Date of Award


Document Type

Open Access Thesis


Health Promotion, Education and Behavior


The Norman J. Arnold School of Public Health

First Advisor

James F. Thrasher


Pictorial health warning labels (HWLs) on cigarette packs are used worldwide to curb cigarette smoking, the leading preventable cause of death in the United States While individual-level mediators of HWLs’ effects on cessation have been thoroughly studied, interpersonal communication about HWLs has received less attention in HWL research. However, results from one study demonstrated the importance of interpersonal communication, finding that conversations about HWLs predicted quit attempts in Australia, Canada, and Mexico. That study also found that smokers in Mexico, where most smokers are Latino, reported more conversations than smokers in Australia and Canada, where most smokers are non-Latino White. This thesis extended research on HWL conversations to the United States, where HWLs are text-only. The study aims were to compare the frequency of HWL conversations between U.S. Latino and White smokers and to assess the association of these conversations with subsequent quit attempts.

The current study used data from an online panel of U.S. Latino and White adult smokers. From January 2013 to September 2014, approximately 1,300 respondents were surveyed every four months (total individuals: N= 4,628). HWL conversations, quit attempts in the prior four months, smoking behaviors, and socio-demographic variables were measured at each wave. Poisson generalized estimating equation (GEE) models regressed HWL conversation on study variables, and logistic GEE models regressed quit attempts at one wave on predictor variables from the prior wave, including interactions between ethnicity and HWL conversations. Results indicated that HWL conversations were most prevalent among Spanish-speaking Latinos (85%), followed by English-speaking Latinos (59%), and non-Latino Whites (35%), and the statistical significance of these between-group differences was confirmed in adjusted models. Frequency of HWL conversations predicted subsequent quit attempts (AIRRlow v none=1.17, 95% CI=1.02,1.33; AIRRhigh v none=1.27, 95% CI=1.12, 1.43), although ethnicity/language preference did not mediate this effect. Latinos appear to talk more often about HWLs than non-Latino Whites, yet HWL conversations are associated with quit attempts across ethnic groups. Future research should explore reasons for ethnic difference in HWL communication as well as other characteristics of message recipients that might influence conversations. Cessation campaigns should attempt to promote interpersonal communication to increase cessation.