烟盒包装图形健康警示有效性评估

目的通过实验性研究,评估原卫生部设计的健康警示图形与中外现行烟包健康警示的有效性。方法在北京、绍兴共调查600人。12种模拟烟盒以中华烟为背景制作,包含原卫生部设计的10种健康警示图形、1种澳大利亚现行图形警示以及中国现行文字警示。调查对象针对健康警示是否能够有效促使吸烟者戒烟和阻止青少年开始吸烟两方面对12种健康警示分别进行评价。结果澳大利亚全警示烟盒包装在促进戒烟[(4.09±1.17)分,F=157.10,P0.01]和阻止尝试吸烟[(4.13±1.13)分,F=166.53,P0.01]2个方面都被评价为最有效,其次是原卫生部的10种图形警示,中国现行文字警示有效性评价得分最低。结论图形警示有效性远远强于文字警示,可以有效地向公众宣传吸烟、二手烟危害。     

烟盒健康警语对6个城市吸烟者警示效果分析

目的 了解现行的烟盒包装健康警语对北京、沈阳、上海、长沙、广州、银川等6个城市吸烟者的警示效应.方法 采用多阶段抽样方法 ,在6个城市抽取4 815名成年吸烟者进行人户调查,测量健康警语对其的警示效应,采用多因素Logistic回归分析健康警语对吸烟者警示作用的影响因素.结果 6个城市调查对象中男性占94.9%.警示效应平均得分为1.38分(≥2分为有警示作用);过去1个月经常因健康警语而没有吸烟的比例为2.15%;只有13.31%的吸烟者会在吸烟时回避健康警语;因健康警语而经常考虑吸烟对健康危害的比例为8.26%,因烟盒上的健康警语很想戒烟的比例为5.29%.多因素分析提示,不同城市和吸烟时间长短是警语对吸烟者警示效应的影响因素.结论 现行的烟盒健康警语已经失去应有的警示效应.6城市中大部分吸烟者不会回避烟盒上的健康警语或因健康警语而停止吸烟.也不会因警语而经常考虑吸烟危害或很想戒烟.     

关于烟盒包装及警示烟盒推广分析

查找大量文献资料进行数据比对,并对国内外烟盒包装的现况和警示烟盒的推广效果进行统计分析。经对比发现,国外大部分国家在烟盒上添加警示图片,且警示图片面积均高达百分之40%及以上,警示效果优于警示文字,吸烟率远低于中国,而中国烟盒包装仅有的警示文字的警示效果不明显。建议中国严格按照《烟草控制框架公约》有关规定,推广带有警示图片的烟盒,向烟草消费者充分宣传吸烟的危害性,以达到警示的效果,降低吸烟率,共同建设无烟健康环境。     

烟草包装对上海市居民健康警示效应调查

目的了解公众对警示包装的知晓程度以及图片警示在公众中的警示效应,评价这一控烟措施的有效性和可行性。方法采用多阶段整群抽样方法选取上海市某区居民2300人,包括吸烟者和非吸烟者,进行人户调查,采用自填式问卷调查。结果76．7％的居民知道我国现有的烟盒上印有健康警示。79．6％的公众认为图片警示可以减少吸烟者的吸烟量;78．7％的公众认为图片警示可以防止青少年吸烟;72．9％的公众认为图片警示可以减少人们之间互相递烟的行为。相对于不知道和没注意过烟包警示的人群,知道烟包警示的人更支持更换图片警示,OR值为1．43（95％CI：1．09～1．88）;和非吸烟者相比,吸烟者和戒烟者支持更换图片警示比例较低,OR分别为0．22（95％CI：0．17～0．28）和0．38（95％CI：0．23～0．60）。结论疾病图片警示可以在公众中产生广泛的警示效应,公众对更换图片警示包装呈支持态度。     

《烟草控制框架公约》第11条实施准则循证依据

烟盒包装健康警示是最有效的公众烟草健康危害信息来源之一。大多数吸烟者表示,除电视外,烟盒包装是他们获得吸烟危害信息的最重要途径^[1]。与其他方式相比（如付费的媒体广告）,健康警示是极为经济的炯草危害宣传方式。     

世界卫生组织敦促我国在烟盒上印图形警示

<正>据新华社电,"吸烟有害健康"是我国烟草广告和烟盒上很不起眼的警示语。4月8日世界卫生组织(WHO)与国际烟草控制政策评估项目(ITC)在北京提出,这几个字几乎未起到警示作用,而在烟盒上印制图形警示才是鼓励吸烟者戒烟的有效方式。世界卫生组织与国际烟草控制政策评估项     

六城市吸烟者对烟草危害的认知现状

目的了解北京、沈阳、上海、长沙、广州、银川等6城市吸烟者对烟草危害的认知现状，为我国制定新的烟盒健康警语提供依据。方法采用多阶段抽样法，在6城市抽取4815名成年吸烟者进行入户调查，计算其对吸烟健康危害相关知识的知晓率，用多因素Logistic回归分析研究影响吸烟者对烟草健康危害认知的影响因素。结果调查对象中男性占94．9％。75．5％的调查对象认为吸烟有害健康，知道吸烟可以导致吸烟者和被动吸烟者患肺癌的比例分别为68．1％和53．0％，但是知道吸烟可以导致中风、阳痿以及知道低焦油卷烟同样有害的人所占比例较低，分别为16．0％、16．6％和17．2％。多因素Logistic回归分析发现，看到健康警语的频率以及是否仔细阅读健康警语都不会影响吸烟者对吸烟有害健康的认知。结论中国的烟盒包装上应设置为可轮换且有针对性的健康警语，而不是笼统的“吸烟有害健康”等在人群中已经接近饱和的健康信息。     

烟草包装对上海不同职业人群的警示效应分析

目的比较烟草包装的图片警示与我国现有文字警示的警示效应,评价不同人群对烟草图片警示控烟措施的支持态度以及该措施的可行性。方法采用目的抽样的方法,在上海市3个区选取4组不同人群共789人:进城务工人员、在校大学生、幼儿园家长以及医务人员。采用自填式问卷调查,分析烟草包装对于不同人群的警示效应。结果 93.7%的调查对象对于我国烟草包装使用大幅疾病图片予以支持。98.2%的调查人群能够从烟草包装的疾病图片有效获取信息,55.1%的对象能够获得全部有效信息。如果采用图形警示,83.9%的现在吸烟者表示愿意减少吸烟量,48.4%的现在吸烟者考虑戒烟。结论现有的烟草警示已经无法起到警示作用,疾病图片警示可以在不同的人群中产生广泛的警示效应,并得到广大公众的认可。     

福建省开展烟包健康警示图展览活动效果评价

目的评估2012年福建省开展的烟包健康警示图展览活动的效果。方法采用统一的《烟包健康警示图片展览活动效果评估问卷》,在全省各地市巡展活动现场用方便抽样的方法对观展人员进行拦截调查。结果调查957人,吸烟者全部为男性,男性吸烟率为32.38%,观看展览前,男性不吸烟者对于吸烟及吸二手烟能导致的危害的认知情况总体来说高于男性吸烟者(P<0.01);有关吸烟导致疾病的知识知晓率参观前为77.85%,参观后为94.98%(P<0.01);有关二手烟导致疾病的知识知晓率参观前为76.59%,参观后为93.73%(P<0.01);60岁以下年龄者提高效果更为显著;支持在中国大陆烟盒上放置警示图片的占86.10%,已戒烟或不吸烟者支持率高于吸烟者(P<0.01)。结论烟包健康警示图片对于提高居民对吸烟和被动吸烟危害的认识是非常有效的。进行大规模的烟包健康警示图展览活动,呼吁健康警示图片上烟包是我国目前控烟的重要策略之一。     

重庆市城市男性吸烟者戒烟意愿及其影响因素分析

目的探讨重庆市城市男性吸烟者的戒烟意愿及其影响因素。方法在重庆市主城区采取横断面多阶段抽样法,对435名男性吸烟者进行问卷调查。运用单因素X~2检验和多因素logistic回归分析方法检验吸烟者的戒烟意愿影响因素。结果重庆市主城区男性吸烟者44.83%的吸烟者有戒烟意愿;最近一个月是否注意到烟盒上的警示语、家庭吸烟规定、是否因目前烟价贵而减少吸烟、是否有过3次以上的戒烟经历是影响吸烟者戒烟意愿的主要因素。结论吸烟者的戒烟意愿受主观认识和客观环境的影响,戒烟行动应当受到吸烟者个人和社会的共同关注,可从培养吸烟者的健康意识、扩大健康宣传、大幅度提高烟草税率、夸张表现烟盒上的警示语以及社会和家庭的共同支持几个方面来提高吸烟者的戒烟意愿。     

Adolescents' Perceptions of Cigarette Brand Image: Does Plain Packaging Make a Difference?

PurposeTo examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.MethodsWe used a 5 (degree of plain packaging and graphic health warning)× 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.ResultsWhen brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.ConclusionsRemoving as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced.     

Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study

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.     

Cigarette pack labelling in 12 countries at different levels of economic development

With increasing restrictions on cigarette marketing, the cigarette pack itself has become a main means of marketing. We describe a method to examine cigarette labelling and use it to evaluate packs collected from 12 countries at different stages of economic development. Health warnings were present on all 115 packs of cigarettes examined, but were on the front and back panels of only 68 per cent. Promotional labels were widespread, found on packs from all countries and more numerous (although not necessarily larger) than health warning labels in 10 of the 12 countries. Deceptive terms such as 'light' and 'mild' were observed on 42 per cent of all packs examined. The simple method described here can be used to compare cigarette labelling and potentially evaluate and track the implementation of cigarette labelling policy. We found health warning legislation poorly enforced and cigarette packs widely used to promote smoking and deceive smokers about health risks. The findings underline the need for generic (plain) packaging.     

Estimating the impact of pictorial health warnings and “plain” cigarette packaging: Evidence from experimental auctions among adult smokers in the United States

Objective

To estimate differences in demand for cigarette packages with different packaging and health warning label formats.

Methods

Adult smokers (n = 404) in four states participated in experimental auctions. Participants bid on two of four experimental conditions, each involving a different health warning label format but with the same warning message: (1) text on 50% of pack side; (2) text on 50% of the pack front and back; (3) text with a graphic picture on 50% of the pack front and back; and (4) same as previous format, but without brand imagery.

Results

Mean bids decreased across conditions (1: $3.52; 2: $3.43; 3: $3.11; 4: $2.93). Bivariate and multivariate random effects models indicated that there was no statistically significant difference in demand for packs with either of the two text only warnings; however, demand was significantly lower for both packs with prominent pictorial warnings, with the lowest demand associated with the plain, unbranded pack.

Conclusions

Results suggest that prominent health warnings with graphic pictures will reduce demand for cigarettes. Regulators should not only consider this type of warning label, but also plain packaging policies for tobacco products.     

Evaluating the Emotional Impact of Warning Images on Young Adult Smokers and Susceptible Non-Smokers

On-pack tobacco warnings typically feature long-term health risks, which many young adults rationalize or reject. We examined the emotions generated by more proximal warnings to see if we could identify common features among the most effective warnings. Respondents in a sample of 474 smokers and 476 susceptible non-smokers used a modified Geneva Emotion Wheel (GEW) to assess cigarette packs displaying 12 test warnings and one current warning. The strongest emotions aroused in smokers were disgust, disappointment, and regret. Three warnings showing the effect of smoking on babies and animals had significantly higher emotional potency scores than a current health warning. Among susceptible non-smokers, warnings showing harm to animals, child labor, and a dying smoker had the highest emotional potency. Stronger negative emotions were elicited from both smokers and susceptible non-smokers by warnings that featured more proximal outcomes than are typically shown in on-pack tobacco warnings. On-pack warnings that resonate with young people, the group most at risk of smoking and most likely to benefit from quitting, could promote cessation and deter initiation more effectively than warnings depicting long-term health outcomes. The GEW could be used to screen potential warning images to identify those most likely to be worth evaluating.     

Reactions of young adult smokers to warning labels on cigarette packages

BACKGROUND: In 1984, the United States Congress enacted legislation requiring four new warning labels for cigarettes; warning labels in the United States have not changed since then. Other countries, such as Canada, have taken a more active and aggressive approach. The purpose of this study was to examine how U.S. smokers and former smokers might respond to stronger and more graphic warnings for U.S. cigarettes packages. METHODS: Data were collected in 2003 and analyzed in 2004. The perceived impact and effectiveness of the more-explicit Canadian labels was examined among young adult smokers (n=572) and former smokers (n=191) between the ages of 18 and 24 years in the United States, using a web-based survey that allowed participants to view both the text-only and the text-plus-graphic warning labels. RESULTS: Both current and former smokers thought that cigarette warning labels with text plus graphics were substantially more of a deterrent than text-only labels. The perceived effectiveness of these labels was not only higher overall, but also for the specific areas of smoking-related health effects, prevention, cessation, and maintenance of abstinence. Few differences were noted by gender. CONCLUSIONS: The findings from this study support previous research that has found that text-plus-graphic warning labels are more salient and potentially more effective than text-only labels.     

The new EU cigarette health warnings benefit smokers who want to quit the habit: results from the Dutch Continuous Survey of Smoking Habits

BACKGROUND: As of September 2004, all European Union countries are required to have new health warnings on cigarette packs. This study examined the self-perceived impact of these warnings on the attractiveness of cigarettes, smokers' motivation to quit and smoking behaviour. METHODS: This was a cross-sectional study comprising 3937 Dutch adult smokers. RESULTS: Of smokers, 14% became less inclined to purchase cigarettes because of the new warnings, 31.8% said they prefer to purchase a pack without the new warnings, 17.9% reported that warnings increased their motivated to quit and 10.3% said they smoked less. A strong dose-response relationship was observed between these effects and intention to quit. CONCLUSIONS: The new warnings made cigarette packs less attractive, especially to smokers who already intended to stop smoking.     

Australian University Student Perceptions of Health Messages on Cigarette Sticks

ABSTRACT

University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on individual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and individual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings (divided into four themes; immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on individual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (n = 479; Mean age = 22 years) rated three themes (ISC, LMC, and SFC) as being overall more effective (all p < .001) than current packaging warnings (Odds Ratios = 5.93 [4.51–7.80], 3.60 [2.79–4.64], and 2.86 [2.21–3.69] respectively). Participants described a desensitisation to current packaging warnings, and the novel warnings displayed potentially overcoming this issue, with over 85% agreeing that individual cigarette sticks should include health warnings. Health warnings on cigarette sticks may serve as an effective means in reducing tobacco use, with the provision of this additional intervention for communicating the health and other negative consequences of smoking likely reinforcing the effects of current packaging warnings.     

Public preferences for an attribution to government or to medical research versus unattributed messages in cigarette warning labels in Israel

The history of cigarette warning labels is fraught with dispute, and in many instances official anti-smoking warnings that appear on cigarette packets are the result of political compromise. Despite mixed findings on the effectiveness of these warning labels, they are viewed as a cost-effective anti-smoking measure by their mere presence and as an important part of larger anti-smoking efforts. Israel's Ministry of Health, in its recent initiative to introduce a new series of warning labels, has grappled with the attribution issue. A committee established by the Ministry to revise the warnings decided to survey public opinion to guide its decision regarding to whom warnings should be attributed and to counter tobacco lobby oppositions. Two surveys were conducted: a limited phone survey of the adult population (n = 1000) and a face-to-face survey of 200 adult smokers. Findings indicate there was little support for unattributed warnings and that smokers, when presented with actual warnings, tended to favor the attribution to "medical studies." Nonsmokers were somewhat more likely to prefer an attribution to the Ministry of Health, explaining that it is "responsible for the topic" or "has the authority." Attributional preferences were found to be associated to some extent with educational level. Discrepancies found between preferences of light smokers across the 2 surveys suggest that the method of preference elicitation may play an important role. The discussion of the attributional preferences draws from the persuasion literature and it is suggested that warning messages should be matched with selected sources.