Gera E Nagelhout1, Marc C Willemsen1, Hein de Vries2, Ute Mons3, Sara C Hitchman4, Anton E Kunst5, Romain Guignard6, Mohammad Siahpush7, Hua-Hie Yong8, Bas van den Putte9, Geoffrey T Fong10, James F Thrasher11. 1. Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Dutch Alliance for a Smokefree Society, The Hague, The Netherlands. 2. Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands. 3. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Unit Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany. 4. UK Centre for Tobacco and Alcohol Studies (UKCTAS), London, UK Department of Addictions, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK. 5. Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 6. French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France. 7. Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA. 8. VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Carlton, Victoria, Australia. 9. Department of Communication, University of Amsterdam (ASCoR), Amsterdam, The Netherlands Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands. 10. Department of Psychology, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada. 11. Department of Health Promotion, Education and Behaviour, University of South Carolina, Columbia, South Carolina, USA Department of Tobacco Research, Mexican National Institute of Public Health, Cuernavaca, Mexico.
Abstract
OBJECTIVE: To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. METHODS: Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. FINDINGS: Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). CONCLUSIONS: The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. 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/
OBJECTIVE: To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. METHODS: Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. FINDINGS: Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). CONCLUSIONS: The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. 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:
Packaging and Labelling; Public policy; Socioeconomic status
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