Large pictorial warnings are credible and have high levels of public support both in Australia1-3 and internationally.4-8
Public support for warnings remains very strong in Australia. An Australian Government evaluation conducted two years after graphic pack warnings were introduced in 2006 reported that 76% of non-smokers, 70% of long-term ex-smokers, 68% of recent quitters and 53% of smokers thought it was ‘very important’ that such warnings were in place.1 Supplementary work also found support for inclusion of the Quitline number prominently on packets.1 Data from the International Tobacco Control Policy Evaluation study in 2007 showed that 62% of Australian smokers thought the amount of information was about right and 25% would like more, leaving only 13% who thought it excessive.9 A 2018 survey of 900 persons in Australia reported that 80% of respondents supported the increased warning label size of cigarette packs introduced in 2012.10 According to a 2018 government sponsored survey of the impact of these warnings, approximately 81% of the population agreed or strongly agreed that the health warnings should be in place. This support varied across smoker status and was highest among non-smokers (85%) and recent quitters (78%) with the lowest level of support among smokers (66%).2
Elsewhere, health warnings have proved similarly popular, including in countries such as Canada4, 5 and Thailand.6 In Brazil, three months after the introduction of pictorial health warnings in 2002, 73% of smokers approved of them and 67% said the warnings made them want to quit. The impact was especially strong in those with low incomes and education.7 Two years after large pictorial warnings were introduced in Uruguay, 62% of adult smokers stated that they would like to see more information about health effects on the packet.8
In the US, as of 2019, graphic health warnings have not yet been implemented. However, there is growing evidence that most residents would support the introduction of Canadian-style graphic health warnings on tobacco products in the US.3 Another US study conducted in 2017 examined attitudes toward larger warning sizes on cigarette packages. Participants’ attitudes toward health warnings that covered 25, 50, or 75% of a cigarette pack were assessed. Nearly three-quarters (72%) of adults were supportive of larger warning labels on cigarette packs. Among the full sample and smokers only, most adults had favorable attitudes toward labels that covered 25% (78.2% and 75.2%, respectively), 50% (70% and 58.4%, respectively), and 75% (67.9% and 61%, respectively) of a cigarette pack.
Another study published in 201811 examined public support for graphic health warnings and the factors that influence public support for these warnings in the US. Adult smokers were provided with pictorial warnings or text-only warnings on their cigarette packs for four weeks between 2014 and 2015. Although message reactance (i.e., an oppositional reaction to the warning) partially diminished the impact of pictorial warnings on policy support, support for pictorial warnings was high. Exposure to pictorial warnings increased policy support over time, which indicates that exposing people to a policy, educating them about its effectiveness, and stimulating conversations about the policy could increase public support.
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References
1. Shanahan P and Elliott D. Evaluation of the effectiveness of the graphic health warnings on tobacco product packaging 2008. Canberra, Australia: Australian Government Department of Health and Ageing, 2009. Available from: http://webarchive.nla.gov.au/gov/20140801094931/http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-tobacco-eval-graphic-health-warnings-exec-sum.
2. Essence Communications. Evaluation of effectiveness of graphic health warnings on tobacco product packaging: An evaluation report. Prepared for the Department of Health, 2018. Available from: https://beta.health.gov.au/resources/publications/evaluation-of-effectiveness-of-graphic-health-warnings-on-tobacco-product-packaging.
3. Peters E, Romer D, Slovic P, Jamieson K, Wharfield L, et al. The impact and acceptability of Canadian-style cigarette warning labels among US smokers and nonsmokers. Nicotine & Tobacco Research, 2007; 9(4):473–81. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17454702
4. Hammond D, Fong G, McDonald P, Brown K, and Cameron R. Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. American Journal of Public Health, 2004; 94(8):1442–5. Available from: http://www.ajph.org/cgi/content/full/94/8/1442
5. Canadian Cancer Society. Canadians overwhelmingly support graphic cigarette warnings, 2002, Canadian Cancer Society.
6. International Tobacco Control Policy Evaluation Survey. ITC South-east Asia wave 2 data. 2007.
7. Costa e Silva VL. Presentation to EU Commission/Brussels on the enforcement of health warnings in Brazil, 2002.
8. International Tobacco Control Policy Evaluation Survey. ITC Uruguay project, wave 1 data. 2006.
9. Borland R. Personal communication, 2008.
10. No authors listed. Tobacco health warnings are burning out. This Money (UK), 2018. Available from: http://www.thisismoney.co.uk/wires/aap/article-5768337/Tobacco-health-warnings-burning-out.html
11. Hall MG, Marteau TM, Sunstein CR, Ribisl KM, Noar SM, et al. Public support for pictorial warnings on cigarette packs: An experimental study of US smokers. Journal of Behavioral Medicine, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29411272