Background
Health warnings on cigarette packages provide smokers with universal access to information
on the risks of smoking. However, warnings vary considerably among countries, ranging
from graphic depictions of disease on Canadian packages to obscure text warnings in
the United States. The current study examined the effectiveness of health warnings
on cigarette packages in four countries.
Methods
Quasi-experimental design. Telephone surveys were conducted with representative cohorts
of adult smokers (n=14,975): Canada (n=3687), United States (n=4273), UK (n=3634), and Australia (n=3381). Surveys were conducted between 2002 and 2005, before and at three time points
following implementation of new package warnings in the UK.
Results
At Wave 1, Canadian smokers reported the highest levels of awareness and impact for
health warnings among the four countries, followed by Australian smokers. Following
the implementation of new UK warnings at Wave 2, UK smokers reported greater levels
of awareness and impact, although Canadian smokers continued to report higher levels
of impact after adjusting for the implementation date. U.S. smokers reported the lowest
levels of effectiveness for almost every measure recorded at each survey wave.
Conclusions
Large, comprehensive warnings on cigarette packages are more likely to be noticed
and rated as effective by smokers. Changes in health warnings are also associated
with increased effectiveness. Health warnings on U.S. packages, which were last updated
in 1984, were associated with the least effectiveness.
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© 2007 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
