Open Access Research article

Perceptions of young Jordanian adults to proposed anti-tobacco pictorial warning labels

Feras I Hawari1*, Rasha K Bader1, Hamza M Beano2, Nour A Obeidat1, Hiba S Ayub1, Malek A Habashneh3, Aisha S Shtaiwi1, Rawan A Shihab1, Hala N Madanat45 and Thomas E Novotny46

Author Affiliations

1 Cancer Control Office, King Hussein Cancer Center, Amman, Jordan

2 Faculty of Medicine, University of Jordan, Amman, Jordan

3 Health Awareness and Promotion Directorate, Jordanian Ministry of Health, Jordan

4 Graduate School of Public Health, San Diego State University, San Diego, CA, USA

5 San Diego Prevention Research Center, San Diego, CA, USA

6 Family and Preventive Medicine, University of California San Diego, San Diego, CA, USA

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BMC Public Health 2011, 11:414  doi:10.1186/1471-2458-11-414

Published: 31 May 2011



In commitment to the Framework Convention on Tobacco Control (FCTC), four new pictorial warnings are now being proposed for display on cigarette packages sold in Jordan. The aim of this study was to gauge the immediate perceptions of young Jordanian adults towards these new pictorials and compare these perceptions to those of the pictorial currently being used in the country.


A cross-sectional survey was conducted on a convenience sample of youth aged 17-26. The interviewer-administered survey gauged participants' perceptions of salience, fear elicitation, and gained information as well as participants' motivation to remain non-smokers or quit smoking after viewing each of the four proposed new pictorials as well as the current pictorial used in Jordan. Perceptions regarding each new pictorial were compared to the current pictorial.


A total of 450 surveys were included in the analysis. The sample (mean age 20.9) was 51.6% female and 31.3% cigarette (regular or occasional) smokers. In smokers, only one proposed pictorial had significantly more smokers perceiving it as salient or adding to information when compared to the current pictorial. More smokers reported fear when observing the proposed pictorials compared with current pictorial, but overall proportions reporting fear were generally less than 50%. Furthermore, all new pictorials motivated significantly more smokers to consider quitting compared with the current pictorial; however, the overall proportion of smokers reporting motivation was < 25%. Among nonsmokers, significantly more respondents perceived the new pictorials as salient and fear-eliciting compared to the old pictorial, but there were no major differences in information added. Motivation to remain non-smokers was comparable between the old and new pictorials.


Given the variability of response across both smokers and nonsmokers, and across the three elements of perception (salience, added information, fear) for each pictorial, further testing of the pictorials in a more diverse sample of Jordanian young adults prior to launch is recommended.

health warnings; Middle-East; salience; fear-elicitation; tobacco