Australia has implemented three sets of regulations mandating graphic health warnings—in 2006, in 2012 and in 2025. A large group of studies have examined the impact of the 2006 warnings in Australia and 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 2006 and 2012 graphic health warnings in Australia.
In general, studies show strong public support for the warnings and increased awareness of the health impacts of smoking, increased quit attempts, increased calls to Quitline and a decreased prevalence of smoking after rollout of the warnings in combination with concurrent mass media campaigns. However, there were signs of ‘wear out’ where awareness of specific health risks reduced over time or when warnings were no longer present, highlighting the importance of ‘refreshing’ graphic health warnings.
12A.5.1 The impact of the 2006 warnings in Australia
As described in Section 12A.2, graphic health warnings for tobacco products sold in Australia were introduced in 2006, appearing on the back and front lid of cigarette packs (see Front warnings in Figure 12A.5.1 and their cartons, and on 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 and Set B warnings appearing for sale from early 2007 and covering lung cancer, heart disease, blindness, stroke, effects on unborn child, addictiveness of smoking and toxicity of tobacco smoke.1
Studies on the impact of the 2006 warnings in Australia include: studies of tobacco industry behaviour and media coverage concerning the new health warnings;2-4 a study of the impact of the warnings on adolescent smoking-related beliefs and behaviours, studies of changes in awareness of warning-related health effects and motivation to quit among people who smoke in Victoria5,6 and South Australia;7 and Australia wide8 the impact of the effects of the new warnings (which include the Quitline number) on use of the Quitline;9; 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 Survey10,11 are summarised below.
12A.5.1.1 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 (Figure 12A.5.2).2 It is unknown how many people kept these tins for future use (allowing cigarettes to be stored in cases without the new health warnings), but very few people reported use of such tins in subsequent reviews of the effects of the second set of regulations for graphic health warnings introduced in 2012.
A study3 that monitored the roll-out 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.3 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.3 A similar study conducted in 40 shops in Sydney4 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, people who smoke were intercepted in city streets in Adelaide and asked about their reactions. Newest images had the highest recall, and initial reactions were in line with tobacco control objectives. About 60% said new warnings detracted from the look of their brand,3 about 51% reported feeling at increased risk of dying from smoking-related illness and about 38% felt motivated to quit.3
12A.5.1.2 Impact on adolescents
To assess the impact of the introduction of graphic health warnings among adolescents, surveys were conducted of students at year levels 8 to 12 in greater metropolitan Melbourne before and shortly after introduction of the graphic health warnings.13 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. The study found that awareness of smoking as a cause of gangrene and mouth cancer (both not covered 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. Those who smoked 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 Impact on people who smoke (from household survey studies)
Telephone surveys of Victorian adults who smoke measuring changes in awareness of smoking-related health effects from before (2005) to after (2006) the pack warnings were introduced, showed that the proportion of those 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%.5 In contrast, awareness of throat cancer decreased by 4.3%, an illness mentioned in the pack warnings but not the advertisements. Population groups targeted by the Government’s advertising campaign (low-socioeconomic status 18 to 44 year olds who smoke) were interviewed about their cognitive and emotional responses and intentions to quit after they had watched one of the campaign advertisements. People who smoked and had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions compared with those without prior exposure. Study authors concluded that television advertisements and graphic health warnings on cigarette packs may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit.
Another Victorian study6 showed a significant increase among people who smoke in the salience of smoking-related illnesses primarily in the Set B warnings between 2006 and 2007. For four of the warnings in set B (lung cancer, heart disease, stroke and eye problems), there was an increases in the spontaneous recall of these conditions as being caused by smoking in 2007 (Figure 12A.5.3). Spontaneous recall of pregnancy complications as smoking related illness showed a trend towards an increase from 0.3% in 2006 to 2% in 2007. People who smoke showed relatively low levels recall for the set A warnings for mouth cancer (12%), throat cancer (11%), and gangrene (6%) compared to the set B warnings.14 The lower levels of awareness of some 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 smoke that 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 (not shown in the figure). 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.
Representative samples of people who smoke in South Australia 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.7 People who smoke 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 beliefs than more familiar information and less emotive images.
12A.5.1.4 Impact on smoking initiation and quitting
A study of the effect of the 2006 health warnings on smoking initiation and quitting analysing panel data from the Household Income and Labor Dynamics (HILDA) study concluded that smoking rates reduced by about 4% within the first year of the policy.15 This effect was stronger among young people and slightly larger for low-educated compared to high-educated individuals. The study author reports that the health warning reform lowered smoking rates primarily due to increased quitting in 2006, although acknowledges that this may have worked in combination with the concurrent mass communication campaigns.15 See Section 12A.3.5 for more studies on documented quit attempts.
12A.5.1.5 Impact on Quitline
An examination of calls to the Australian Quitline two years before and after the new packets were introduced showed twice as many calls to the Quitline in 2006 (the year of introduction), as there were in each of the preceding two years.9 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.5.1.6 Analysis of data from the International Tobacco Control (ITC) Policy Evaluation study
Another approach to evaluating the impact of the graphic health warnings in Australia involved comparing several indicators of impact among people who smoke in Australia with those of (i) people who smoke in the UK who were exposed to the larger-than previous text-based warnings introduced in 2003; (ii) and their counterparts in Canada who were exposed to graphic warnings introduced in 2000.8 Indicators measured over the first five waves of the International Tobacco Control (ITC) Policy Evaluation Study (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 people who smoke in Australia 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.16 — See Section 12A.3 for further details.
12A.5.1.7 Evaluation of effectiveness for the Australian Government
In 2009, a report prepared for the Australian Government Department of Health and Ageing was released (‘the Elliott and Shanahan Research report’).17 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 a previous report in 2000.12
The research included 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 people who were committed smokers, six groups of people who recently quit (in the past 12 months), five groups of people who are contemplating quitting in the next six months and five groups of people who do not smoke
- 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.
The major findings of the Elliott and Shanahan Research report are summarised:
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 preceding two years. More than one third of adults who do not smoke could recall at least one specific warning. Awareness was particularly high among people who smoke (86%) and those who recently quit (80%).
There was a decrease in the number of people who smoke 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 the people in the non-smoking group.
Readership
Readership of health information (text) among people who smoke and those who recently quit is shown in Table 12A.5.1:
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.
Importance, believability and effectiveness of health warnings
The 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 people who smoke (92%) and those who recently quit (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 – 38% of people who smoke and 59% of those who recently quit in 2008, compared to 32% of people who smoke and 28% of those who recently quit in 2000
- would help to prevent people from taking up smoking - 63% of people who do not smoke and 54% of long-term former smokers in 2008, with 22% of people who do not smoke stating that graphic warnings have helped them from taking up smoking
- was more effective in helping people who used to smoke to stay quit - 35% of long-term former smokers and 55% of people who recently quit
- helped to de-glamourise 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.
Wear out
The 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. People who smoke 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.
Recommendations from the Elliott and Shanahan Research report
The report suggested 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.
12A.5.1.8 National Drug Strategy Household Surveys in 2007 and 2010
Findings from the National Drug Strategy Household Surveys showed that, shortly after the introduction of the new health warnings, there was an increase in the proportion of people who smoke or recently quit who cited health warnings as a motivating factor in their smoking reduction/cessation attempts—see Figure 12A.5.4.
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 (Figure 12A.5.5). The effects and wear out of the 2012 warnings in Australia has been examined in two studies and one major report (Sections 12A.5.2.1 to 12A.5.2.3)19-21 and these studies examine the impact of the warnings on quit related cognition and behaviours20 and wear out of the 2012 warning labels across subgroups of people who smoke.19 Other studies examined the impacts of the 2012 warnings on priority populations and the effects of increased warning size (Section 12A.5.2.4).22-25 The findings of these studies are summarised below.
12A.5.2.1 Impact on quitting-related cognitions and behaviours
A study examining the impact of the policy compared the responses of people who smoke and those who recently quit 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 people who smoke 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 people who smoke 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 people who continued to smoke 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.20
People who smoke were significantly more likely to report increased rates of concealing their pack in late transition and year one compared to pre-plain packaging. They were also significantly more likely to report increases in stubbing out their cigarette in year one. Compared to pre-plain packaging, people who smoke who were 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.20
12A.5.2.2 Impacts over time of graphic health warning labels and their differences across subgroups of people who smoke
A two-country (Australia and Canada) study19 investigated wear out of the 2012 warning labels implemented in Australia across subgroups of people who smoke. 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 people who smoke were surveyed every four months between September 2012 and September 2014. Subgroups of people who smoke were based on education level, income level and age, and attention to the health warnings, and cognitive and behavioural 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 subgroups of people who smoke. Those with high income and/or education showed an increase over time in attention and cognitive responses to warning labels compared to people who smoke with low income and/or education. Younger people who smoke showed less decline over time in attention and greater increase in cognitive and forgoing responses to warning labels compared to older people.
12A.5.2.3 Evaluation of effectiveness for the Australian Government (Essence Communications review)
A report by Essence Communication prepared for the Australian Government Department of Health was released in 2018.26 The intention of the report was to evaluate the continuing 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 in 2008 after the introduction of the 2006 warnings and documented in Elliot and Shanahan’s report in 2009.17
The research conducted in preparing the Essence Research report included qualitative and quantitative research on the continuing effects 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 people who smoke cigars (n=7) and people in remote areas who smoke (n=8) during May 2018
- an online quantitative survey of 2649 individuals in June 2018 including people who do not smoke (n=941), people who smoke (n=1380), those who have recently quit in the past 10 years (n=328), and indigenous people who smoke or who have recently quit (as one group) (n=120) or who do not smoke (n=38)
- eye tracking and post activity questionnaire of an online research panel (n=419) including people who smoke (n=166) and those who don’t (n=253). Approximately 414 completed questionnaires were used in the analysis.
The major findings of the report are summarised:
Awareness and noticeability of health warnings
The findings provide evidence that graphic health warnings were continuing to attract attention and be noticed and encoded in memory. The majority of people were able to describe at least one of the 14 current graphic health warnings. People who smoke and those who recently quit were more likely to recall graphic images than written warnings (63% versus 27%). People who smoke were most likely to notice and recall graphic pictures, health warnings and plain packaging.
Eye tracking studies suggested that the front graphic area on the package was the first area most commonly looked at most participants. For those who smoke, the front top warning message and back graphic image tied as the second area most commonly viewed at 14% each. For those who don’t smoke, the front top warning was the second area most commonly viewed.
The Quitline message area was the graphic health warning part viewed the most. The front graphic image area was the second longest area looked at for people who smoke (36%) and people who don’t (29%).
The graphic health warning areas looked at least by people who smoke 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 people who don’t smoke were the side warning message area the back top warning message area and branding information area.
Readership
Around half of people who smoke or those who recently quit read at least some of the written information on the packaging and on the front of the pack. Fewer of these people read the back of the back (40%) or 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 of the population received information about the health harms of smoking from graphic health warnings. Almost half of people who don’t smoke 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 over half of people who smoke and those who had recently quit, who mostly 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 varies across gender. About 62% of women who smoked identified these warnings as a source of information compared to 51% for men. As people move from smoking towards quitting, they were more likely to consider graphic health warnings to be a source of information about risks or harms to health.
Health warnings are also contributing to the perceived health risks of smoking. Almost half of people who smoke and those who recently quit 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 than those in action/relapse (58% compared to 55%). The health warnings are also having an impact on people who don’t smoke; 61% said that they would worry more about the effects of smoking because of the health warnings.
A large proportion of the population view the graphic health warnings as somewhat or very believable. Believability of health warnings was over 80% for people who don’t smoke, those who recently quit and those who smoke. The 2018 survey results around believability of health warnings are slightly down from 2008 measures on believability for people who smoke (92%) and those who recently quit (97%).
The majority of the population considered the pictures on packaging to be effective in communicating the health effects of smoking. For all participants, 70% considered the warnings to be somewhat to very effective, (an increase on 60% from 2008) and 31% of people considered them to be very effective. People who smoke and those who recently quit also considered the pictures on packaging to be somewhat effective or very effective at communicating the health effects of smoking (71%, compared to 63% in 2008). 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 people moved closer from smoking 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).
Over half of people who smoke and those who recently quit had an emotional response to the graphic health warnings. The most common responses amongst those who smoke were disgust, worry/concern, guilt/fear/scared. Thirty-one per cent of these people said that they either felt nothing/were desensitised, or ignored the graphic health warnings.
Less than half of people who smoke engage in practices to avoid tobacco packaging including transferring or decanting tobacco products into another case, concealing the pack or selecting specific packs or tearing away certain parts of the packaging. 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 of people who smoke or those who recently quit 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 people who smoke (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 people who smoke and 4% of those who recently quit said that the health warnings led them to call the Quitline.
Wear out
The report concluded that since the introduction of the 2012 graphic health warnings, there had been a reduction in their impact over time. More than half of people who smoke and those who recently quit believed they took more notice of the health warnings when they first came out. The majority also claimed to ‘not take any notice’ of the health warnings on the pack. More people who smoke reported not taking notice of the graphic health warnings compared to people who had quit (66% compared to 59%). Avoidance practices 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 Graphic Health Warning policy
The findings demonstrate that there is widespread support for the health warnings. The majority of the population support health warnings on packaging and agree or strongly agree that cigarette/tobacco packaging should have health warnings. This support was highest among people who didn’t smoke (85%) followed by those who recently quit (78%) and those who smoke (66%). As people moved closer from smoking 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).
Recommendations from the Essence Communications report
The Essence Communications research report26 suggested further consideration of a number of improvements raised by Elliott and Shanahan in their 2009 Research report.17 These include:
- addressing 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.
12A.5.2.4 Further studies
A study using data from the ITC project, described above in Section 12A.5.1.6, found that increasing the size of graphic health warnings (from 30% to 75%) and introducing them concurrently with plain packaging in Australia appears to have led to an overall increase in desired levels and strength of the reactions of smokers, such as noticing and cognition. However, there was evidence of a form of warning avoidance behaviour among a small minority of people who smoke that may diminish the effectiveness of the warnings.25
Another study using data from the ITC project found positive impacts of Australia’s 2012 ‘blindness’ warnings.23 After rollout of this warning, knowledge of smoking causing blindness was more common in people who smoke in Australia compared to three other countries that did not include blindness in their health warnings.23 Similarly, knowledge about the toxic constituents of tobacco smoke was increased in Australia, Canada and Mexico after roll-out of specific health warnings on this topic, but not in the United States, which did not have such warnings.27
The impact of new health warnings declined in the first five years after implementation in Australia, Canada and the United Kingdom.28 These declines included the salience of the warnings, forgoing cigarettes and avoiding warnings, but not cognitive responses to warnings. Having two rotating sets of warnings, like for the 2012 warnings in Australia, did not appear to reduce this wear-out compared to a single set of warnings.28
A focus group study examined the responses of highly disadvantaged people who smoke and were living in regional Australia to the 2012 graphic health warnings.22 Graphic health warnings on highly emotive subjects were more commonly recalled and considered effective by participants. But there was also some active avoidance of looking at tobacco packets where participants reported being quickly desensitised to them.22
A study of Aboriginal and Torres Strait Islander peoples who smoke found that the 2012 graphic health warnings increased their knowledge of the harmful effects of smoking and generated reactions that have been shown to be determinants of quitting activity.24 These reactions include forgoing cigarettes due to warning labels and increased concerns about smoking.24
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References
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