Academic journal article Canadian Journal of Public Health

Challenging Key Assumptions Embedded in Health Canada's Cigarette Packaging Legislation: Findings from in Situ Interviews with Smokers in Vancouver

Academic journal article Canadian Journal of Public Health

Challenging Key Assumptions Embedded in Health Canada's Cigarette Packaging Legislation: Findings from in Situ Interviews with Smokers in Vancouver

Article excerpt

Tobacco product warning labels are a cornerstone of population-level tobacco control. The World Health Organization's Framework Convention on Tobacco Control recommends that: "warning messages should cover at least 50% of the principal display areas of the package," based on the assumption that the labels counteract smokers' tendency to "underestimate the full extent of the risk [of smoking] to themselves and others"1(p. 18) and disrupt "the marketing value of the packages".1(p. 22)

In Canada, text-based warnings came into effect in 1989, with graphic warning labels mandated for use in 2000. Initially, 16 graphic warning labels were launched, along with 16 package inserts containing health information. In 2012, the Canadian government implemented an updated set of 16 labels for cigarette packaging.* The new labels are more visually graphic than their predecessors and their size has increased from 50% to 75% of the front and back of the pack, based on the premise that "bolder" labels are more effective. According to a 2012 press release by Health Canada: "Recent research has reminded us that young people are still very vulnerable to the attractions of tobacco use : : :We welcome the new, stronger warning labels for tobacco products as a critical step to deter Canada's youth from taking up smoking."2

Other additions included four text-based warnings on cigarettes and toxic emissions placed on the side panels of the packages, and an updated set of eight different health information inserts that include graphics and images, which legislators suggest "enhance" health messages and are easier to understand.2 In this framework, the labels and inserts are seen as providing distinct but complementary information that smokers will engage equally with. For example, Thrasher et al.3 state that: "inserts contrast with the loss-framed pictorial warnings on the pack exteriors in Canada, providing messages that are consistent with communication recommendations that suggest that fear-arousing messages should be followed by behavioral recommendations to help escape the source of the fear."3(p. 871)

A final core assumption guiding cigarette packaging legislation is that warning labels provide universal exposure and continual reinforcement. To quote a Canadian report:

"Package warnings reach every smoker : : : every day. Warnings are always working - 24 hours per day, 7 days per week. A pack a day smoker would take his or her pack out 20 times per day, 7300 times per year. Warnings are also seen by those around the consumers, such as family, friends and coworkers." 4(p. 7)

Although these assumptions are integral to the legislation, little is known about potential variations in how smokers engage with labels on a daily basis. In addition to the predominance of quasiexperimental and cross-sectional survey research on warning labels, studies have explored how smokers interact with cigarette packets in "naturalistic" settings by giving them rebranded packets to use for a short period and soliciting their responses at various points via surveys and interviews.5-8 However, such results are relatively artificial insofar as pre-selected smokers are given different packets from those they typically use, and the study contexts require them to be attuned to the packets as a marked (rather than everyday) object. Moreover, most of this evidence is indirect, focusing on intentions rather than actions and outcomes;9 a recent review thus suggests that the evidence on the effectiveness of warning labels in reducing smoking is weak.10

Through our research, we have asked different questions about how smokers interact with warning labels. Our approach has been influenced by our positioning as social scientists (in sociology and anthropology respectively) with a critically-engaged interest in public health. Informed by post-structuralist and phenomenological perspectives, and with lived experience of smoking,11 we have emphasized the need for reflexivity within tobacco control about the reasons people smoke, and the barriers they face with regard to cessation. …

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