Investigating the Effectiveness of Pictorial Health Warnings in Mauritius: Findings From the ITC Mauritius Survey

Abstract

introduction: Health warnings on tobacco packages are an effective strategy for informing the public about the harms associated with tobacco use. Most studies investigating the effectiveness of pictorial health warnings (PHWs) on cigarette packages are from high-income countries. This study evaluated the impact of PHWs on smokers' perceptions and behavior in Mauritius, the first country in the World Health Organization African region to implement PHWs.

Educational differences in the impact of pictorial cigarette warning labels on smokers: findings from the International Tobacco Control (ITC) Europe surveys

“…We found that warning salience and cognitive responses decreased in these countries. This pattern of decreases of self-reported warning label responses (warning label ‘wear-out’) has been reported before 14 15 25. We found that warning avoidance increased in Germany, but avoidance remained much lower (6% tried to avoid labels in the past month at the second survey wave) than in France (17%) and the UK (18%) after the implementation of pictorial warning labels.…”

The lower effectiveness of text-only health warnings in China compared to pictorial warnings in Malaysia: findings from the ITC project

“…6 Health warnings constitute a powerful intervention for increasing knowledge about the specific harms of tobacco use 7 and for increasing thoughts and motivations to quit smoking among smokers in many countries including Thailand, Malaysia, Uruguay, Mauritius, Mexico, Australia and Canada. [8][9][10][11][12][13][14] Health warnings also have the potential to prevent smoking initiation among nonsmokers, including youth. 15 Smokers rate health warnings on cigarette packages as a prominent and credible source of information about the harms of tobacco use.…”

Effectiveness of Text-Only Cigarette Health Warnings in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey

“…About one-quarter of smokers (29.7%) and dual users (20.6%) noticed the warnings-which is much lower than the percentage of smokers who noticed warnings in Australia (52.0%) and China (43.1%) at the time when these two countries had text-only warnings of a similar size as Japan's current warnings; and in the United Kingdom (44.0%) at the time when they had text-only warnings that were even smaller than Japan's current warnings [40,45]. The weak salience of Japan's text-only warnings is even more pronounced when compared to significant increases in smokers' noticing of warnings following the change from text-only to pictorial warnings in other countries, such as Malaysia (54 to 67%) [40], Thailand (62 to 70%) [46], and Mauritius (58 to 83%) [42].…”

“…But a more likely outcome over time is that the effectiveness of Japan's warnings would actually decrease because of the known phenomenon of "warning wear-out"-warnings become less effective over repeated exposures. ITC studies have documented warning wear-out in several countries, including Canada and the United States [61] and Mauritius [42]. Longitudinal studies would also be valuable to measure the likely increase in health warning effectiveness if Japan's text-only warnings are replaced with pictorial warnings, as called for by the WHO FCTC.…”

“…We used six measures that have been identified as key indicators of health warning effectiveness [35]. Previous research evaluating the impact of health warnings have used these measures, including studies conducted by the International Tobacco Control Policy Evaluation Project (ITC Project) in Canada, the United States, the United Kingdom, and Australia [36], Uruguay [37], Brazil [14], Mexico [38], Thailand [39], Malaysia [40], China [41], Mauritius [42], and six European countries (Germany, Greece, Hungary, Poland, Romania, and Spain) [43]. Studies have demonstrated that these key indicators of warning effectiveness are significant predictors of important outcomes, such as subsequent quit intentions and quit attempts [44].…”