The Impact of Cigarette Warning Labels and Smoke-Free Bylaws on Smoking Cessation: Evidence from Former Smokers

By Hammond, David; McDonald, Paul W. et al. | Canadian Journal of Public Health, May/June 2004 | Go to article overview

The Impact of Cigarette Warning Labels and Smoke-Free Bylaws on Smoking Cessation: Evidence from Former Smokers


Hammond, David, McDonald, Paul W., Fong, Geoffrey T., Brown, K. Stephen, Cameron, Roy, Canadian Journal of Public Health


ABSTRACT

Background: To effectively address the health burden of tobacco use, tobacco control programs must find ways of motivating smokers to quit. The present study examined the extent to which former smokers' motivation to quit was influenced by two tobacco control policies recently introduced in the Waterloo Region: a local smoke-free bylaw and graphic cigarette warning labels.

Methods: A random digit-dial telephone survey was conducted with 191 former smokers in southwestern Ontario, Canada in October 2001. Former smokers who had quit in the previous three years rated the factors that influenced their decision to quit and helped them to remain abstinent.

Results: Thirty-six percent of former smokers cited smoke-free policies as a motivation to quit smoking. Former smokers who quit following the introduction of a total smoke-free bylaw were 3.06 (CI^sub 95^=I .02-9.19) times more likely to cite smoking bylaws as a motivation to quit, compared to former smokers who quit prior to the bylaw. A total of 31% participants also reported that cigarette warning labels had motivated them to quit. Former smokers who quit following the introduction of the new graphic warning labels were 2.78 (CI^sub 95^=1.20-5.94) times more likely to cite the warnings as a quitting influence than former smokers who quit prior to their introduction. Finally, 38% of all former smokers surveyed reported that smoke-free policies helped them remain abstinent and 27% reported that warning labels helped them do so.

Conclusion: More stringent smoke-free and labelling policies were associated with a greater impact upon motivations to quit.

Helping individuals to quit smoking or decrease their tobacco consumption is the most effective means of reducing the health burden from tobacco use over the next 50 years.1 At present, approximately 30% of North American smokers report no desire to quit, while less than half make a serious quit attempt each year.2,3 Accordingly, tobacco control programs must find ways to enhance smokers' motivation to quit and promote long-term abstinence.

Two new tobacco control policies were recently introduced in the Waterloo Region in Ontario, Canada. A local bylaw implemented on January 1, 2000 required all indoor public places to be smoke-free, including restaurants, nightclubs, and recreational facilities. The total smoke-free bylaw was an extension of a partial ban introduced in 1996 that required restaurants to be 50% smoke-free, while bars and nightclubs faced no restrictions. The total smoke-free bylaw was widely regarded as the most comprehensive of its type in Canada, and compliance has been strictly enforced by a large contingent of public health inspectors, police, and by-law enforcement staff.4

In December 2000, approximately 12 months following the bylaw, new graphic cigarette warning labels were introduced in Canada. The labels feature 16 different warnings with graphic colour images that occupy over 50% of the front and back of packages. More detailed health risk messages and information on how to quit smoking appear on the inside of packages. The previous generation of warnings, implemented in 1994, included 8 black and white text warnings, covering 35% of the package.

A growing body of evidence suggests that both smoke-free and cigarette labelling policies promote smoking cessation.5 Workplace smoking bans have been shown to reduce the prevalence and intensity of smoking,6 while warning labels may prompt cessation behaviours such as cutting back or quit attempts.7,8 However, the evidence on smoke-free policies derives mainly from workplace rather than community-wide restrictions, and to date, there are no studies on cigarette warnings and long-term cessation. More generally, there is lack of research examining the influence of policy interventions on motivations to quit smoking.

As successful quitters, former smokers serve as a valuable benchmark for population-based cessation interventions. …

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