BACKGROUND: By 30th April 2024, all king size cigarettes manufactured for Canada were required to have six rotating text warnings on cigarette stick filters, with this mandatory at the retail level by 1st August. Responses to this innovative policy have not been studied.
METHODS: In May, August, and November 2024, we surveyed an open cohort of Canadian adults who smoked king size cigarettes (n=1403 individuals; n=2425 observations). For the prior 30 days, participants reported how often they read stick warnings (never/rarely=0; sometimes/often/very often/all the time=1), how much the look of their cigarette made them think about smoking risks (not at all/a little=0; moderately/very much/extremely=1), and if the look of their cigarette made them forgo a cigarette (no=0; yes=1). Weighted logistic generalized estimating equation models regressed these outcomes on sociodemographic, smoking-related variables, and survey wave; in models for thinking about risks and forgoing, frequency of reading stick warnings was included as a covariate.
RESULTS: Reading stick warnings and forgoing a cigarette due to its look increased over time (AOR=1.50, 95% CI = 1.20-1.86; AOR=1.51, 95% CI = 1.15-1.98, respectively). Those who intended to quit smoking were more likely to read the stick warnings (AOR=1.73, 95% CI=1.35-2.21). Participants who read the stick warnings (AOR=5.93, 95% CI=4.60-7.64) and those who intended to quit smoking (AOR=2.03, 95% CI=1.56-2.64) were more likely to think about the health risks of smoking due to the look of their cigarettes. Those who read the stick warnings (AOR=6.22, 95% CI=4.78-8.09), intended to quit (AOR=2.14, 95% CI=1.60-2.86), or recently attempted to quit (AOR=1.69, 95% CI=1.23-2.33) were more likely to forgo a cigarette due to the look of their cigarettes.
CONCLUSIONS: Engagement with cigarette stick warnings was associated with greater thinking about smoking risks and forgoing cigarettes, a precursor of cessation attempts. Stick warnings may extend pack labeling policy effects.