Effect of the Framework Convention on Tobacco Control and voluntary industry health warning labels on passage of mandated cigarette warning labels from 1965 to 2012: transition probability and event history analyses

Abstract

Objectives: We quantified the pattern and passage rate of cigarette package health warning labels (HWLs), including the effect of the Framework Convention on Tobacco Control (FCTC) and HWLs voluntarily implemented by tobacco companies.

Methods: We used transition probability matrices to describe the pattern of HWL passage and change rate in 4 periods. We used event history analysis to estimate the effect of the FCTC on adoption and to compare that effect between countries with voluntary and mandatory HWLs.

Results: The number of HWLs passed during each period accelerated, from a transition rate among countries that changed from 2.42 per year in 1965-1977 to 6.71 in 1977-1984, 8.42 in 1984-2003, and 22.33 in 2003-2012. The FCTC significantly accelerated passage of FCTC-compliant HWLs for countries with initially mandatory policies with a hazard of 1.27 per year (95% confidence interval = 1.11, 1.45), but only marginally increased the hazard for countries that had an industry voluntary HWL of 1.68 per year (95% confidence interval = 0.95, 2.97).

Conclusions: Passage of HWLs is accelerating, and the FCTC is associated with further acceleration. Industry voluntary HWLs slowed mandated HWLs.

FIGURE 1—

Kaplan-Meyer event curves for achieving (a) HWLs that met minimum FCTC requirements (rotating detailed HWLs that covered at least 30% of the pack [category 5]) or GWLs (pictures to reinforce the health message [category 6]) and (b) GWLs. Note. FCTC = Framework Convention on Tobacco Control; GWL = graphic warning label; HWL = health warning label. Countries with mandatory HWLs did not achieve FCTC-compliant warning labels in the same median year, 2009, as countries with voluntary HWLs. Countries with initially mandatory HWLs achieved GWLs a median of 2 years before countries that started with voluntary self-regulated HWLs.