Distribution of new graphic warning labels: Are tobacco companies following regulations?
Nick Wilson 1  
Jo Peace 1
Judy Li 1
Janet Hoek 2
James Stanley 1
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Department of Public Health, University of Otago, Wellington, New Zealand
Department of Marketing, University of Otago, Dunedin
Publish date: 2009-08-25
Tobacco Induced Diseases 2009;5(August):14
To test the hypothesis that tobacco companies would not follow a regulation that required seven new graphic health warnings (GHWs) to be evenly distributed on cigarette packs and that they would distribute fewer packs featuring warnings regarded by smokers as being more disturbing.

Cross-sectional survey of purchased packs (n = 168) and street-collected discarded packs (convenience sample of New Zealand cities and towns, n = 1208 packs) with statistical analysis of seven types of new GHWs. A priori warning impact was judged using three criteria, which were tested against data from depth interviews with retailers.

The GHWs on the purchased packs and street-collected packs both showed a distribution pattern that was generally consistent with the hypothesis ie, there were disproportionately more packs featuring images judged as "least disturbing" and disproportionately fewer of those with warnings judged "more disturbing". The overall patterns were statistically significant, suggesting an unequal frequency of the different warnings for both purchased (p < 0.0001) and street-collected packs (p = 0.035). One of the least disturbing images (of a "corpse with toe-tag") dominated the distribution in both samples. Further analysis of the street-collected packs revealed that this image appeared disproportionately more frequently on manufactured cigarettes made by each of the three largest New Zealand tobacco companies. Although stock clustering could explain the purchase pack result, there were no obvious reasons why the same uneven warning distribution was also evident among the street-collected packs.

These results suggest that tobacco companies are not following the regulations, which requires even distribution of the seven different GHWs on cigarette packs; further monitoring is required to estimate the extent of this non-compliance. As an immediate measure, governments should strictly enforce all regulations applying to health warnings, particularly given that these are an effective tobacco control intervention that cost tax payers nothing.

1. New Zealand Government: Smoke-free Environments Regulations 2007 [Part 2, R 11, 1 (b)]. 2007, [].
2. British American Tobacco (NZ): BAT's Submission to the Ministry of Health Consultation Paper on the Review of the Smoke-free Environments Regulations. 2004, Auckland: British American Tobacco (NZ), 23.
3. Ministry of Health: Tobacco Control and Smoking. The New Warnings. Wellington: Ministry of Health, 2008. [].
4. Hoek J, Louviere J, Gendall P: Three evaluations of pictorial warning labels on cigarette packages. Paper presented at the American Marketing Association Marketing and Public Policy Conference. Washington DC, June 1–3. 2007.
5. Norton K, Wilkins K, O'Connor R: New Zealand tobacco product testing. 2008, Buffalo: New York State: Roswell Park Cancer Institute, [].
6. Thomson G, Wilson N: The tobacco industry in New Zealand: A case study of the behaviour of multinational companies. 2002, Wellington: Wellington School of Medicine & Health Sciences, University of Otago, [].
7. Shanahan P, Elliott D: Evaluation of the effectiveness of the graphic health warnings on tobacco product packaging 2008. 2009, Canberra: Australian Government, Department of Health and Ageing, [].
8. Hammond D, Fong GT, McNeill A, Borland R, Cummings KM: Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006, 15 (Suppl 3): iii19-25. 10.1136/tc.2005.012294.
9. Borland R, Yong HH, Wilson N, Fong GT, Hammond D, Cummings KM, Hosking W, McNeill A: How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey. Addiction. 2009, 104: 669-675. 10.1111/j.1360-0443.2009.02508.x.
10. Callard C, Thompson D, Collishaw N: Transforming the tobacco market: why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate. Tob Control. 2005, 14: 278-283. 10.1136/tc.2005.011353.
11. Borland R: A strategy for controlling the marketing of tobacco products: a regulated market model. Tob Control. 2003, 12: 374-382. 10.1136/tc.12.4.374.
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