Effectiveness of Text-Only Cigarette Health Warnings in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey

Health warnings are an effective strategy for communicating the health harms of smoking, encouraging quitting, and preventing smoking initiation. This study examines the effectiveness of existing text-only health warnings, identifies key predictors of warning effectiveness, and assesses support for pictorial warnings in Japan. Data are from the 2018 International Tobacco Control (ITC) Japan Survey, a cohort survey of adult cigarette smokers (n = 3306), dual users of cigarettes and heated tobacco products (n = 555), and non-cigarette smokers (n = 823). Weighted multivariable logistic regression models were used to assess predictors of warning effectiveness and support for pictorial warnings. Overall, 15.6% of respondents noticed warnings, and 7.9% read or looked closely at warnings. Overall, 10.3% of smokers and dual users said the warnings stopped them from having a cigarette, and 7.2% avoided warnings. Overall, 27.5% of respondents said the warnings made them think about health risks of smoking, but only 2.7% of smokers and dual users said the warnings made them more likely to quit. Overall, 57.6% of respondents supported pictorial warnings. The weak effectiveness of Japan’s text-only warnings is consistent with that in other countries with similar warnings. There is majority support for pictorial warnings in Japan, although the level of support is lower than in other countries.

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Country Participation in the WHO Framework Convention on Tobacco Control Health Warnings Database

Tobacco Use Insights ◽

10.1177/1179173x211064214 ◽

2021 ◽

Vol 14 ◽

pp. 1179173X2110642

Author(s):

Christopher M. Seitz ◽

Kenneth D. Ward ◽

Zubair Kabir

Keyword(s):

Tobacco Control ◽

World Health ◽

Warning Labels ◽

Health Warnings ◽

Tobacco Products ◽

Health Warning ◽

Pictorial Warnings ◽

The World ◽

Alternative Tobacco Products ◽

Tobacco Packaging

Background The World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) Health Warnings Database is an online, publicly available resource created for countries to upload and share pictorial health warnings for tobacco packaging. The purpose of this study was to evaluate the extent to which the database is used by countries for the sharing of pictorial warnings. Methods The study’s sample included parties to the FCTC who required graphic health warning labels on cigarette packaging from. Those countries were categorized as having a low, middle, and high Socio-Demographic Index (SDI). The Health Warnings Database was then analyzed for those countries’ unique pictorial images, as well as the number of pictorials that were shared between countries. Results Of the 110 countries that required pictorial warnings on cigarette packaging, only 53 (48%) voluntarily contributed pictorials to the database, with most of those (53%) being high SDI-level countries. There were 342 unique pictorials on the database, with 62 images posted by seven countries that were used by 13 other countries. Conclusion While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.

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Pictorial health warnings and wear-out effects: evidence from a web experiment in 10 European countries

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054402 ◽

2019 ◽

Vol 28 (e1) ◽

pp. e71-e76 ◽

Cited By ~ 5

Author(s):

Eva Woelbert ◽

Béatrice d’Hombres

Keyword(s):

Data Collection ◽

Tobacco Control ◽

Random Order ◽

European Countries ◽

Health Warnings ◽

Tobacco Products ◽

Pictorial Warnings ◽

Tobacco Control Policies ◽

Web Experiment ◽

Over Time

ObjectiveThis paper examines whether there are possible wear-out effects associated with repeated exposure to pictorial health warnings on tobacco products. Wear-out effects can be general, that is, people get used to the presence of pictorial warnings in general, or specific to the content of the warnings (ie, the images used). Distinguishing between these two types of wear-out is important for understanding how to maintain the effectiveness of health warnings over time.MethodsThis study used data from two surveys carried out in 10 European countries. Participants (n=12 600) were exposed in a random order to a series of health warnings and assessed the salience of the warnings as well as their effects on smoking intentions. Using these data and country variations in health warning legislation, we tested whether warning pictures are subject to general and/or specific wear-out effects.ResultsResponses were stronger to combined text+picture warnings than to text-only warnings. This effect was lower for smokers living in countries where combined warnings were already in place at the time of the data collection, compared with smokers residing in countries where text-only warnings were in use. This result, observed for combined warnings with new pictures, is in line with the presence of general wear-out effects. Combined warnings with an unknown pictorial content were more effective than those including pictorial warnings already in use, suggesting that specific wear-out effects are also at play.ConclusionsThese findings strengthen the evidence that pictorial health warnings are an effective tool for tobacco control policies and suggest that, even in the presence of a general wear-out effect among smokers, periodically introducing new pictures helps to maintain warning effectiveness over time.

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Associations between Cognitive and Affective Responses to Tobacco Advertisements and Tobacco Use Incidence: A Four-Year Prospective Study among Adolescent Boys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111666 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11666

Author(s):

Brittney Keller-Hamilton ◽

Hayley Curran ◽

Elise M. Stevens ◽

Michael D. Slater ◽

Bo Lu ◽

...

Keyword(s):

Tobacco Use ◽

Health Risks ◽

Regression Models ◽

Statistical Significance ◽

Smoking Initiation ◽

Tobacco Product ◽

Affective Responses ◽

Standard Errors ◽

Health Warnings ◽

Reduced Risk

Exposure to tobacco advertisements is associated with initiation of tobacco use among youth. The mechanisms underlying this association are less clear. We estimated longitudinal associations between youths’ cognitive and affective responses to advertisements for cigarettes, e-cigarettes, and smokeless tobacco (SLT) and initiation of these products. N = 1220 Ohio-residing boys of ages 11–16 were recruited into a cohort in 2015 and 2016. Participants completed surveys every six months for four years. Surveys assessed cognitive and affective responses to tobacco advertisements (which included health warnings) and tobacco use after an advertisement viewing activity. We used mixed-effects Poisson regression models with robust standard errors to estimate risk of initiating use of each tobacco product according to participants’ cognitive (i.e., memorability of health risks) and affective (i.e., likability of advertisement) responses to advertisements for that product. No associations between affective responses to advertisements and tobacco use outcomes were detected in adjusted models. However, finding health risks memorable was associated with reduced risk of ever smoking initiation (aRR = 0.57; 95% CI: 0.34, 0.95) and a reduced risk of ever SLT initiation that approached statistical significance (aRR = 0.61; 95% CI: 0.36, 1.05). Measures to increase saliency of health risks on cigarette and SLT advertisements might reduce use among youth.

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The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging

Nicotine & Tobacco Research ◽

10.1093/ntr/ntab027 ◽

2021 ◽

Author(s):

Crawford Moodie ◽

Catherine Best ◽

Ingeborg Lund ◽

Janne Scheffels ◽

Nathan Critchlow ◽

...

Keyword(s):

United Kingdom ◽

Health Risks ◽

Health Warnings ◽

Online Surveys ◽

Tobacco Products ◽

Cognitive Reactions ◽

The United Kingdom ◽

Pictorial Warnings ◽

The Uk ◽

The Impact

Abstract Introduction Standardized packaging was phased in between May 2016 and May 2017 in the United Kingdom and July 2017 and July 2018 in Norway. In both countries, the health warnings on packs prior to standardized packaging being implemented were from the former Tobacco Products Directive library of warnings (text warnings covering 43% of the pack front and pictorial warnings covering 53% of the pack reverse). The warnings on packs, postimplementation, were from the current Tobacco Products Directive library of warnings (novel pictorial warnings covering 65% of the pack front and reverse) for the United Kingdom but unchanged in Norway. Aims and Methods Longitudinal online surveys were conducted prior to standardized packaging (United Kingdom: April–May 2016; Norway: May–June 2017) and postimplementation (United Kingdom: September–November 2017 and May–July 2019; Norway: August–September 2018). We explored smokers’ response to the on-pack warnings (salience, cognitive reactions, and behavioral reactions). Results In the United Kingdom, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the health risks, avoidant behaviors, forgoing cigarettes, and being more likely to quit due to the warnings significantly increased from waves 1 to 2, and then decreased from waves 2 to 3, but remained higher than at wave 1. In Norway, noticing warnings, reading or looking closely at them, thinking about them, thinking about the health risks, and being more likely to quit due to the warnings significantly decreased from waves 1 to 2; avoidant behaviors and forgoing cigarettes remained unchanged. Conclusions The inclusion of large novel pictorial warnings on standardized packs increases warning salience and effectiveness. Implications Two longitudinal online surveys in the United Kingdom and Norway explored the impact of standardized packaging on warning salience and effectiveness. That warning salience and effectiveness only increased in the UK postimplementation, where standardized packaging was implemented alongside new larger pictorial warnings on the pack front and reverse, and not in Norway, where standardized packaging was introduced but older smaller text warnings (pack front) and pictorial warnings (pack reverse) were retained, highlights the importance of removing full branding and introducing stronger warnings simultaneously.

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Analysis of the tobacco industry’s interference in the enforcement of health warnings on tobacco products in Brazil

Cadernos de Saúde Pública ◽

10.1590/0102-311x00120715 ◽

2017 ◽

Vol 33 (suppl 3) ◽

Cited By ~ 1

Author(s):

Cristina de Abreu Perez ◽

Vera Luiza da Costa e Silva ◽

Stella Aguinaga Bialous

Keyword(s):

Interest Groups ◽

Tobacco Control ◽

Tobacco Industry ◽

Strong Impact ◽

Health Warnings ◽

Tobacco Products ◽

Tobacco Control Policies ◽

The Relationship ◽

Original Information ◽

Regulatory Measure

Abstract: This article aims to analyze the relationship between the Brazilian government’s adoption of a regulatory measure with a strong impact on the population and the opposition by invested interest groups. The methodology involves the analysis of official documents on the enforcement of health warnings on tobacco products sold in Brazil. In parallel, a search was conducted for publicly available tobacco industry documents resulting from lawsuits, with the aim of identifying the industry’s reactions to this process. The findings suggest that various government acts were affected by direct interference from the tobacco industry. In some cases the interventions were explicit and in others they were indirect or difficult to identify. In light of the study’s theoretical framework, the article provides original information on the Brazilian process that can be useful for government policymakers in the strategic identification of tobacco control policies.

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Awareness about cigarettes and other tobacco products act and impact of health warnings on smokers in a North Indian city

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195017 ◽

2019 ◽

Vol 7 (11) ◽

pp. 4356

Author(s):

Riya Gupta ◽

Mudasir Majeed ◽

Bhavna Langer ◽

Rashmi Kumari ◽

Rajiv Kumar Gupta ◽

...

Keyword(s):

Tobacco Use ◽

Tertiary Care ◽

Care Hospital ◽

Health Warnings ◽

Outpatient Services ◽

Tobacco Products ◽

Medical College ◽

Pictorial Warnings ◽

Increasing Trend ◽

Indian City

Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.

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Effects of IQOS health warnings and modified risk claims among young adult cigarette smokers and non-smokers

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056810 ◽

2021 ◽

pp. tobaccocontrol-2021-056810

Author(s):

Darren Mays ◽

Andrea C Johnson ◽

Allison Glasser ◽

Melissa Mercincavage ◽

Andrew A Strasser

Keyword(s):

Young Adult ◽

Drug Administration ◽

Efficacy Beliefs ◽

Perceived Effectiveness ◽

Health Warnings ◽

Cigarette Smokers ◽

Tobacco Products ◽

Toxicant Exposure ◽

Perceived Credibility ◽

The Usa

IntroductionHeated tobacco products, including Marlboro IQOS, are available globally. In the USA, IQOS was authorised to be advertised with claims about reduced toxicant exposure relative to cigarettes. The effects of such modified risk claims and health warnings have not been studied among young adult cigarette smokers and non-smokers.MethodsIn 2020, US young adult (18–30 years, n=1328) cigarette smokers and non-smokers viewed an IQOS ad in a 4 (modified risk claim variations or none) by 3 (warning variations or none) between-subjects experiment. Outcome measures assessed perceived credibility and effectiveness of the health or risk message for discouraging IQOS use, perceived harms, efficacy beliefs, and IQOS use intentions.ResultsSmokers reported significantly higher (p<0.05) perceived credibility, lower perceived effectiveness, higher efficacy beliefs about switching to IQOS and higher intentions to use IQOS than non-smokers. Among smokers, health warnings increased perceived credibility (p<0.001) and effectiveness (p<0.05), but claims did not affect outcomes examined. Among non-smokers, warnings and claims increased perceived credibility, and warnings increased perceived effectiveness (p<0.003). The reduced exposure claim increased non-smokers’ intentions to use IQOS (b=0.40, 95% CI 0.07 to 0.73).ConclusionsAmong young adult smokers, health warnings increased perceived effectiveness at discouraging IQOS use and perceived credibility. Among non-smokers, warnings and claims increased perceived credibility and warnings increased perceived effectiveness, but the Food and Drug Administration-authorised reduced exposure claim increased intentions to use IQOS. Research is warranted to understand how the content of modified risk claims and health warnings for IQOS affects IQOS use in this population.

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Workplace smoke-free policies that allow heated tobacco products and electronic cigarettes use are associated with use of both these products and conventional tobacco smoking: the 2018 JASTIS study

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055465 ◽

2020 ◽

pp. tobaccocontrol-2019-055465

Author(s):

Yanakawee Siripongvutikorn ◽

Takahiro Tabuchi ◽

Sumiyo Okawa

Keyword(s):

Regression Models ◽

Electronic Cigarettes ◽

Internet Survey ◽

Survey Study ◽

Cigarette Use ◽

Cigarette Smokers ◽

Tobacco Products ◽

National Legislation ◽

Adjusted Rate ◽

Rate Ratios

ObjectivesHeated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) are rapidly gaining popularity, especially in Japan. However, at the time of the survey (2018), there was no national legislation banning HTPs or e-cigarette use in the workplace. The objective is to examine the current situation for workplace smoke-free policies which ban the use of HTPs/e-cigarettes and the associations of such rules with the use of HTP and e-cigarette as well as conventional cigarette smoking.MethodsAn internet-based self-reported questionnaire survey was conducted in 2018 as a part of the Japan Society and New Tobacco Internet Survey study. 5646 eligible employees aged 15–72 years were analysed. Proportions and adjusted rate ratios for HTP and e-cigarette use were calculated according to covariates, using Poisson regression models. Those who reported HTP or e-cigarette use within 30 days were defined as current user of the products.ResultsIn workplaces which prohibited smoking indoors but permitted the use of HTPs/e-cigarettes, the rate ratios of HTP use was 2.19 (95% CI 1.57 to 3.06), e-cigarette use was 3.86 (95% CI 1.97 to 7.57) and combustible cigarette use was 1.67 (95% CI 1.19 to 2.34) when using workplaces which also prohibited HTPs/e-cigarettes as a reference category.ConclusionsWorkplaces that allow HTP/e-cigarette use indoors were associated with higher rate for HTP and e-cigarette users, and for combustible cigarette smokers. National legislation banning tobacco should be enforced and also cover HTPs and e-cigarettes in order to avoid renormalisation of smoking and nicotine addiction.

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The Chilling Effect: Investor-State Dispute Settlement, Graphic Health Warnings, the Plain Packaging of Tobacco Products, and the Trans-Pacific Partnership

10.31219/osf.io/pr28w ◽

2018 ◽

Author(s):

Matthew Rimmer

Keyword(s):

Public Health ◽

Tobacco Control ◽

Dispute Settlement ◽

Trade Agreement ◽

Control Measures ◽

The European Union ◽

Health Warnings ◽

Tobacco Products ◽

Plain Packaging ◽

Philip Morris

Investor-State Dispute Settlement (ISDS) poses significant challenges in respect of tobacco control, public health, human rights, and sustainable development. Two landmark ISDS rulings provide procedural and substantive guidance on the interaction between ISDS and tobacco control. The ISDS action by Philip Morris against Uruguay in respect to graphic health warnings raised important procedural and substantive issues. The ISDS matter between Philip Morris and Australia over the plain packaging of tobacco products highlighted matters in respect of abuse of process. In the Trans-Pacific Partnership (TPP), there was a special exclusion for tobacco control measures in respect of ISDS. There was also a larger discussion about the role of general public health exceptions. In the Comprehensive Economic and Trade Agreement (CETA), there was a debate about the application of ISDS to intellectual property rights. In the European Union, there has been discussion of the creation of an international investment court. In the renegotiation of the North American Free Trade Agreement (NAFTA), there has even been calls to abolish ISDS clauses altogether from both Republicans and Democrats. This article concludes there is a need to protect tobacco control measures implementing the WHO Framework Convention on Tobacco Control 2003 from further investor and trade challenges.

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Antismoking Advertisements and Price Promotions and Their Association With the Urge to Smoke and Purchases in a Virtual Convenience Store: Randomized Experiment

Journal of Medical Internet Research ◽

10.2196/14143 ◽

2019 ◽

Vol 21 (10) ◽

pp. e14143

Author(s):

Lauren McCarl Dutra ◽

James Nonnemaker ◽

Brian Bradfield ◽

Nathaniel Taylor ◽

Jamie Guillory ◽

...

Keyword(s):

Regression Models ◽

Negative Relationship ◽

Convenience Store ◽

Significant Finding ◽

Price Promotions ◽

Cigarette Smokers ◽

Tobacco Products ◽

Current Cigarette ◽

Urge To Smoke ◽

Former Smokers

Background Point of sale (POS) advertising is associated with smoking initiation, current smoking, and relapse among former smokers. Price promotion bans and antismoking advertisements (ads) are 2 possible interventions for combating POS advertising. Objective The purpose of this analysis was to determine the influence of antismoking ads and promotions on urges to smoke and tobacco purchases. Methods This analysis examined exposure to graphic (graphic images depicting physical consequences of tobacco use) and supportive (pictures of and supportive messages from former smokers) antismoking ads and promotions in a virtual convenience store as predictors of urge to smoke and buying tobacco products among 1200 current cigarette smokers and 800 recent quitters recruited via a Web-based panel (analytical n=1970). We constructed linear regression models for urge to smoke and logistic regression models for the odds of purchasing tobacco products, stratified by smoking status. Results The only significant finding was a significant negative relationship between exposure to supportive antismoking ads and urge to smoke among current smokers (beta coefficient=−5.04, 95% CI −9.85 to −0.22; P=.04). There was no significant relationship between graphic antismoking ads and urge to smoke among current smokers (coefficient=−3.77, 95% CI −8.56 to 1.02; P=.12). Neither relationship was significant for recent quitters (graphic: coefficient=−3.42, 95% CI −8.65 to 1.81; P=.15 or supportive: coefficient=−3.82, 95% CI −8.99 to 1.36; P=.20). There were no significant differences in urge to smoke by exposure to promotions for current smokers (coefficient=−1.06, 95% CI −4.53 to 2.41; P=.55) or recent quitters (coefficient=1.76, 95% CI −2.07 to 5.59; P=.37). There were also no differences in tobacco purchases by exposure to graphic (current smokers: coefficient=0.93, 95% CI 0.67 to 1.29; P=.66 and recent quitters: coefficient=0.73, 95% CI 0.44 to 1.19; P=.20) or supportive (current smokers: coefficient=1.05, 95% CI 0.75 to 1.46; P=.78 and recent quitters: coefficient=0.73, 95% CI 0.45 to 1.18; P=.20) antismoking ads or price promotions (current smokers: coefficient=1.09, 95% CI 0.86 to 1.38; P=.49 and recent quitters: coefficient=0.90, 95% CI 0.62 to 1.31; P=.60). Conclusions The results of this analysis support future research on the ability of supportive antismoking ads to reduce urges to smoke among current cigarette smokers. Research on urges to smoke has important tobacco control implications, given the relationship between urge to smoke and smoking cigarettes, time to next smoke, and amount smoked.

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