Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms?

Abstract

ObjectiveTo examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on Australian adolescents’ cognitive processing of warnings and awareness of different health consequences of smoking.MethodsCross-sectional school-based surveys conducted in 2011 (prior to introduction of standardised packaging, n=6338) and 2013 (7–12 months afterwards, n=5915). Students indicated frequency of attending to, reading, thinking or talking about warnings. Students viewed a list of diseases or health effects and were asked to indicate whether each was caused by smoking. Two—‘kidney and bladder cancer’ and ‘damages gums and teeth’—were new while the remainder had been promoted through previous health warnings and/or television campaigns. The 60% of students seeing a cigarette pack in previous 6 months in 2011 and 65% in 2013 form the sample for analysis. Changes in responses over time are examined.ResultsAwareness that smoking causes bladder cancer increased between 2011 and 2013 (p=0.002). There was high agreement with statements reflecting health effects featured in previous warnings or advertisements with little change over time. Exceptions to this were increases in the proportion agreeing that smoking was a leading cause of death (p<0.001) and causes blindness (p<0.001). The frequency of students reading, attending to, thinking or talking about the health warnings on cigarette packs did not change.ConclusionsAcknowledgement of negative health effects of smoking among Australian adolescents remains high. Apart from increased awareness of bladder cancer, new requirements for packaging and health warnings did not increase adolescents’ cognitive processing of warning information.

Australia's plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010–2013

“…Others might have over-reported the impact of the changes on their behaviour due to social desirability concerns, as has been found with some smoking-related behaviours for youth surveyed over the phone 45. Nonetheless, the findings of this study are congruent with other research showing decreases in smoking prevalence during this period among students aged 12–17 years 10 11 46. We note that ex-smokers were not asked whether plain packaging had influenced their decision to quit, as the number of youth who had quit smoking in that 8-month postimplementation period was anticipated to be too few to provide reliable insights.…”

“…This sample extends previous research on the impact of the new tobacco packs10 11 by using population-level sampling (rather than being limited to school students) and by including young adults. The representativeness of the sample was strengthened by inclusion of the dual-frame sample in 2013.…”

“…Extending research conducted to date on the impact of the new packs on youth in relation to the expected mechanisms of change,10 11 the current study aimed to assess, among adolescents and young adults: (1) attitudes towards plain packaging, (2) the impact of plain packaging on never and former smokers' likelihood of smoking in the future, (3) smokers' quitting-related responses to plain packaging and (4) social denormalisation responses among young smokers. Though there have been documented increases in support for plain packaging among adult smokers using plain packs,22 30 changes in adolescents' and young adults' attitudes or responses towards plain packaging from preimplementation to postimplementation are, as yet, unexplored.…”

Current smokers’ perception of cigarette graphic health warnings and smoking habits: a cross sectional study from Nepal

“…We also found that respondents had a favorable attitude towards the GHW, for instance, majority of respondents saying the anti-tobacco message in the new package is noticeable and less appealing. Favorable attitude towards GHW in this study accords the earlier study among adult smokers which found that new packages with enlarged GHW increased promoted knowledge on consequences of smoking (28) and Flemish adolescents' study, which revealed that plain packages are perceived as less attractive, cheap and unreliable by young people (24). Another Australian study showed plain packaging with larger GHWs reduced misinformation about harms of smoking, appeal and increased health warning effectiveness among young and adults (29).…”

Effects of plain package branding and graphic health warnings on adolescent smokers in the USA, Spain and France

“…Other survey work with adolescents (again not necessarily smokers) has shown shifts over time in pack perceptions, brand image, and beliefs of harmful consequences due to a combined presentation of the GWHs and plain packs 44 45. Our experimental study across three different countries focuses on two key outcomes from GHWs and plain packs—that is, short-term cigarette craving21 and longer-term thoughts of quitting 22.…”