Louise Hassan about health warnings in the UK

Louise Hassan compares the UK warnings with Canada's graphic warnings.
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Effectiveness of Cigarette Warning Labels After Implementation of the FCTC Minimal Standard in the United Kingsom: Findings from the ITC Four Country Survey

David Hammond, PhD¹, Louise Hassan, PhD, BSc, (Hons)², Gerard Hastings, PhD², Pete Driezen, MSc³, and Geoffrey T. Fong, PhD⁴. (1) Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada, (2) Cancer Research UK Centre for Tobacco Control, University of Stirling & the Open University, Cottrell Building, Stirling, FK9 4LA, United Kingdom, (3) Population Health Research Group, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada, (4) Department of Psychology, University of Waterloo, 200 University Avenue West, 200 University Ave West, Waterloo, ON N2L 3G1, Canada

 

Objectives: The Framework Convention on Tobacco Control (FCTC) calls for warning labels covering at least 30% of the principal surfaces of the package, but recommends that they be 50% of the package and include pictorial images. In this study, we: 1) compared salience and self-reported effectiveness of health warnings in Australia, Canada, US, and UK during 2002–2005; 2) measured the impact of the 2002 enhancement of the UK warnings (to the FCTC minimum); and 3) tested whether warning impact varied on socioeconomic status (SES).

Methods: The ITC Four Country Survey is an annual cohort telephone survey of adult smokers in Australia, Canada, US, and UK (N about 2,000 in each country), which includes questions on each FCTC policy, including questions on warnings (e.g., salience, noticing, perceived effectiveness, linking warning labels to thinking about the risks of smoking, influence on quitting).

Results: The UK warning label enhancement increased label salience and perceived effectiveness. Comparing Canada's graphic warnings and the text-only UK warnings at a comparable point after implementation (Canada: 2002; UK: 2004) showed greater impact of the Canadian warnings on the more important measures (e.g., thinking about health risks, label stopped them from having a cigarette). Analyses of the moderating impact of SES (income) suggests that warnings may have greater impact among low-income smokers.

Conclusions: Enhancing warning labels in size, text, and graphic images enhance psychosocial variables that have been shown to be related to favorable behavioral changes (e.g., quit attempts). Including graphic elements may lead to more lasting impact.