 706 | 86.6 |
Rating Questions | n | Nonreligious Death | Religious Death | Nonreligious SHS | Religious SHS | Nonreligious Gangrene | Religious Gangrene | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean ± SD | Med | Mean ± SD | Med | Mean ± SD | Med | Mean ± SD | Med | Mean ± SD | Med | Mean ± SD | Med | ||||
Grabs My Attention | 810 | 6.9 ± 3.3 | 8.0 | 6.8 ± 3.3 | 8.0 | 7.3 ± 3.0 | 8.0 | 7.2 ± 3.1 | 8.0 | 7.0 ± 3.3 | 8.0 | 7.0 ± 3.2 | 8.0 | ||
p* | 0.080 | 0.492 | 0.528 | ||||||||||||
Easy to Understand | 810 | 7.4 ± 3.0 | 8.0 | 7.4 ± 3.0 | 8.0 | 7.8 ± 2.8 | 9.0 | 7.6 ± 2.8 | 9.0 | 7.1 ± 3.1 | 8.0 | 7.1 ± 3.1 | 8.0 | ||
p* | 0.577 | 0.131 | 0.489 | ||||||||||||
Credible | 804 | 7.4 ± 3.0 | 9.0 | 7.1 ± 3.1 | 8.0 | 8.0 ± 2.7 | 9.0 | 7.7 ± 2.8 | 9.0 | 7.0 ± 3.1 | 8.0 | 7.0 ± 3.2 | 8.0 | ||
p* | 0.001 | <0.001 | 0.704 | ||||||||||||
Makes Me Feel More Concerned about Smoking | 807 | 6.7 ± 3.4 | 8.0 | 6.7 ± 3.3 | 8.0 | 6.8 ± 3.2 | 8.0 | 6.7 ± 3.3 | 8.0 | 6.7 ± 3.3 | 7.0 | 6.8 ± 3.4 | 8.0 | ||
p* | 0.436 | 0.011 | 0.086 | ||||||||||||
Makes Me Think about the Health Risks of Smoking | 804 | 6.9 ± 3.3 | 8.0 | 6.8 ± 3.2 | 8.0 | 7.0 ± 3.2 | 8.0 | 6.8 ± 3.2 | 8.0 | 6.9 ± 3.3 | 8.0 | 7.0 ± 3.2 | 8.0 | ||
p* | 0.141 | 0.002 | 0.042 | ||||||||||||
Motivates Me to Stay Smoke-Free (Non-Smokers) | 175 | 8.5 ± 2.5 | 10.0 | 8.6 ± 2.4 | 10.0 | 8.6 ± 2.4 | 10.0 | 8.6 ± 2.4 | 10.0 | 8.7 ± 2.3 | 10.0 | 8.7 ± 2.3 | 10.0 | ||
p* | 0.229 | 0.805 | 0.911 | ||||||||||||
Makes Me Think about Quitting (Smokers) | 628 | 6.1 ± 3.4 | 6.0 | 5.9 ± 3.4 | 6.0 | 6.1 ± 3.4 | 6.0 | 5.9 ± 3.4 | 6.0 | 6.1 ± 3.4 | 7.0 | 6.1 ± 3.4 | 7.0 | ||
p* | 0.076 | 0.027 | 0.431 | ||||||||||||
Motivates Me to Quit Smoking (Smokers) | 624 | 6.1 ± 3.5 | 6.0 | 6.0 ± 3.4 | 6.0 | 6.1 ± 3.4 | 6.0 | 5.9 ± 3.4 | 6.0 | 6.1 ± 3.4 | 7.0 | 6.1 ± 3.4 | 7.0 | ||
p* | 0.219 | 0.001 | 0.490 | ||||||||||||
Makes Me Avoid Looking at the Warning Label | 799 | 5.9 ± 3.5 | 6.0 | 5.9 ± 3.5 | 6.0 | 5.8 ± 3.5 | 6.0 | 5.7 ± 3.5 | 6.0 | 6.1 ± 3.5 | 7.0 | 6.2 ± 3.5 | 7.0 | ||
p* | 0.842 | 0.040 | 0.985 | ||||||||||||
In General, How Effective is This Warning | 797 | 7.1 ± 3.1 | 8.0 | 6.9 ± 3.2 | 8.0 | 7.2 ± 3.0 | 8.0 | 7.1 ± 3.0 | 8.0 | 7.0 ± 3.2 | 8.0 | 7.1 ± 3.1 | 8.0 | ||
p* | 0.016 | 0.007 | 0.714 | ||||||||||||
Overall Rating Score | Average Rating Score of All RELIGIOUS HWLs | Average Rating Score of All NONRELIGIOUS HWLs | |||||||||||||
Mean ± SD | Median | Mean ± SD | Median | ||||||||||||
815 | 6.8 ± 2.6 | 7.2 | 6.9 ± 2.6 | 7.3 | |||||||||||
p* | 0.005 |
Rating Questions | n | Nonreligious Death | Religious Death | Nonreligious SHS | Religious SHS | Nonreligious Gangrene | Religious Gangrene |
---|---|---|---|---|---|---|---|
GMR * (95%CI) | GMR * (95%CI) | GMR* (95%CI) | GMR* (95%CI) | GMR* (95%CI) | GMR* (95%CI) | ||
Grabs My Attention | 810 | 1.01 (0.98–1.04) | 1.04 (1.01–1.07) | 1.04 (1.01–1.06) | 1.03 (0.99–1.05) | 1.01 (0.97–1.03) | 1.02 (0.99–1.05) |
Easy to Understand | 810 | 1.02 (0.99–1.05) | 0.99 (0.96–1.02) | 0.99 (0.97–1.02) | 0.97 (0.95–0.99) | 0.99 (0.97–1.02) | 1.03 (0.99–1.06) |
Credible | 804 | 1.05 (1.01–1.09) | 1.07 (1.02–1.12) | 1.05 (1.02–1.09) | 1.07 (1.03–1.11) | 1.06 (1.02–1.11) | 1.08 (1.04–1.13) |
Makes Me Feel More Concerned about Smoking | 807 | 1.02 (0.99–1.06) | 1.04 (1.01–1.07) | 1.04 (0.99–1.07) | 1.04 (1.01–1.08) | 1.02 (0.99–1.05) | 1.02 (0.99–1.05) |
Makes Me Think about the Health Risks of Smoking | 804 | 1.03 (0.99–1.06) | 1.04 (1.01–1.07) | 1.05 (1.02–1.09) | 1.03 (0.99–1.07) | 1.02 (0.98–1.05) | 1.02 (0.98–1.05) |
Motivates Me to Stay Smoke-Free (Non-Smokers) | 175 | 0.98 (0.91–1.05) | 1.02 (0.96–1.09) | 1.03 (0.96–1.11) | 0.97 (0.91–1.04) | 1.04 (0.97–1.12) | 0.99 (0.93–1.05) |
Makes Me Think about Quitting (Smokers) | 628 | 1.04 (0.99–1.08) | 1.05 (1.01–1.09) | 1.03 (0.99–1.07) | 1.05 (1.02–1.11) | 1.03 (0.99–1.07) | 1.02 (0.98–1.06) |
Motivates Me to Quit Smoking (Smokers) | 624 | 1.03 (0.99–1.08) | 1.04 (1.01–1.08) | 1.03 (0.99–1.07) | 1.04 (0.99–1.09) | 1.03 (0.98–1.07) | 1.01 (0.97–1.04) |
Makes Me Avoid Looking at the Warning Label | 799 | 1.02 (0.98–1.07) | 1.01 (0.96–1.05) | 1.02 (0.97–1.07) | 1.01 (0.95–1.05) | 1.01 (0.96–1.05) | 0.99 (0.95–1.04) |
In General, How Effective is This Warning | 797 | 1.01 (0.98–1.03) | 1.02 (0.99–1.05) | 1.02 (0.99–1.05) | 0.99 (0.96–1.02) | 1.01 (0.97–1.03) | 0.99 (0.96–1.02) |
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Kaplan, B.; Hardesty, J.J.; Martini, S.; Megatsari, H.; Kennedy, R.D.; Cohen, J.E. The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2019, 16, 4287. https://doi.org/10.3390/ijerph16214287
Kaplan B, Hardesty JJ, Martini S, Megatsari H, Kennedy RD, Cohen JE. The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2019; 16(21):4287. https://doi.org/10.3390/ijerph16214287
Chicago/Turabian StyleKaplan, Bekir, Jeffrey J. Hardesty, Santi Martini, Hario Megatsari, Ryan D. Kennedy, and Joanna E. Cohen. 2019. "The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study" International Journal of Environmental Research and Public Health 16, no. 21: 4287. https://doi.org/10.3390/ijerph16214287
APA StyleKaplan, B., Hardesty, J. J., Martini, S., Megatsari, H., Kennedy, R. D., & Cohen, J. E. (2019). The Effectiveness of Cigarette Pack Health Warning Labels with Religious Messages in an Urban Setting in Indonesia: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 16(21), 4287. https://doi.org/10.3390/ijerph16214287