Previous research on the impact of tobacco package warnings in some countries shows that in the short term following the introduction of larger and stronger pack warnings, smokers reported greater levels of awareness and impact. However, no study to date has systematically explored differential decay of effects over time and how this might vary by warning regimen.
This study aimed to examine longer term impact of the 2006 Australian pictorial package warnings in comparison to the 2003 UK text only warnings, and controlling for time since implementation, to assess the strength of warnings from Australia, UK and Canada for a comparable period (2-5 years post implementation).
The data came from the International Tobacco Control Australia, Canada, and UK Surveys (2002-2012), prospective multi-country cohort surveys of adult smokers. Key measures included reported salience of pack warnings, cognitive responses to warnings, forgoing cigarettes as a result of the warnings, and avoiding warnings.
Although salience of the UK warnings was higher than the Australian and Canadian pictorial warnings, this did not lead to greater levels of cognitive reactions, forgoing or avoiding. There was no difference in ratings between the Australian and UK warnings for cognitive responses and forgoing, but the Canadian warnings were responded to more strongly. Reactions to the Australian warnings were greater than UK ones on avoiding, but were inferior to the Canadian warnings. The impact of warnings wore-out over time in all three countries. Declines were comparable between Australia and the UK on all measures except avoiding, where Australia had a greater decline; for salience Canada had a lower rate of decline.
Conclusions:The data suggests that warning size may be more important than warning type (pictorial vs. text-only), but that both likely play a critical and interactive role.