Quasi-experimentally examining the impact of introducing tobacco pictorial health warnings: Findings from the International Tobacco Control (ITC) 4C and Netherlands surveys in the Netherlands, Australia, Canada, United Kingdom, and the United States

Source:

van Mourik, D. J. A., Nagelhout, G. E., de Vries, H., van den Putte, B., Cummings, K. M., Borland, R., ... & Willemsen, M. C. (2020). Quasi-experimentally examining the impact of introducing tobacco pictorial health warnings: Findings from the International Tobacco Control (ITC) 4C and Netherlands surveys in the Netherlands, Australia, Canada, United Kingdom, and the United States. Drug and Alcohol Dependence, 207, 107818.

Highlights

•This is the first quasi-experimental study to evaluate the impact of tobacco pictorial health warnings (PHWs) required by the European Union.

•Introducing PHWs appeared to be effective in increasing health warning salience, avoidance of warnings and knowledge about smoking health risks.

•Outcomes more closely related to quitting smoking (attitude, intention, self-efficacy) did not seem to be directly influenced by PHWs.

•After introducing PHWs there was a stronger increase among high educated smokers in avoidance of warnings and cognitive response to warnings.

•Low educated smokers showed a stronger increase in knowledge about smoking health risks.

 

Abstract

Background

Our study evaluated the short-term impact of introducing European Union’s tobacco pictorial health warnings (PHWs).

Methods

Longitudinal data were collected at two time-points from adult smokers, participating in the International Tobacco Control (ITC) surveys, conducted in the Netherlands, Australia, Canada, the United Kingdom and the United States. In the Netherlands, textual health warnings (THWs) were replaced by PHWs between both time-points. Health warning policies did not change in the other countries. Data from continuing smokers were used (N = 3,487) and analyzed using Generalized Estimating Equations.

Results

Between both time-points, only Dutch smokers showed increases in noticing health warnings (β = 0.712, p < 0.001), self-reports of health warnings leading to a cognitive response such as thinking about smoking health-risks (SHRs) (OR = 1.834, p < 0.001), knowledge about SHRs (β = 0.369, p < 0.001), and avoiding health warnings (OR = 9.869, p < 0.001). However, Dutch smokers showed no changes in attitude towards smoking (β = 0.035, p = 0.518), intention to quit smoking (OR = 0.791, p = 0.157), self-efficacy to quit smoking (β=-0.072, p = 0.286), or reporting that health warnings helped them to resist having a cigarette (OR = 1.091, p = 0.714).

Conclusions

Results suggest that introducing the European PHWs was effective in provoking changes closely related to health warnings, but there was no direct impact on variables more closely related to smoking cessation.