Mannocci Alice, Antici Daniele, Boccia Antonio, La Torre Giuseppe
Sezione igiene, Dipartimento di sanità pubblica e malattie infettive, Università Sapienza di Roma, Italy.
Epidemiol Prev. 2012 Mar-Apr;36(2):100-7.
the principal aim was to assess the impact of health warnings on cigarette packages in Italy, the reduction of daily number of cigarette smoked, in relationship to the tobacco-smoking dependence and motivation to quit. The second aim was to compare the impact of text warnings versus graphi depictions.
cross-sectional study (survey).
the study was conducted through interviews to an opportunistic sample of smokers.The subject enrolled were adult smokers (years ≥ 18), living in the province of Rome. Data were collected in two outpatient clinics located in Morlupo and Rome. Interviews were administered in the waiting rooms, to patients or to their relatives/ helpers. The survey was conducted in June-September 2010. The sample size (266 participants) was computed using a power of 80%, a confidence level of 95%, an expected frequency of smokers with a low motivation to quit who reduced number of cigarettes due to warnings of 15%, and a frequency of smokers with a higher motivation to quit who reduced number of cigarettes due to warnings of 30%.
the effect of the health warnings used in Italy on smoking reduction was measured with the following self-reported items: "Are you or have you been influenced by the health warnings on cigarettes packages (in relation to the daily number of cigarettes smoked)?"; "Have you changed your smoking habits due to the warnings (for example: don't smoking after a coffee.)?"; "Have you ever stopped smoking due to the warnings?" The effect of labels that used shock images on cigarette boxes was measured using followed self-reported questions: "If shocking images were used on cigarette boxes, would they have greater effect than simple warning text currently used?"; "If your favourite cigarettes brand decide to change the look of its cigarette boxes with shocking images on smoking health damages, would you be driven to change it?"
thanks to the health warnings, 95% of the 270 participants were informed on smoking damages, 14% (34 smokers) reduced the number cigarettes per day, and 5% (12 smokers) attempted to quit. Forty-five percent of smokers did not know the real impact of light cigarettes on their health, and 49% decided to smoke light cigarettes after having read the warnings. Women were more susceptible to immediate consequences of smoking (appearance of wrinkles; p<0.001), and were more prone to switch to light cigarettes (p=0.002). Smoking dependence, computed with Fagerstrom's test, showed significant differences by age groups (higher in smokers aged 30-45 years; p=0.001), and in smokers who were not interested to deepen knowledge of smoking effects (p=0.009). Individuals more motivated to quit were younger smokers (p=0.012). Smokers aged ≥ 45 years (OR=2.54; 95%CI 1.05-6.17), more motivated to quit (OR=2.92; 95%CI 1.17-7.30), those who reported they do not like the smoking smell on their own clothes (OR=3.6; 95%CI 1.4-9.0), those who reported warning messages are important (OR=4.93; 95%CI 1.55-15.71), those who changed their own smoking behavior due the warnings (OR=3.31; 95%CI 1.10-9.99) were more likely to reduce daily number of cigarettes due the health warnings. Forty-seven percent thought that health warnings with text and images could have a higher impact in comparison to text-only warnings. Moreover, women were more motivated to change cigarette brand if a brand should introduce pictorial warnings (OR=2.54; 95%CI 1.41-4.56).
our study showed some positive effects of the introduction of health warnings on cigarette packages. In fact, almost all were informed on tobacco effects, 14% of them reduced the amount of daily smoking, and 5% attempted to quit. Many smokers still believe that switching to lighter cigarettes (e.g. those with less nicotine and tar contents) reduces smoking-related diseases. More than 50% of smokers recognized the importance of health warnings in communicating health risks of smoking, while women were more impressed than men by shocking pictorial warnings.
主要目的是评估意大利香烟包装上的健康警示对每日吸烟量减少的影响，以及与吸烟依赖和戒烟动机的关系。第二个目的是比较文字警示与图形描绘的影响。
横断面研究（调查）。
该研究通过对吸烟者的机会性样本进行访谈来进行。纳入的受试者为成年吸烟者（年龄≥18岁），居住在罗马省。数据在位于莫尔卢波和罗马的两家门诊诊所收集。访谈在候诊室对患者或其亲属/助手进行。调查于2010年6月至9月进行。样本量（266名参与者）使用80%的检验效能、95%的置信水平、因警示而戒烟动机低且吸烟量减少的吸烟者预期频率为15%、因警示而戒烟动机高且吸烟量减少的吸烟者频率为30%进行计算。
通过以下自我报告项目测量意大利使用的健康警示对减少吸烟的效果：“您是否或曾经受到香烟包装上健康警示的影响（与每日吸烟量有关）？”；“您是否因警示而改变了吸烟习惯（例如：喝完咖啡后不吸烟）？”；“您是否曾因警示而戒烟？”使用以下自我报告问题测量在香烟盒上使用震撼图像的标签的效果：“如果在香烟盒上使用震撼图像，它们会比目前使用的简单警示文字产生更大的效果吗？”；“如果您最喜欢的香烟品牌决定用关于吸烟对健康损害的震撼图像来改变其烟盒外观，您会因此而改变品牌吗？”
由于健康警示作用，270名参与者中有95%了解了吸烟危害，14%（34名吸烟者）减少了每日吸烟量，5%（12名吸烟者）尝试戒烟。45%的吸烟者不知道淡烟对其健康的实际影响，49%的吸烟者在阅读警示后决定吸淡烟。女性更容易受到吸烟直接后果的影响（出现皱纹；p<0.001），并且更倾向于改吸淡烟（p=0.002）。用法格斯特龙测试计算的吸烟依赖性在不同年龄组中有显著差异（30 - 45岁的吸烟者中更高；p=0.001），在对深入了解吸烟影响不感兴趣的吸烟者中也有显著差异（p=0.009）。更有戒烟动机的个体是年轻吸烟者（p=0.012）。年龄≥45岁的吸烟者（OR = 2.54；95%CI 1.05 - 6.17）、更有戒烟动机的吸烟者（OR = 2.92；95%CI 1.17 - 7.30）、那些报告自己不喜欢衣服上烟味的吸烟者（OR = 3.6；95%CI 1.4 - 9.0）、那些报告警示信息很重要的吸烟者（OR = 4.93；95%CI 1.55 - 15.71）、那些因警示而改变自己吸烟行为的吸烟者（OR = 3.31；95%CI 1.10 - 9.99）更有可能因健康警示而减少每日吸烟量。47%的人认为带有文字和图像的健康警示相比仅文字警示可能有更大影响。此外，如果一个品牌引入图片警示，女性更有动机更换香烟品牌（OR = 2.54；95%CI 1.41 - 4.56）。
我们的研究显示了在香烟包装上引入健康警示的一些积极效果。事实上，几乎所有人都了解了烟草的影响，其中14%减少了每日吸烟量，5%尝试戒烟。许多吸烟者仍然认为改吸淡烟（例如尼古丁和焦油含量较低的香烟）可减少与吸烟相关的疾病。超过50%的吸烟者认识到健康警示在传达吸烟健康风险方面的重要性，而令人震撼的图片警示对女性的影响比男性更大。
