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. 2016 Jul:88:59-65.
doi: 10.1016/j.ypmed.2016.03.006. Epub 2016 Mar 10.

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

James F Thrasher  1 , Kamala Swayampakala  2 , K Michael Cummings  3 , David Hammond  4 , Dien Anshari  5 , Dean M Krugman  6 , James W Hardin  7
Affiliations

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

James F Thrasher et al. Prev Med. 2016 Jul.

Abstract

Background: In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers' attention toward warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up.

Methods: Data were analyzed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models were estimated to assess associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects.

Results: Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11-0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06-0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14-0.47), quit attempts (ORtwice or more vs none=1.68, 95% CI: 1.28-2.19), and sustained quit attempts (ORtwice or more vs none=1.48, 95% CI: 1.01-2.17).

Conclusions: More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs.

Keywords: Cessation; Health Promotion; Health Warnings; Policy; Smoking.

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Conflict of interest statement

Conflict of interest statement: This work was supported by the U.S. National Cancer Institute (R01 CA167067). The funding agency had no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Figures

Figure 1
Figure 1. Reading HWLs and reading inserts in past month over the study period among all participants from wave-I to wave-VI
See this image and copyright information in PMC

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References

    1. Canadian Cancer Society. Cigarette package warning labels: International status report. 2014.
    1. Brandt AM. The cigarette century. New York, NY: Basic Books; 2007.
    1. Thrasher JF, Osman A, Abad-Vivero EN, et al. The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy. Nicotine & Tobacco Research. 2015;17(7):870–875. - PMC - PubMed
    1. Thrasher JF, Arillo-Santillan E, Villalobos V, et al. Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content. Cancer Causes & Control. 2012;23(Suppl 1):69–80. - PMC - PubMed
    1. Huang J, Chaloupka FJ, Fong GT. Cigarette graphic warning labels and smoking prevalence in Canada: a critical examination and reformulation of the FDA regulatory impact analysis. Tobacco Control. 2014;23(Suppl 1):i7–12. - PMC - PubMed

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