• Alice Mannocci, Vittoria Colamesta, Vittoria Conti, Maria Sofia Cattaruzza, Gregorino Paone, Maria Cafolla, Rosella Saulle, Vincenzo Bulzomì, Daniele Antici, Pasquale Cuccurullo, Antonio Boccia, Giuseppe La Torre, and Claudio Terzano.
• Department Public Health and Infection Disease, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
• Biomed Res Int. 2014 Jan 1;2014:723035.

IntroductionThis paper presents the final results of a cross-sectional study started in 2010. It compares the perceived efficacy of different types of tobacco health warning (texts versus shocking pictures) to quit or reduce tobacco use.MethodsThe study conducted between 2010 and 2012 in Italy enrolled adults smokers. Administering a questionnaire demographic data, smokers behaviors were collected. Showing text and graphic warnings (the corpse of a smoker, diseased lungs, etc.) the most perceived efficacy to reduce tobacco consumption or to encourage was quit.Results666 subjects were interviewed; 6% of responders referred that they stopped smoking at least one month due to the textual warnings. The 81% of the smokers perceived that the warnings with shocking pictures are more effective in reducing/quitting tobacco consumption than text-only warnings. The younger group (<45 years), who are more motivated to quit (Mondor's score ≥ 12), and females showed a higher effectiveness of shocking warnings to reduce tobacco consumption of, 76%, 78%, and 43%, respectively with P < 0.05.ConclusionsThis study suggests that pictorial warnings on cigarette packages are more likely to be noticed and rated as effective by Italian smokers. Female and younger smokers appear to be more involved by shock images. The jarring warnings also appear to be supporting those who want to quit smoking. This type of supportive information in Italy may become increasingly important for helping smokers to change their behavior.

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