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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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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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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Journal of Public Health Vol.49 No.2 (May-Aug 2019)
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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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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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Journal of Public Health Vol.49 No.2 (May-Aug 2019)
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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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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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Journal of Public Health Vol.49 No.2 (May-Aug 2019)
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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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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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Journal of Public Health Vol.49 No.2 (May-Aug 2019)
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
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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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
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Journal of Public Health Vol.49 No.2 (May-Aug 2019)
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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วารสารสาธารณสขศาสตร ปท 49 ฉบบท 2 (พ.ค.-ส.ค. 2562)
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