Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive-findings from the longitudinal EUREST-PLUS ITC Europe surveys
File(s)
Author(s)
Type
Journal Article
Abstract
BACKGROUND: Tobacco product packaging is a key part of marketing efforts to make tobacco use appealing. In contrast, large, prominent health warnings are intended to inform individuals about the risks of smoking. In the European Union, since May 2016, the Tobacco Products Directive 2014/40/EU (TPD2) requires tobacco product packages to carry combined health warnings consisting of a picture, a text warning and information on stop smoking services, covering 65% of the front and back of the packages. METHODS: Key measures of warning label effectiveness (salience, cognitive reactions and behavioural reaction) before and after implementation of the TPD2, determinants of warning labels' effectiveness and country differences were examined in a longitudinal sample of 6011 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain (EUREST-PLUS Project) using longitudinal Generalized Estimating Equations (GEE) models. RESULTS: In the pooled sample, the warning labels' effectiveness increased significantly over time in terms of salience (adjusted OR = 1.18; 95% CI: 1.03-1.35), while cognitive and behavioural reactions did not show clear increases. Generally, among women, more highly educated smokers and less addicted smokers, the effectiveness of warning labels tended to be higher. CONCLUSION: We found an increase in salience, but no clear increases for cognitive and behavioural reactions to the new warning labels as required by the TPD2. While it is likely that our study underestimated the impact of the new pictorial warning labels, it provides evidence that health messages on tobacco packaging are more salient when supported by large pictures.
Date Issued
2020-07-01
Date Acceptance
2020-01-23
Citation
European Journal of Public Health, 2020, 30 (Suppl_3), pp.iii84-iii90
ISSN
1101-1262
Publisher
Oxford University Press
Start Page
iii84
End Page
iii90
Journal / Book Title
European Journal of Public Health
Volume
30
Issue
Suppl_3
Copyright Statement
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.This is a pre-copy-editing, author-produced version of an article accepted for publication in European Journal of Public Health following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/eurpub/article/30/Supplement_3/iii84/5904944
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32918822
PII: 5904944
Subjects
Adult
Europe
Female
Germany
Greece
Humans
Hungary
Male
Poland
Product Labeling
Romania
Smoking Prevention
Spain
Tobacco
Tobacco Products
Tobacco Use
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2020-09-12