Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study
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College of Medicine and Dentistry, James Cook University, Townsville, Australia
Aaron Drovandi   

College of Medicine and Dentistry, James Cook University, Townsville, Australia
Publish date: 2019-03-28
Tob. Induc. Dis. 2019;17(March):23
Innovations 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 cigarettestick warnings across four countries.

An 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.

Participants (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.

The 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.

The authors would like to thank Rhondda Jones from the Division of Tropical Health and Medicine at James Cook University for her assistance in the analysis of the data in this study.
Authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
This work was supported by an Australian Government Research Training Program Scholarship and by research grants provided by the College of Medicine and Dentistry, James Cook University.
AD designed the survey and wrote the ethics application. BG and BMA reviewed the survey and assisted in preparation of the ethics application. AD and BMA analysed the data. AD wrote the manuscript, and PAT and BMA reviewed the final draft of the manuscript.
Not commissioned; externally peer reviewed.
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