12A.5 What has been the impact of pictorial health warnings in Australia?

Last updated: July 2019     

Suggested citation:Scollo, M., Hippolyte, D. & Miller, C. 12A.5 What has been the impact of graphic health warnings in Australia?  In Scollo, MM and Winstanley, MH [editors].  Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2019. Available from: https://www.tobaccoinaustralia.org.au/chapter-12-tobacco-products/attachment-12-1-health-warnings/12a-5-the-impact-of-2006-warnings-in-australia

Australia implemented two rounds of graphic health warnings, one in 2006 and another in 2012. A large group of studies have examined the impact of the 2006 warnings in Australia. A smaller group of studies has examined the impact of the 2012 warnings. This section examines the findings of these studies on the impact of the health warnings in Australia.

12A.5.1 The impact of the 2006 warnings in Australia

Studies on the impact of the 2006 warnings in Australia include: studies of tobacco industry behaviour and media coverage concerning the new health warnings; 1-3 a study of the impact of the warnings on adolescent smoking-related beliefs and behaviours, a study of changes in awareness of warning-related health effects and motivation to quit among Victorian 4, 5 and South Australian smokers; 6 impact of the effects of the new warnings (which include the Quitline number) on use of the Quitline; 7 assessment of the impact of warnings on smokers in the Australian arm of the International Tobacco Control Policy Evaluation study; 8 and a comprehensive set of focus group studies and interviews commissioned by the Australian Government. Findings from each of these studies as well as data on motivators to change smoking behaviour from the National Drug Strategy Household Survey 9, 10 are summarised below.

12A.5.1.1 Miller et al and other implementation studies

Shortly before the implementation date for new graphic health warnings in 2006, one tobacco manufacturer sold products in ‘retro’-tins from which the label could easily be removed. 1 It is unknown how many smokers kept these tins for future use (allowing cigarettes to be stored in cases without the new health warnings).

Figure 12.1.5.1

Figure 12.1.5.1
Retro tin cigarette case marketed shortly before the introduction of the new warnings

Source: M Swanson, National Heart Foundation Australia 1

Miller et al 2 monitored the roll-out of the health policy initiative using multiple methodologies. They observed that plans by government to introduce graphic warnings were delayed up to two years, apparently by heavy industry lobbying. Print media coverage of new pack warnings was observed over three years. The balance of coverage was overwhelmingly positive: of the 67 media stories, 85% were positive or neutral about the new warnings and 15% were negative. 2  Supportive content presented health benefits, while unsupportive content presented industry arguments. An observational study of a small random sample of metropolitan stores over seven months measured the pace of the roll-out in shops. After the legislative change, it took two months before any new packs appeared in stores. After six months, the majority carried them. 2  A similar study conducted in 40 shops in Sydney 3 found that in July 2007 (sixteen months after the introduction date) 70% of shops were still selling tobacco products with the old health warnings. Once new packs were readily available in stores, smokers were intercepted in city streets in Adelaide and asked about their reactions. Newest images had highest recall among smokers. Smokers’ initial reactions were in line with tobacco control objectives. About 60% said new warnings detracted from the look of their brand. About 51% reported feeling at increased risk of dying from smoking-related illness. About 38% felt motivated to quit. 2  

12A.5.1.2 White, Webster and Wakefield study of Victorian adolescents

To assess the impact of the introduction of graphic health warnings among adolescents at various stages of smoking uptake, White, Webster and Wakefield conducted surveys of students at year levels 8 to 12 in greater metropolitan Melbourne in 2005 and approximately six months after the introduction of the graphic health warnings in 2006. 11 At baseline, 72% of students had seen cigarette packs in the previous six months, while at follow-up 77% had seen packs and 88% of these had seen the new warning labels. They found that awareness of smoking as a cause of gangrene and mouth cancer (both not covered before in previous health warnings) increased substantially among students at all stages of smoking uptake. Cognitive processing of warning labels increased, with students more frequently reading, attending to, thinking and talking about warning labels at follow-up. Experimental and established smokers thought about quitting and forgoing cigarettes more at follow-up. At follow-up intention to smoke was lower among those students who had talked about the warning labels and had forgone cigarettes compared to those who had not.

12A.5.1.3 Brennan et al Victorian and Miller et al South Australian household survey studies

As described in Section 12A.2 , graphic health warnings for tobacco products sold in Australia were introduced in 2006, covering cigarette packs and their cartons, and packaging for roll-your-own and pipe tobacco. The warnings for cigarette packs were introduced in two stages, with Set A warnings covering gangrene, emphysema, mouth and throat cancer, clogged arteries, illness in children, improvement of health with quitting and scale of deaths (smoking... a leading cause of death) appearing for sale from mid-2006 12 and Set B warnings appearing for sale from early 2007 13 and covering lung cancer, heart disease, blindness, stroke, effects on unborn child, addictiveness of smoking and toxicity of tobacco smoke.

In a Victorian study, 4 telephone surveys of two cross-sections of adult smokers measuring changes in top-of-mind awareness of smoking-related health effects from before (2005) to after (2006) the pack warnings were introduced, showed that the proportion of smokers aware that gangrene is caused by smoking increased by 11.2%, and awareness of the link between smoking and mouth cancer increased by 6.6%. In contrast, awareness of throat cancer decreased by 4.3%, an illness mentioned in the pack warnings but not the advertisements. People who were identified as smokers in the target market for the Government’s advertising campaign (low-SES smokers 18 to 44 years) were interviewed about their cognitive and emotional responses and intentions to quit after they had watched one of the campaign advertisements, comparing outcomes of those with and without prior exposure to the pack warnings. Smokers who had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions. Study authors concluded that television advertisements and pictorial health warnings on cigarette packets may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit.

Another Victorian study 5 showed a significant increase among smokers in the salience of smoking-related illnesses primarily in the Set B warnings between 2006 and 2007.

Lung cancer was the most frequently spontaneously identified smoking related illness (50%), and spontaneous recall of this illness increased from 2006 (42%). Thirty-four per cent of Victorian smokers spontaneously identified heart disease/heart attack as smoking caused illness, which was a trend towards an increase from 2003 (25%). Stroke/vascular disease (Set B) was spontaneously identified as a smoking related illness by 14% of smokers in 2007 and this was a significant increase from 2006 (8%). Top of mind awareness of eye problems increased significantly amongst smokers to 8% (from 3% in 2006). Spontaneous recall of pregnancy complications as smoking related illness showed a trend towards an increase from 0.3% in 2006 to 2% in 2007. By contrast, smokers showed very low levels of top-of-mind awareness for mouth cancer (12%), throat cancer (11%), and gangrene (6%) which were the subject of the Set A graphic health warnings. 12 The lower levels of awareness of the Set A health warnings following a period of non-exposure suggests that the impact of these warnings appears to stabilise or dissipate after a period of non-exposure. The one exception was the high proportion of Victorians who accepted the link between passive smoking and a range of illnesses, including asthma (Set A), SIDS (Set A), and pneumonia in children (Set A), which increased significantly between 2006 and 2007. This may in part have been due to the introduction of the smoking bans in hospitality venues and other media or public health activity surrounding this policy initiative.

Miller et al also made use of annual household surveys to evaluate the effects of health warnings in South Australia. 6 Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005, 2006, 2007 and 2008. Unprompted recall of new graphic cigarette warnings was high in the months following their introduction. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images.

12A.5.1.4 Miller et al study of impact on Quitline

Miller et al 7 monitored calls to the Australian Quitline over four years, two years before and after the new packets were introduced. They recorded twice as many calls to the Quitline in 2006 (the year of introduction), as there were in each of the preceding two years. The observed increase in calls exceeds that which is explained by the accompanying television advertising alone. While call volume tapered back in 2007, it remained higher than before the introduction of new packets. No change was observed in the proportion of first time callers.

12A.5.1.5 International Tobacco Control Policy Evaluation study

The impact of the graphic health warnings in Australia was assessed by comparing several indicators of impact among smokers in Australia with those of (i) UK smokers exposed to the larger-than previous text-based warnings introduced in 2003; (ii) and Canadian smokers exposed to graphic warnings introduced in 2000. 8 Indicators measured over the five waves of the surveys (2002 to 2006) were: pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings. All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, Australian graphic warnings stimulated more cognitive responses than the UK (text-only) changes and were avoided more. A further study prospectively examined the impact of health warnings on quitting activity. 14  – See Section 12A.3 for further details.

12A.5.1.6 Shanahan and Elliot review for the Australian Government

In 2009, a report by Patrick Shanahan and David Elliott prepared on behalf of the Australian Government Department of Health and Ageing was released (‘the Elliott and Shanahan Research report’). 15 The intention of the report was to evaluate the effectiveness of health warnings (both graphic and accompanying explanatory messages) in increasing knowledge of the health effects of smoking, encouraging cessation of smoking and discouraging smoking uptake or relapse. The report also included comparisons with the impact of previous text-only warnings using data collected after the introduction of these warnings in 2006 and documented in Elliot and Shanahan’s report in 2000. 16

12A.5.1.6.1 Methodology

The research conducted in preparing the Elliott and Shanahan Research report included:

  • a literature review of graphic health warnings in Australia and overseas
  • qualitative and quantitative research of the effectiveness of graphic health warnings and explanatory messages on tobacco product packaging including:
    • group discussions (with 24 qualitative target audience groups divided into eight groups of committed smokers, six groups of recent quitters, i five groups of contemplators ii and five groups of non-smokers)
    • a national telephone survey (of 1304 individuals)
    • stakeholder interviews (28 key informants from organisations involved in tobacco control).

For further information on the methodology used, see Section 3: Methodology p33–7.

12A.5.1.6.2 Report findings

Awareness of health warnings

Two out of three people involved in the telephone survey were aware of changes to tobacco and cigarette packaging made in the preceeding two years. More than one third of adult non-smokers could recall at least one specific warning. Awareness was particularly high among smokers (86%) and recent quitters (80%).

There was a decrease in the number of smokers who were aware of health messages and information on the front (from 98% in 2000 to 91% in 2008) and side (from 67% in 2000 to 46% in 2008) of the cigarette pack. However, there was an increase in the awareness of warnings and information on the back of the pack (from 62% in 2000 to 73% in 2008). A similar pattern was observed with non-smoker groups.

Readership

Readership of health information (text) among smokers and recent quitters is shown in Table A12.1.5.1.

Table A12.1.5.1
Change in readership of front, back and side of Australian cigarette packets, 2008 compared to 2000

Year

Front

Back

Side

 

Smokers

Recent quitters

Smokers

Recent quitters

Smokers

Recent quitters

2000

93%

92%

57%

45%

58%

47%

2008

80%

82%

66%

62%

41%

33%

Change in readership

-13%

-10%

+9%

+17%

-17%

-14%

Source: Elliott and Shanahan Research, 2009 15

The above table shows that, while readership of the front of the pack was greatest, there was a decrease in readership of the front and side of cigarette packs but an increase in readership of the back. The report notes that this appears to have been influenced by the inclusion of graphic warnings that are more prominent on the back of packs.

For further information on awareness of health warnings, see Section 5.2: Noticeability of Graphic Health Warnings , p60–76.

Importance, believability and effectiveness of health warnings

The Elliott and Shanahan Research report demonstrates that there is strong public support for the inclusion of health warnings on packs of tobacco and cigarettes. Seventy-one per cent of individuals who participated in the telephone survey indicated that it was ‘very important’ that health warnings be contained on tobacco and cigarettes with a further 14% stating that it was ‘quite important’.

A significant majority of smokers (92%) and recent quitters (97%) found the health warnings to be believable, particularly those that referred to well-known smoking-related health issues and those that had appeared in anti-smoking television campaigns.

The report concluded that the use of graphic images has effectively increased the impact of public health messages about the health consequences associated with smoking. Those who participated in the telephone interview claimed that the use of graphic images, as opposed to text-only warnings:

  • had resulted in improved knowledge of consequences iii
  • would help to prevent people from taking up smoking iv
  • was more effective in helping ex-smokers to stay quit v
  • helped to deglamourise smoking.

Awareness of the Quitline had improved since 2000, with 63% stating that they were aware that the Quitline telephone number was included on tobacco packs. Five per cent of interviewees said they had called the Quitline.

The report concludes that there have been significant positive movements in attitudes relating to smoking since the introduction of graphic health warnings, including an increase in:

  • knowledge of health risks associated with smoking
  • concern about the risks of smoking
  • the intention to quit.

For further information on importance, believability and effectiveness of health warnings, see Sections 5.3 to 5.8.

Wear out

The Elliott and Shanahan Research report acknowledges that there is some evidence that health warnings can lose their effectiveness once they become familiar.

Plain packaging

A majority of people (57%) agreed with a statement that cigarettes should be sold in plain packs to assist smokers to quit. Smokers acknowledged that the design and colour of cigarette packaging is an attraction to purchase or try a brand. It was also mentioned that pack design negatively impacts on recall of health warnings.

Stakeholder response to graphic health warnings

Stakeholders provided a positive response to the use of graphic health warnings on tobacco packs. Overall, stakeholders perceived that the existing range of graphic health warnings was well balanced and effective but that there were further improvements that could be made including:

  • refreshing pack design elements of graphic warnings to improve impact
  • developing and maintaining an integrated strategy in relation to graphic health warnings
  • implementing plain packaging.

For further information on stakeholders' responses, see Section 6: Stakeholder Reactions to Graphic Health Warnings, p165.

12A.5.1.6.3 Recommendations

The Elliott and Shanahan Research report suggests a number of improvements that were raised by consumers and stakeholders and in other research studies covered in the report's literature review. These include:

  • use clear, well-defined images to reduce confusion in identifying and understanding graphic images
  • increase the size of graphic warnings on the front of the pack to improve readership (which had declined since 2000)
  • improve readership of the side of pack by simplifying the text and including content such as tips to quit, larger Quitline number and/or simplified ingredients information
  • refresh the existing health warnings, introduce new warnings and add new images to existing text warnings to reduce overexposure and ensure the impact of the message is sustained
  • ensure that text messages are simple and clear by using non-technical language and choosing appropriate font style and size
  • further use of statistics in text warnings to increase the sense of urgency, use pronouns to personalise the messages and introduce messages that relate to social consequences
  • align graphic images used on cigarette packs with other media forms such as television campaigns
  • use graphic health warnings on other tobacco products such as cigars sold individually and on water pipes
  • introduce plain packaging to remove conflict and competition between the pack design and health warnings.

For further information on the suggestions raised in the Elliott and Shanahan Research report, see Section 7.5:Areas for Improvement and Future Consideration , p186.

12A.5.1.7 National Drug Strategy Household Survey 2007 and 2010

Among the 23% of smokers and recent ex-smokers who reported in the 2010 National Drug Strategy Household Survey 10 having attempted to quit or cut down smoking in the previous year, 15.2% mentioned health warnings as being a factor motivating their behaviour. This was down from 19.4% in 2007 (shortly after introduction of the new health warnings) which in turn was higher than the 16.4% naming health warnings as a motivator in 2004 17 which was shortly before the introduction of the new warnings.

12A.5.2 The impact of the 2012 warnings in Australia

As discussed in Section 12A.2, new and larger graphic health warnings covering 75% of the front of cigarette packs (up from 30% previously) and maintaining coverage of 90% of the back, were introduced along with plain packaging in Australia in 2012. A small group of studies have examined the impact of the 2012 warnings in Australia. 18-20 These studies examine the impact of the warnings on quit related cognition and behaviours 19 and wear out of the 2012 warning labels across smoker subgroups. 18 The findings of these studies are summarised below.

12A.5.2.1 Durkin et al study on the impact on quitting-related cognitions and behaviours

Durkin et al 19  conducted a study to examine the short-term effects of changes to tobacco packaging on quitting-related cognitions and behaviours one year after the full implementation of plain packaging and the new warnings.

Effects of these changes on quitting related cognition and behaviours were assessed based on the following three outcomes:

  • frequency of thoughts about quitting
  • covering up or concealing cigarette packs, prematurely stubbing out cigarettes in response to thoughts about the harms, and forgoing cigarettes,
  • attempts to quit smoking over the past month.

The study compared smokers’ and recent quitters’ responses at four time points: before plain packaging, over the period of transition (early and late) to plain packaging, and during the first year of plain packaging. Findings showed that smokers were more likely to show short-term increases in quitting intentions, and to engage in quitting behaviours after implementation of the packaging changes. Compared to the pre-plain packaging phase there were no significant differences in the proportion of smokers who changed their thoughts about quitting to at-least-daily at follow-up across each subsequent phase. However, there were significant increases in the rate of intentions to quit at follow-up during late transition , although the rate returned to baseline levels among continuing smokers during the first year. A similar pattern emerged for the proportion of those reporting a firm date to quit within the next month, although the difference between those surveyed during pre-plain packaging and late transition was not significant.

Smokers were significantly more likely to report increased rates of concealing their pack in late transition and year one compared to pre-plain packaging. Smokers were also significantly more likely to report increases in stubbing out their cigarette in year one. Compared to pre-plain packaging, smokers surveyed during early transition were significantly more likely to report increased rates of stopping smoking when they had an urge. Importantly, there were significant increases in quit attempts in the early transition and year one phases, compared to the pre-plain packaging phase.

12A.5.2.2 Swayampakala et al study on the over-time impacts of pictorial health warning labels and their differences across smoker subgroups

A two-country (Australia and Canada) study 18 investigated wear out of the 2012 warning labels implemented in Australia across smoker subgroups. The study examined patterns of change in smoker subgroups' responses to the 2012 health warning during the two-year period following implementation of the warnings. A thousand smokers were surveyed every four months between September 2012 and September 2014. Smoker subgroups were based on education level, income level and age, and attention to the health warnings, and cognitive and behavioral responses to these warnings were examined.

Based on the study findings, plain packaging (Australia) delayed wear out over the first two years after implementation. While attention to the health warnings declined, cognitive responses, and behavioural responses such as forgoing cigarettes, increased. The study also reported differences in these responses across smoker subgroups. Smokers with high income and/or education showed an increase over time in attention and cognitive responses to warning labels compared to smokers with low income and/or education. Younger smokers showed less decline over time in attention and greater increase in cognitive and forgoing responses to warning labels compared to older smokers.

12A.5.2.3 Essence Communications review for the Australian Government

In 2018 a report by Essence Communication prepared on behalf of the Australian Government Department of Health was released. 21 The intention of the report was to evaluate the effectiveness of health warnings (both graphic and accompanying explanatory messages) in increasing knowledge of the health effects of smoking, encouraging cessation of smoking, and discouraging smoking uptake or relapse. The report also included comparisons with the impact of previous health warnings using data collected after the introduction of these warnings in 2008 and documented in Elliot and Shanahan’s report in 2009. 15

12A.5.2.3.1 Methodology

The research conducted in preparing the Essence Research report included:

  • a literature review on graphic health warnings in Australia and overseas
  • qualitative and quantitative research on the impact of graphic health warnings and explanatory messages on tobacco product packaging including:
    • community group focus groups (n=23) and indigenous groups (n=3) along with in-depth interviews with cigar smokers (n=7) and remote area smokers (n=8) during May 2018
    • an online quantitative survey of 2649 individuals in June 2018 including non-smokers (n=941), smokers (n=1380), recent quitters vi (n=328), indigenous smokers and recent quitters vii (n=120) and indigenous non-smokers (n=38)  
    • eye tracking and post activity questionnaire of an online research panel (n= 419) including smokers (n=166) and non-smokers (n=253). Approximately 414 completed questionnaires were used in the analysis.

For the online survey, a disproportionate stratified sample design was employed with quotas applied for age, gender and location. The results were weighted back to the population and the incidence of smoking within the community.

For further information on the methodology used, see Section 8: Research Methodology p23–37.

12A.5.2.3.2  Report findings

Awareness and noticeability of health warnings

The findings provide evidence that graphic health warnings are attracting attention and are being noticed and encoded in memory. Both smokers and non-smokers provided some description of tobacco packaging, including graphic health warnings on the pack when asked to recall elements of the packaging. The majority of smokers and non-smokers (64%) were able to describe at least one of the 14 current graphic health warnings. Smokers and recent quitters were more likely to recall graphic images (63%) than written warnings (27%). Smokers were most likely to notice and recall graphic pictures (43%), health warnings (27%) and plain packaging (23%).

The front graphic area on the package was the first area most commonly looked at by smokers (72%) and non-smokers (93%). For smokers, the front top warning message and back graphic image tied as the second area most commonly viewed at 14% each. For non-smokers, the front top warning was the second area most commonly viewed at 7%.

The Quitline message area was the graphic health warning part most looked at for smokers (43%) and non-smokers (71%). The front graphic image area was the second longest area looked at for smokers (36%) and non-smokers (29%).

The graphic health warning areas smokers looked at least were the side warning message area and back top warning message areas (36% respectively), the branding information area (13%) and front top warning message area (13%). The graphic health warning areas least looked at by non-smokers were the side warning message area (50%) the back top warning message area (29%) and branding information area (21%).

Readership

Around half of smokers (54%) or recent quitters (53%) read at least some of the written information on the packaging. Just over 50% of smokers and quitters read the written information on the front of the pack. Fewer smokers and quitters read the back of the back (40%). The least read text was the yellow box text on the side of the box (33%). 

Importance, believability and effectiveness of health warnings

There is evidence that graphic health warnings are important in shaping levels of knowledge about the health harms of smoking and that these health warnings are viewed as believable. Half (50%) of the population received information about the health harms of smoking from graphic health warnings. About 46% of non-smokers identified graphic health warning as a source of information about those health harms. Graphic health warnings are the primary source of information on smoking health harms for more than half (58%) of smokers and recent quitters. More than half (57%) of smokers and quitters believe that the inclusion of pictures and health information improved their knowledge of the health effects of smoking. The importance of these health warnings as a source of information among smokers varies across gender. About 62% of female smokers identified these warnings as a source of information compared to 51% for male smokers. As smokers move towards quitting, they were more likely to consider graphic health warnings to be a source of information about risks or harms to health (46% for pre-contemplators, viii 59% for contemplators ix and 61% for those in action/relapse x ).

Health warnings are also contributing to the perceived health risks of smoking. Close to half (49%) of smokers and recent quitters worried more about the health effects of smoking because of the graphic health warnings. Smokers in contemplation or action/relapse stages in relation to quitting were more likely to have worried more about the effects of smoking on health because of these health warnings (58%) than smokers in action/relapse (55%). The health warnings are also having an impact on non-smokers; 61% said that they would worry more about the effects of smoking because of the health warnings.

A large proportion (85%) of the population view the graphic health warnings as believable. xi Believability of health warnings was highest among non-smokers (86%) followed by recent quitters (85%) and smokers (82%). The 2018 survey results around believability of health warnings are slightly down from 2008 measures on believability for smokers (92%) and recent quitters (97%).

The majority of the population considered the pictures on packaging to be effective in communicating the health effects of smoking (70% somewhat to very effective, 31% very effective). xii Smokers and recent quitters also considered the pictures on packaging to be somewhat effective or very effective at communicating the health effects of smoking (71%). xiii Smokers were more likely to consider the pictures to be somewhat effective (44%) with 23% considering the pictures to be very effective and 28% not effective at all. As smokers moved closer to quitting, they were more likely to consider the pictures to be more effective at communicating (58% for pre-contemplators versus 78% for contemplators and 67% for quitting/relapsed).

Fifty-seven percent of smokers and recent smokers had an emotional response to the graphic health warnings. The most common responses amongst smokers were disgust (14%), worry/concern (6%), guilt/fear/scared (6%). Thirty-one per cent of smokers said that they either felt nothing/were desensitised, or ignored the graphic health warnings.

Less than half of smokers (44%) engage in practices to avoid tobacco packaging including transferring or decanting tobacco products into another case (24%), concealing the pack or selecting specific packs (10%) or tearing away certain parts of the packaging (10%). The evidence suggests that this avoidance behaviour is also related to social pressures and the increasing exclusion of smoking in public.

Cessation and Quit Attempts

Just over half (52%) of smokers or recent quitters agreed that health warnings on the packaging made them think about quitting. Fourteen per cent of smokers and quitters cited health warnings as the reason they want to quit smoking. A similar number of smokers (15%) said these health warnings helped them try to quit, 28% said it raised their concerns about smoking, and 23% said the warnings led them to reduce how much they smoke. Only 5% of smokers and 4% of recent quitters said that the health warnings led them to call the Quitline.

Wear out

The report concludes that since the introduction of the graphic health warnings, there has been a reduction in their impact over time. More than half of smokers and recent quitters (54%) believe they took more notice of the health warnings when they first came out. The majority (62%) also claimed to ‘not take any notice’ of the health warnings on the pack. More smokers admitted to not take notice of the graphic health warnings (66%) compared to recent quitters (59%). Avoidance practices initially used by smokers including decanting the tobacco product into other formats and the use of cigarette cases and/or stickers to hide graphic images, significantly decreased over time.

Support for the Health Warnings on Packages

The findings demonstrate that there is widespread support for the health warnings. The majority of the population (81%) support health warnings on packaging and agree or strongly agree that cigarette/tobacco packaging should have health warnings. This support was highest among non-smokers (85%) followed by recent quitters (78%) and smokers (66%). As smokers moved closer to quitting, they were more likely to support health warnings on packaging (53% for pre-contemplators versus 72% for contemplators and 71% for quitting/relapsed).

The Essence Research report also provides an assessment of the 2012 warnings against each of the recommendations raised in the 2008 review of the health warnings introduced in 2006, see Section 21.3: Evaluating 2008 Changes , p152-56.

12A.5.2.2.3 Recommendations

The Essence Communications research report 21 suggested further consideration of a number of improvements raised by Elliott and Shanahan in their 2009 Research report. 15 These include:

  • address wear out through further rotation and refreshing images and written warnings
  • optimising images and associated text
  • introducing new diseases with established links
  • consideration of the use of statistics in some explanatory texts
  • increasing the personalisation of Graphic health warnings
  • extending Graphic health warnings on other tobacco products.

For more detailed recommendations for future warnings see Section 22 of the report.

i 'Recent quitters' stopped smoking in the past 12 months.

ii 'Contemplators' refers to smokers who are considering quitting in the next six months and one month. See footnote j of the Executive Summary of the report.

iii Thirty-eight per cent of smokers and 59% of recent quitters in 2008 compared with 32% of smokers and 28% of recent quitters in 2000.

iv Sixty-three per cent of non-smokers and 54% of long-term ex-smokers in 2008 with 22% of non-smokers stating that graphic warnings have helped them from taking up smoking.

v Thirty-five per cent of long-term ex-smokers and 55% of recent quitters.

vi Recent quitters smoked or used tobacco products but stopped in the last ten years

vii Smoker/quitter are a mix of smokers and recent quitters

viii Pre contemplators are committed smokers or those smokers not seriously thinking about quitting

ix Contemplators are smokers who are thinking about quitting in the next 6 months

x Smokers who have tried quitting but start smoking again

xi This refers to those who find the health warnings very believable and somewhat believable

xii An increase from 60% in 2008

xiii An increase from 63% in 2008

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