Gravely Shannon, Fong Geoffrey T, Driezen Pete, McNally Mary, Thrasher James F, Thompson Mary E, Boado Marcelo, Bianco Eduardo, Borland Ron, Hammond David
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
Tob Control. 2016 Jan;25(1):89-95. doi: 10.1136/tobaccocontrol-2014-051742. Epub 2014 Dec 15.
Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness.
Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in five cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (prepolicy: wave 2) and 2010/11 (postpolicy: wave 3).
Overall, 1746 smokers participated in the study at wave 2 (n=1379) and wave 3 (n=1411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly (noticing HWLs: OR=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<0.001; and reports that HWLs stopped smokers from having a cigarette 'many times': OR=3.42, p<0.001).
The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness.
《烟草控制框架公约》第11条准则建议健康警示标签应至少占据烟包面积的50%，但烟草行业声称扩大标签面积不会带来更多益处。本文报告了第一项针对将健康警示标签面积增加至50%以上的影响进行的人群研究。我们检验了这样一个假设：乌拉圭2009/2010年对健康警示标签的强化措施将与更高的效果水平相关。
数据取自参与乌拉圭国际烟草控制（ITC）调查的成年吸烟者（≥18岁）队列。该概率抽样队列代表了五个城市的成年吸烟者。调查包括健康警示标签效果的关键指标。数据于2008/09年（政策实施前：第2轮）和2010/11年（政策实施后：第3轮）收集。
总体而言，1746名吸烟者参与了第2轮（n = 1379）和第3轮（n = 1411）的研究。在乌拉圭2009/2010年健康警示标签发生变化（面积从50%增至80%）后，健康警示标签效果的所有指标均显著提高（注意到健康警示标签：比值比[OR]=1.44，p = 0.015；阅读健康警示标签：OR = 1.42，p = 0.002；健康警示标签对思考吸烟风险的影响：OR = 1.66，p < 0.001；健康警示标签增加戒烟意愿：OR = 1.76，p < 0.001；避免看健康警示标签：OR = 2.35，p < 0.001；以及报告健康警示标签多次阻止吸烟者吸烟：OR = 3.42，p < 0.001）。
乌拉圭2009/2010年对健康警示标签的改变，包括大幅增加标签面积，导致健康警示标签关键指标上升，从而支持了以下结论：将健康警示标签强化至超出最低准则建议的水平可带来更高的效果。
