Promoting cessation resources through cigarette package warning labels: a longitudinal survey with adult smokers in Canada, Australia and Mexico

Abstract

Introduction Health warning labels (HWLs) on tobacco packaging can be used to provide smoking cessation information, but the impact of this information is not well understood. Methods Online consumer panels of adult smokers from Canada, Australia and Mexico were surveyed in September 2012, January 2013 and May 2013; replenishment was used to maintain sample sizes of 1000 participants in each country at each wave. Country-stratified logistic Generalised Estimating Equation (GEE) models were estimated to assess correlates of citing HWLs as a source of information on quitlines and cessation websites. GEE models also regressed having called the quitline, and having visited a cessation website, on awareness of these resources because of HWLs. Results At baseline, citing HWLs as a source of information about quitlines was highest in Canada, followed by Australia and Mexico (33%, 19% and 16%, respectively). Significant increases over time were only evident in Australia and Mexico. In all countries, citing HWLs as a source of quitline information was significantly associated with self-report of having called a quitline. At baseline, citing HWLs as a source of information about cessation websites was higher in Canada than in Australia (14% and 6%, respectively; Mexico was excluded because HWLs do not include website information), but no significant changes over time were found for either country. Citing HWLs as a source of information about cessation websites was significantly associated with having visited a website in both Canada and Australia. Conclusions HWLs are an important source of cessation information.

Public health benefits from pictorial health warnings on US cigarette packs: a SimSmoke simulation

“…Accumulating research, however, indicates that compared with text-only warnings, PWLs are more effective for capturing smokers' attention,14–16 influencing perceived risks of smoking and attitudes towards smoking17 and motivating quit attempts,15 17–19 but also work directly to reduce smoking prevalence 19 20. Moreover, FDA estimates of the likely impacts of PWLs in the USA were based on their findings that PWLs had little impact on smoking in Canada 21.…”

The retail environment for tobacco: a barometer of progress towards the endgame

“…In a multicountry survey, pictorial warnings improve smokers’ awareness of quitlines and cessation websites, moreso when the information appeared on both the front and back panels 18. This issue includes the first pictorial warning about the economic impact of smoking which tested well with adolescents and young adults in Lebanon,19 and would likely resonate with other target audiences, particularly low-income smokers.…”

A comparison of on-pack Quitline information formats

“…Despite increase in the call numbers documented, reviews of Quitline awareness indicate that knowledge of contact numbers is not always high and question whether the current format is optimal 14 17 27. Our study examined this latter question by testing the relative effect of alternative Quitline information formats on New Zealand smokers’ perceptions, choices and projected behaviours.…”

“…Studies report that PWLs are significantly more effective than the text-only warnings they replaced, and those featuring highly graphic imagery are more effective than other warning themes 11 12. Since PWLs appear on cigarette packages, they have a longevity and utility that mass media advertising cannot match; they reach target audiences directly and efficiently and achieve very high reach and frequency at no cost to governments 13 14…”

“…As PWLs may create a strong negative effect that elicits maladaptive responses,15 they often appear alongside Quitline information, an approach that has significantly increased number recognition and stimulated calls from groups with higher smoking prevalence 14 16–19. To date, more than 20 countries have required tobacco packaging to feature Quitline contact details,20 and as more countries introduce PWLs, the potential to complement these with prominent cessation information is high.…”