Shannon Gravely1, Geoffrey T Fong2, Pete Driezen1, Mary McNally1, James F Thrasher3, Mary E Thompson4, Marcelo Boado5, Eduardo Bianco6, Ron Borland7, David Hammond8. 1. Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada. 2. Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada. 3. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA. 4. Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada. 5. Facultad de Ciencias Sociales, Universidad de la República, Montevideo, Uruguay. 6. Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay. 7. The Cancer Council Victoria, Melbourne, Victoria, Australia. 8. School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Abstract
BACKGROUND: Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness. METHODS: Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in five cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (prepolicy: wave 2) and 2010/11 (postpolicy: wave 3). RESULTS: Overall, 1746 smokers participated in the study at wave 2 (n=1379) and wave 3 (n=1411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly (noticing HWLs: OR=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<0.001; and reports that HWLs stopped smokers from having a cigarette 'many times': OR=3.42, p<0.001). CONCLUSIONS: The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness. METHODS: Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in five cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (prepolicy: wave 2) and 2010/11 (postpolicy: wave 3). RESULTS: Overall, 1746 smokers participated in the study at wave 2 (n=1379) and wave 3 (n=1411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly (noticing HWLs: OR=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<0.001; and reports that HWLs stopped smokers from having a cigarette 'many times': OR=3.42, p<0.001). CONCLUSIONS: The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Global health; Harm Reduction; Low/Middle income country; Packaging and Labelling
Authors: Ron Borland; Hua-Hie Yong; Nick Wilson; Geoffrey T Fong; David Hammond; K Michael Cummings; Warwick Hosking; Ann McNeill Journal: Addiction Date: 2009-02-10 Impact factor: 6.526
Authors: James F Thrasher; Matthew J Carpenter; Jeannette O Andrews; Kevin M Gray; Anthony J Alberg; Ashley Navarro; Daniela B Friedman; K Michael Cummings Journal: Am J Prev Med Date: 2012-12 Impact factor: 5.043
Authors: Hua-Hie Yong; Geoffrey T Fong; Pete Driezen; Ron Borland; Anne C K Quah; Buppha Sirirassamee; Stephen Hamann; Maizurah Omar Journal: Nicotine Tob Res Date: 2013-01-04 Impact factor: 4.244
Authors: Georges J Nahhas; David Braak; K Michael Cummings; Bryan W Heckman; Anthony J Alberg; Hua-Hie Yong; Geoffrey T Fong; Christian Boudreau; Sara C Hitchman; Ann McNeill Journal: Addiction Date: 2019-05-27 Impact factor: 6.526
Authors: Carla J Berg; James F Thrasher; Joaquin Barnoya; Joanna E Cohen; Wasim Maziak; Harry Lando; Jeffrey Drope; Raul Mejia; Kristie Foley; Rima Nakkash; Geoffrey T Fong; Linda E Kupfer; Rachel Sturke; Mark Parascandola Journal: Nicotine Tob Res Date: 2019-07-17 Impact factor: 4.244
Authors: Sandra Braun; Christy Kollath-Cattano; Inti Barrientos; Raúl Mejía; Paola Morello; James D Sargent; James F Thrasher Journal: Tob Control Date: 2015-10-01 Impact factor: 7.552
Authors: Paula Lozano; James F Thrasher; Melinda Forthofer; James Hardin; Luz Myriam Reynales Shigematsu; Edna Arillo Santillán; Nancy L Fleischer Journal: Nicotine Tob Res Date: 2020-01-27 Impact factor: 4.244
Authors: Farahnaz Islam; Ramzi G Salloum; Rima Nakkash; Wasim Maziak; James F Thrasher Journal: Int J Public Health Date: 2016-03-14 Impact factor: 3.380
Authors: Inti Barrientos-Gutierrez; Farahnaz Islam; Yoo Jin Cho; Ramzi George Salloum; Jordan Louviere; Edna Arillo-Santillán; Luz Myriam Reynales-Shigematsu; Joaquin Barnoya; Belen Saenz de Miera Juarez; James Hardin; James F Thrasher Journal: Tob Control Date: 2020-07-14 Impact factor: 7.552