Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study

Abstract

INTRODUCTIONInnovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries.METHODSAn online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis.RESULTSParticipants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings.CONCLUSIONSThe findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.

Consumer Response to Standardized Tobacco Packaging in the United Kingdom: A Synthesis of Evidence from Two Systematic Reviews

“…Five of the studies raised minor methodological concerns 22 , 24–26 , 29 and two major methodological concerns. 27 , 28 Table 2 summarizes the direction of effect and/or key findings for the results of the studies.…”

“…Increase in warning salience at Wave 2 was greater in England than in other six countries. Drovandi et al 27 Cross-sectional online survey Jun 2018 (approx. one year after end of transition period) Smokers 19–74 years UK, Australia, Canada, USA n=155 UK n=532 other countries Smokers in UK (UK standardized packs) vs smokers in Australia, Canada, USA (each countries’ own packs) Favors UK standardized packs (perceived effectiveness of warnings in prompting smokers to quit).…”

Extending health messaging to the consumption experience: a focus group study exploring smokers’ perceptions of health warnings on cigarettes

“… 2018 ; Drovandi et al. 2019a , 2019b , 2019c ). Given that some participants suggested that they would switch to rolling tobacco or use rolling tobacco papers to cover warnings on cigarettes, research with smokers of rolling tobacco would be fruitful, particularly in markets where this product has a significant share of the tobacco market.…”

“…It is also possible that the findings were influenced by socially desirable responding. As wear-out is an issue with all warnings (Fischer et al 1993), with habituation raised within the groups, future research should consider additional, appropriate warning messages (Drovandi et al 2018;Drovandi et al 2019aDrovandi et al , 2019bDrovandi et al , 2019c. Given that some participants suggested that they would switch to rolling tobacco or use rolling tobacco papers to cover warnings on cigarettes, research with smokers of rolling tobacco would be fruitful, particularly in markets where this product has a significant share of the tobacco market.…”

Influence of health warnings present on cigarette packets, on motivation to quit smoking, among smokers in a slum of Kolkata

“…18 According to a study by Drovandi et al, done in Australia, Canada, UK and US smokers found cigarette packet warning minimally effective in prompting smokers to quit. 19 In a systemic review done by Noar et al, it was found that with strengthening the cigarette pack warnings cigarette consumption decreased in three of the eight studies, quit attempt increased in four of the seven studies and smoking prevalence decreased in six of the nine studies. 20 In the present study also it was found that 84.8% of the subject had no effect of HW on their smoking habit.…”