PAXIS Institute Warning Posters and Coasters for Pregnant Women

Many local and state governments have policies regarding placing warning posters or warning information up in settings that sell alcohol or tobacco products. The policies may aim pregnant mothers for instance or groups or acts that are health or public safety danger.

Warning posters, signs and point-of-sale displays can alter the behavior of adults, provided that the warnings appeal to more than health danger and change so that habituation does not occur 1-5. It is also important to pay attention to the cognitive and emotional processes when designing warnings.6 What does this mean?

Studies suggest that warning about health dangers per se may not be effective, and can be counter productive. For example, many pregnant women who smoke or drink during pregnancy are ambivalent about having the baby. There are theoretical reasons to suggest that excessive health warnings can lead ambivalent mothers-to-be to consume more tobacco and alcohol during pregnancy, if the baby is not wanted. Thus, more babies might be born exposed to alcohol, tobacco and drugs in those instances. The “health warnings” may be more effective with more mature adults, but not or less so with adolescents or young adults.7 8 Among young adults of child-rearing age, many warning messages evoke skepticism and disbelief rather than reduction in harm.9

In preparing warning materials for pregnant women in public venues, PAXIS staff interviewed servers and sellers of tobacco and alcohol. All of the interviewees commented how much they loathed selling or serving such products to pregnant women. Many commented that when they said something, the servers or sellers were often attacked by the woman or her male partner. Thus, the sellers and servers were between a rock and hard place.

Previously, PAXIS had developed and successfully used “humor cards” to deal the aggressive underage youth who bullied clerks, and which are now included as copyrighted materials in our trademarked evidence-based environmental strategy, Reward & Reminder.™ The humor cards were loved by sellers, and solved the problem of aggressive underage youth who were denied alcohol or tobacco products.

In our case study for dealing with pregnant women who were smoking or drinking, we decided to develop humorous posters and coasters that could be used easily. Further, we developed a large variety that would be changed several times a year, since such variety had been previously shown to be more effective.

               

Implementation

A brochure explains deployment of the posters, stickers and coasters.

Alcohol serving establishments are asked to place a selection of posters and rotate them on a monthly basis, to increase salience and effectiveness. Other locations are encouraged to rotate signage, too. Some posters are designed for establishments serving mostly men.

Stickers are designed for placement in toilet stalls or urinal stalls and other closed space locations such as pay phones at bars or restaurants.

Drink coasters, which are humorous, are designed for use by servers—when they would like to make a point

Accountability

Every month, a random selection of establishments can be monitored for implementation These data can be released to the media, honoring the establishments using the Reward & Reminder™ protocol of reinforcing clerks, servers or establishments for doing the right thing for babies in the area.

Clerks or servers can receive rewards and recognition, including if they use coasters with pregnant women who have been enlisted to probe their use.

Case Study Results

Here are data before and after the humor campaign, related to self-reported binge drinking by women of child-rearing age.

References

References Cited

1. Hankin JR. Fetal alcohol syndrome prevention research. Alcohol Research & Health 2002;26(1):58-65.
2. Engs RC. Do warning labels on alcoholic beverages deter alcohol abuse? Journal of School Health 1989;59(3):116-8.
3. Kaskutas L, Greenfield TK. First effects of warning labels on alcoholic beverage containers. Drug & Alcohol Dependence 1992;31(1):1-14.
4. Kaskutas LA, Graves K. Relationship between cumulative exposure to health messages and awareness and behavior-related drinking during pregnancy. American Journal of Health Promotion 1994;9(2):115-24.
5. Kaskutas LA, Greenfield TK. The role of health consciousness in predicting attention to health warning messages. American Journal of Health Promotion 1997;11(3):186-93.
6. Strahan EJ, White K, Fong GT, Fabrigar LR, Zanna MP, Cameron R. Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective. Tob Control 2002;11(3):183-90.
7. Robinson TN, Killen JD. Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents. Arch Pediatr Adolesc Med 1997;151(3):267-72.
8. White V, Webster B, Wakefield M. Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours? Addiction 2008;103(9):1562-71.
9. Koval JJ, Aubut JA, Pederson LL, O'Hegarty M, Chan SS. The potential effectiveness of warning labels on cigarette packages: the perceptions of young adult Canadians. Can J Public Health 2005;96(5):353-6.