Smokers' recall of Australian graphic cigarette packet warnings & awareness of associated health effects, 2005-2008.

BACKGROUND: In 2006, Australia introduced graphic cigarette packet warnings. The new warnings include one of 14 pictures, many depicting tobacco-related pathology. The warnings were introduced in two sets; Set A in March and Set B from November. This study explores their impact on smokers' beliefs about smoking related illnesses. This study also examines the varying impact of different warnings, to see whether warnings with visceral images have greater impact on smokers' beliefs than other images. METHODS: Representative samples of South Australian smokers were interviewed in four independent cross-sectional omnibus surveys; in 2005 (n=504), 2006 (n=525), 2007 (n=414) and 2008 (n=464). RESULTS: Unprompted recall of new graphic cigarette warnings was high in the months following their introduction, demonstrating that smokers' had been exposed to them. Smokers also demonstrated an increase in awareness about smoking-related diseases specific to the warning messages. Warnings that conveyed new information and had emotive images demonstrated greater impact on recall and smokers' beliefs than more familiar information and less emotive images. CONCLUSIONS: Overall graphic pack warnings have had the intended impact on smokers. Some have greater impact than others. The implications for policy makers in countries introducing similar warnings are that fresh messaging and visceral images have the greatest impact.

Response of mass media, tobacco industry and smokers to the introduction of graphic cigarette pack warnings in Australia.

BACKGROUND: In the year 2006, Australia introduced graphic cigarette packet warnings. Previous warnings were text only. New warnings include one of 14 pictures, many depicting tobacco-related pathology. METHODS: This study monitored the roll-out of the health policy initiative using multiple methodologies. Print media coverage of new pack warnings was observed over 3 years. Story content was coded as positive (supportive of pack warnings), neutral or negative. An observational study of small random sample of metropolitan stores (n = 16) over 7 months measured the pace of the roll-out in shops. Once new packs were readily available in stores, smokers (n = 152) were intercepted in city streets and asked about their reactions. RESULTS: Of the 67 media stories, 85% were positive or neutral about the new warnings and 15% were negative. Supportive content presented health benefits. Unsupportive content presented industry arguments. After the legislative change, it took 2 months before any new packs appeared in stores. After 6 months, the majority carried them. Newest images had highest recall among smokers. About 60% said new warnings detracted from the look of their brand. About 51% felt the increased risk of dying from smoking-related illness. About 38% felt motivated to quit. CONCLUSION: Plans by government to introduce graphic warnings were delayed up to 2 years, apparently by heavy industry lobbying. Actual widespread appearance in shops occurred several months after the implementation date. While media coverage of the new warnings reported the industry arguments against them, the balance of coverage was overwhelmingly positive. Smokers' initial reactions were in line with tobacco control objectives.