The Potential Effectiveness of Warning Labels on Cigarette Packages: The Perceptions of Young Adult Canadians
Koval, John J., Aubut, Jo-Anne L., Pederson, Linda L., O'Hegarty, Michelle, Chan, Stella S. H., Canadian Journal of Public Health
Background: Since 1989 when health warning labels appeared on Canadian cigarette packages, the labels have changed from text only covering less than one quarter of the package to text and graphics covering over half the package. This study examines how Canadians in their 20s feel about the current graphic warning labels and their potential to prevent smoking and encourage quitting.
Methods: Participants between 20 and 24 years of age were part of a 10-year cohort study begun when the group was in Grade 6, with the purpose of examining factors that may affect smoking. Five questions about warning labels were added to the 2002 questionnaire requesting information on perceptions of the labels and their potential impact on smoking behaviours of young adults. One item had been included in previous questionnaires.
Results: 32.8% (n=1267) of the respondents were smokers, with males (35.6%) being more likely to smoke than females (30.4%). Current smokers were less likely than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting.
Conclusion: Despite the efforts taken in developing the labels, some young adults are skeptical about their effects. Warning labels may have to be modified to target issues that are relevant to young adults; gender differences are important in this modification. Warning labels can offer an additional component to a comprehensive tobacco control program, in that they provide health information.
MeSH terms: Smoking; product labelling; statistics
In Canada, overall smoking prevalence has dropped substantially since the mid-1990s, (32% in 1994 to 20% in 2003).1 From 1998 to 2003, there has been a reduction in the prevalence of current smoking among young adults aged 20-24, from 38% to 30%. However, this age group is still smoking at a considerably higher rate than the general Canadian population.1,2 In the US, smoking levels among 18 to 24 year olds surpass youth (ages 12-17) smoking rates, and they are not declining, compared to declines in other age groups;3 prevalence was 28.5% in 2002, 26.9% in 2001.4,5 Several tobacco control measures have been instituted to help reduce prevalence, including increasing the price of tobacco products through taxation, restrictions on tobacco advertising, restrictions on vending machine cigarette distribution, restrictions on smoking-allowed environments,6-9 increasing public awareness of the dangers of smoking and second-hand smoke through education programs.10,11 More prominent warning labels on cigarette packs can contribute to tobacco control efforts through the provision of information about health effects and tobacco ingredients.12 In Canada, warning labels have evolved from text-only labels covering 20% of the pack in 1989 to graphics and text covering over 50% of the pack in 2000.13
In this report, we present findings from a group of young adults who have participated in a 10-year longitudinal study.14-16 The original purpose of the study was to examine the influence of specific psychosocial factors on the smoking behaviour of adolescents from the Greater Toronto area.15 The cohort, who in 2002 were in their early 20s, were asked how they perceived the warning labels that had been on cigarette packages for two years, and the potential effectiveness of these labels in preventing young people from starting to smoke and in encouraging current smokers to quit.
Ethics approval was obtained from the University of Western Ontario; 1,409 questionnaires were sent out and 1,270 (90.1%) were returned.* Methods for this cohort study have been described elsewhere.14-16 In the 88-item questionnaire, respondents were asked about their demographics, current education status, work status, social involvement, illegal drug and alcohol use, parental education and occupation, attitudes and psychosocial factors, smoking environment and smoking status. …