RESEARCH PAPER
Did the introduction of pictorial health warnings increase information seeking for smoking cessation?: Time-series analysis of Google Trends data in six countries
 
More details
Hide details
1
Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
CORRESPONDING AUTHOR
Jizzo R. Bosdriesz   

Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
Publish date: 2019-08-02
Submission date: 2019-04-17
Final revision date: 2019-06-20
Acceptance date: 2019-07-23
 
Tob. Prev. Cessation 2019;5(August):27
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Pictorial health warnings (PHW) can influence smoking cessation rates and precursors thereof. However, both the magnitude and duration of their impact, in national populations, remain uncertain because of limitations of the available data. In this study we used Google Trends data from six European countries to evaluate whether the implementation of PHW was followed by a short-term increase in online searches on smoking cessation.

Methods:
We applied an interrupted time-series design using ARIMA models. We used weekly or monthly data on the relative search volume (RSV) for search terms about smoking cessation. First, RSV trends were seasonally adjusted and adjusted for autocorrelation. Next, regression models were fitted that included terms for the potential effect of PHW in month 1, months 2–3, and months 4–6 after implementation.

Results:
Our findings for France and the United Kingdom were partly in line with our initial expectations. In France, a 4% increase (95% CI: -2% – 11%) occurred in the first month after implementation, but not later. In the UK, a 3% increase (95% CI: 1% – 6%) in ‘quit smoking’ searches occurred in months 2–3. No increases were observed for any other periods for France, the UK, Ireland, Norway, Denmark or Switzerland.

Conclusions:
We found no consistent support that the implementation of PHW was associated with increased internet searches for smoking cessation. Further studies are needed to assess and understand the magnitude and duration of populationwide impacts of PHW.

ACKNOWLEDGEMENTS
An earlier version of this work was included as a chapter in the PhD thesis of Jizzo R. Bosdriesz. Work on this thesis was conducted at the Department of Public Health, Amsterdam UMC, University of Amsterdam, from 2012 to 2017.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (43)
1.
World Health Organization. WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. Geneva, Switzerland: World Health Organization; 2013. https://www.who.int/tobacco/gl.... Accessed April 17, 2019.
 
2.
Gibbons D, Byers L, Kurie J. Smoking, p53 mutation, and lung cancer. Mol Cancer Res. 2014;12(1):3-13. doi:10.1158/1541-7786.MCR-13-0539
 
3.
Phelan S. Smoking cessation in pregnancy. Obstet Gynecol Clin North Am. 2014;41(2):255-66. doi:10.1016/j.ogc.2014.02.007
 
4.
Li LF, Chan RL, Lu L, et al. Cigarette smoking and gastrointestinal diseases: the causal relationship and underlying molecular mechanisms (review). Int J Mol Med. 2014;34(2):372-380. doi:10.3892/ijmm.2014.1786
 
5.
World Health Organization. WHO report on the global tobacco epidemic 2008: the MPOWER package. Geneva, Switzerland: World Health Organization; 2008. https://www.who.int/tobacco/mp.... Accessed April 17, 2019.
 
6.
Magnan RE, Cameron LD. Do Young Adults Perceive That Cigarette Graphic Warnings Provide New Knowledge About the Harms of Smoking? Ann Behav Med. 2015;49(4):594-604. doi:10.1007/s12160-015-9691-6
 
7.
Canadian Cancer Society. Cigarette Package Health Warnings: International Status Report. Canadian Cancer Society; 2014. http://www.cancer.ca/~/media/c.... Accessed April 17, 2019.
 
8.
Xu Y, Xu S, Wu Q, Guo Y. Tobacco Knowledge among Adults in Zhejiang Province, China. PloS One. 2013;8(3):e59172. doi:10.1371/journal.pone.0059172
 
9.
Gupta B, Kumar N. A cross-country comparison of knowledge, attitudes and practices about tobacco use: findings from the global adult tobacco survey. Asian Pac J Cancer Prev. 2014;15(12):5035-5042. doi:10.7314/APJCP.2014.15.12.5035
 
10.
Hall MG, Ribisl KM, Brewer NT. Smokers' and nonsmokers' beliefs about harmful tobacco constituents: implications for FDA communication efforts. Nicotine Tob Res. 2014;16(3):343-350. doi:10.1093/ntr/ntt158
 
11.
Weinstein ND, Marcus SE, Moser RP. Smokers’ unrealistic optimism about their risk. Tob Control. 2005;14(1):55-59. doi:10.1136/tc.2004.008375
 
12.
Hammond D, Fong GT, McDonald PW, Cameron R, Brown KS. Impact of the graphic Canadian warning labels on adult smoking behaviour. Tob Control. 2003;12(4):391-395. doi:10.1136/tc.12.4.391
 
13.
Hammond D. Health warning messages on tobacco products: a review. Tob Control. 2011;20(5):327-337. doi:10.1136/tc.2010.037630
 
14.
O'Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P. Young adults' perceptions of cigarette warning labels in the United States and Canada. Prev Chronic Dis. 2007;4(2):1545-1551. PMID: 17362618.
 
15.
Vardavas CI, Connolly G, Karamanolis K, Kafatos A. Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels. Eur J Public Health. 2009;19(2):212-217. doi:10.1093/eurpub/ckp015
 
16.
Monarrez-Espino J, Liu B, Greiner F, Bremberg S, Galanti R. Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior. Am J Public Health. 2014;104(10):e11-e30. doi:10.2105/ajph.2014.302129
 
17.
Alaouie H, Afifi RA, Haddad P, Mahfoud Z, Nakkash R. Effectiveness of pictorial health warnings on cigarette packs among Lebanese school and university students. Tob Control. 2015;24(e1):e72-e80. doi:10.1136/tobaccocontrol-2012-050745
 
18.
Agaku IT, Filippidis FT, Vardavas CI. Effectiveness of text versus pictorial health warning labels and predictors of support for plain packaging of tobacco products within the European Union. Eur Addict Res. 2015;21(1):47-52. doi:10.1159/000366019
 
19.
Hitchman SC, Driezen P, Logel C, Hammond D, Fong GT. Changes in effectiveness of cigarette health warnings over time in Canada and the United States, 2002-2011. Nicotine Tob Res. 2014;16(5):536-543. doi:10.1093/ntr/ntt196
 
20.
Bethea J, Murtagh B, Wallace SE. “I don’t mind damaging my own body” A qualitative study of the factors that motivate smokers to quit. BMC Public Health. 2015;15(1):4. doi:10.1186/1471-2458-15-4
 
21.
Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control. 2015;25(3):341-354. doi:10.1136/tobaccocontrol-2014-051978
 
22.
Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Soc Sci Med. 2016;164:118-129. doi:10.1016/j.socscimed.2016.06.011
 
23.
Ginsberg J, Mohebbi MH, Patel RS, Brammer L, Smolinski MS, Brilliant L. Detecting influenza epidemics using search engine query data. Nature. 2009;457(7232):1012-1014. doi:10.1038/nature07634
 
24.
Nuti SV, Wayda B, Ranasinghe I, et al. The Use of Google Trends in Health Care Research: A Systematic Review. PloS One. 2014;9(10):e109583. doi:10.1371/journal.pone.0109583
 
25.
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, et al. Monitoring of non-cigarette tobacco use using Google Trends. Tob Control. 2015;24(3):249-255. doi:10.1136/tobaccocontrol-2013-051276
 
26.
Salloum RG, Osman A, Maziak W, Thrasher JF. How popular is waterpipe tobacco smoking? Findings from internet search queries. Tob Control. 2015;24(5):509-513. doi:10.1136/tobaccocontrol-2014-051675
 
27.
Troelstra SA, Bosdriesz JR, de Boer MR, Kunst AE. Effect of Tobacco Control Policies on Information Seeking for Smoking Cessation in the Netherlands: A Google Trends Study. PloS One. 2016;11(2):e0148489. doi:10.1371/journal.pone.0148489
 
28.
Eurostat. Households with broadband access. http://ec.europa.eu/eurostat/e.... Accessed April 17, 2019.
 
29.
Box GEP, Jenkins GM, Reinsel GC, Ljung GM. Time Series Analysis: Forecasting and Control. Hoboken, NJ: Wiley; 2015.
 
30.
Tan SSL, Goonawardene N. Internet Health Information Seeking and the Patient-Physician Relationship: A Systematic Review. J Med Internet Res. 2017;19(1):e9. doi:10.2196/jmir.5729
 
31.
Tieks A, Troelstra SA, Hoekstra T, Kunst AE. Associations of the Stoptober smoking cessation program with information seeking for smoking cessation: A Google trends study. Drug Alcohol Depend. 2018;194:97-100. doi:10.1016/j.drugalcdep.2018.08.040
 
32.
Statcounter GlobalStats. Search Engine Market Share Worldwide [June 2018-2019]. http://gs.statcounter.com/sear.... Accessed June 20, 2019.
 
33.
Bittencourt L, Person SD, Cruz RC, Scarinci IC. Pictorial health warnings on cigarette packs and the impact on women. Revista de Saúde Pública. 2013;47(6):1123-1129. doi:10.1590/S0034-8910.2013047004782
 
34.
Volchan E, David IA, Tavares G, et al. Implicit Motivational Impact of Pictorial Health Warning on Cigarette Packs. PloS One. 2013;8(e72117). doi:10.1371/journal.pone.0072117
 
35.
Mannocci A, Colamesta V, Conti V, et al. Demographic Characteristics, Nicotine Dependence, and Motivation to Quit as Possible Determinants of Smoking Behaviors and Acceptability of Shocking Warnings in Italy. Biomed Res Int. 2014;2014:1-10. doi:10.1155/2014/723035
 
36.
Pew Research Center. Internet User Demographics - 2014. http://www.pewinternet.org/dat.... Accessed May 26, 2019.
 
37.
Ayers JW, Althouse BM, Ribisl KM, Emery S. Digital Detection for Tobacco Control: Online Reactions to the United States’ 2009 Cigarette Excise Tax Increase. Nicotine Tob Res. 2013;16(5):576-583. doi:10.1093/ntr/ntt186
 
38.
Nagelhout GE, Willemsen MC, de Vries H, et al. Educational differences in the impact of pictorial cigarette warning labels on smokers: findings from the International Tobacco Control (ITC) Europe surveys. Tob Control. 2015;25(3):325-232. doi:10.1136/tobaccocontrol-2014-051971
 
39.
Moodie C, Mackintosh AM, Hastings G. Adolescents' response to pictorial warnings on the reverse panel of cigarette packs: a repeat cross-sectional study. Tob Control. 2015;24(e1):e93-e97. doi:10.1136/tobaccocontrol-2013-050999
 
40.
Miller CL, Hill DJ, Quester PG, Hiller JE. Impact on the Australian Quitline of new graphic cigarette pack warnings including the Quitline number. Tob Control. 2009;18(3):235-237. doi:10.1136/tc.2008.028290
 
41.
Wilson N, Li J, Hoek J, Edwards R, Peace J. Long-term benefit of increasing the prominence of a quitline number on cigarette packaging: 3 years of Quitline call data. N Z Med J. 2010;123(1321):109-111. https://www.researchgate.net/p.... Accessed April 17, 2019.
 
42.
World Health Organization. Guidelines for implementation of Article 11 of the WHO Framework Convention on Tobacco Control : Packaging and labelling of tobacco products. Geneva, Switzerland: World Health Organization; 2008. https://www.who.int/fctc/guide.... Accessed April 17, 2019.
 
43.
Kennedy RD, Spafford MM, Behm I, Hammond D, Fong GT, Borland R. Positive impact of Australian ‘blindness’ tobacco warning labels: findings from the ITC four country survey. Clin Exp Optom. 2012;95(6):590-598. doi:10.1111/j.1444-0938.2012.00789.x
 
eISSN:2459-3087