Warning Signs and Communication Effects: The Influence of Pictorial Health Warnings on Smoking-Related Knowledge, Attitudes, and Practices among Student Athletes

Abstract

INTRODUCTION: Pictorial health warnings (PHWs) on cigarette packaging are a widely recognised tobacco control strategy that aims to increase awareness of smoking-related health risks and discourage tobacco use. Although PHWs have demonstrated effectiveness in the general population, evidence regarding their impact on athletic populations remains limited. This study examined the relationship between responses to pictorial health warnings on cigarette boxes (PHWCB) and smoking-related knowledge, attitudes, and practices (KAP) among university student athletes. MATERIALS AND METHODS: A cross-sectional study was conducted among 68 university student athletes selected through convenience sampling. Data were collected using a self-administered online questionnaire assessing participants' cognitive and emotional responses to PHWCB and their smoking-related KAP. Descriptive statistics and Spearman's rank correlation were used to analyse the associations between PHWCB responses and KAP. RESULTS: Significant positive correlations were found between PHWCB responses and smoking-related knowledge (p<0.05) and attitudes (p<0.05), indicating that stronger responses to PHWCB were associated with greater awareness of smoking hazards and more negative attitudes toward smoking. However, no significant association was observed between PHWCB responses and smoking practices (p>0.05). PHWCB effectively enhanced knowledge and influenced attitudes toward smoking but did not significantly affect smoking practices among student athletes. This intention–behaviour gap may be explained by factors beyond awareness, including social influences, nicotine dependence, and athlete-specific motivations. CONCLUSION: PHWCB improves smoking-related knowledge and attitudes but has limited influence on smoking behaviour among university student athletes. Athlete-specific tobacco control interventions emphasising the immediate effects of smoking on physical performance are recommended.