Fathelrahman Ahmed I, Li Lin, Borland Ron, Yong Hua-Hie, Omar Maizurah, Awang Rahmat, Sirirassamee Buppha, Fong Geoffrey T, Hammond David
Clearing House for Tobacco Control, the National Poison Center, Universiti Sains Malaysia, Minden, Pulau Pinang 11800, Malaysia.
Tob Induc Dis. 2013 Sep 18;11(1):20. doi: 10.1186/1617-9625-11-20.
We examined the impact of cigarette pack warning labels on interest in quitting and subsequent quit attempts among adult smokers in Malaysia and Thailand.
Two overlapping cohorts of adults who reported smoking factory- made cigarettes from Malaysia and Thailand were interviewed face-to-face (3189 were surveyed at baseline and 1781 re-contacted at Wave 2; 2361 current smokers were surveyed at Wave 2 and 1586 re-contacted at Wave 3). In Thailand at baseline, large text only warnings were assessed, while at Wave 2 new large graphic warnings were assessed. In Malaysia, during both waves small text only warnings were in effect. Reactions were used to predict interest in quitting, and to predict making quit attempts over the following inter-wave interval.
Multivariate predictors of "interest in quitting" were comparable across countries, but predictors of quit attempts varied. In both countries, cognitive reactions to warnings (adjusted ORs; 1.57 & 1.69 for Malaysia at wave 1 and wave 2 respectively and 1.29 & 1.19 for Thailand at wave 1 and wave 2 respectively), forgoing a cigarette (except Wave 2 in Malaysia) (adjusted ORs; 1.77 for Malaysia at wave 1 and 1.54 & 2.32 for Thailand at wave 1 and wave 2 respectively), and baseline knowledge (except wave 2 in both countries) (adjusted ORs; 1.71 & 1.51 for Malaysia and Thailand respectively) were positively associated with interest in quitting at that wave. In Thailand only, "cognitive reactions to warnings" (adjusted ORs; 1.12 & 1.23 at wave 1 and wave 2 respectively), "forgoing a cigarette" (adjusted OR = 1.55 at wave 2 only) and "an interest in quitting" (adjusted ORs; 1.61 & 2.85 at wave 1 and wave 2 respectively) were positively associated with quit attempts over the following inter-wave interval. Salience was negatively associated with subsequent quit attempts in both Malaysia and Thailand, but at Wave 2 only (adjusted ORs; 0.89 & 0.88 for Malaysia and Thailand respectively).
Warnings appear to have common mechanisms for influencing quitting regardless of warning strength. The larger and more informative Thai warnings were associated with higher levels of reactions predictive of quitting and stronger associations with subsequent quitting, demonstrating their greater potency.
我们研究了香烟包装警示标签对马来西亚和泰国成年吸烟者戒烟意愿及后续戒烟尝试的影响。
对两个重叠队列中报告吸食工厂生产香烟的马来西亚和泰国成年人进行面对面访谈（基线调查3189人，第2波随访重新联系1781人；第2波调查2361名当前吸烟者，第3波随访重新联系1586人）。在泰国基线调查时，评估了仅大字警告，而在第2波时评估了新的大幅图形警告。在马来西亚，两波调查期间均实施仅小字警告。通过反应情况来预测戒烟意愿，并预测在后续波次间隔期间进行戒烟尝试的情况。
“戒烟意愿”的多变量预测因素在各国之间具有可比性，但戒烟尝试的预测因素有所不同。在两个国家，对警告的认知反应（调整后的比值比；马来西亚第1波和第2波分别为1.57和1.69，泰国第1波和第2波分别为1.29和1.19）、放弃吸烟（马来西亚第2波除外）（调整后的比值比；马来西亚第1波为1.77，泰国第1波和第2波分别为1.54和2.32）以及基线知识（两国第2波除外）（调整后的比值比；马来西亚和泰国分别为1.71和1.51）与该波次的戒烟意愿呈正相关。仅在泰国，“对警告的认知反应”（第1波和第2波调整后的比值比分别为1.12和1.23）、“放弃吸烟”（仅第2波调整后的比值比 = 1.55）和“戒烟意愿”（第1波和第2波调整后的比值比分别为1.61和2.85）与后续波次间隔期间的戒烟尝试呈正相关。在马来西亚和泰国，显著性与后续戒烟尝试均呈负相关，但仅在第2波时如此（马来西亚和泰国调整后的比值比分别为0.89和0.88）。
无论警告强度如何，警告似乎具有影响戒烟的共同机制。泰国更大且信息更丰富的警告与更高水平的预测戒烟反应以及与后续戒烟更强的关联相关，证明了其更大的效力。
