Nagelhout Gera E, Willemsen Marc C, de Vries Hein, Mons Ute, Hitchman Sara C, Kunst Anton E, Guignard Romain, Siahpush Mohammad, Yong Hua-Hie, van den Putte Bas, Fong Geoffrey T, Thrasher James F
Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Dutch Alliance for a Smokefree Society, The Hague, The Netherlands.
Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.
Tob Control. 2016 May;25(3):325-32. doi: 10.1136/tobaccocontrol-2014-051971. Epub 2015 Apr 14.
To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level.
Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change.
Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001).
The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers.
研究（1）带有图片的香烟警示标签对自我报告的警示标签反应变化的影响：警示显著性、认知反应、放弃吸烟和避开警示，以及（2）这些变化是否因吸烟者的教育程度而异。
使用了国际烟草控制（ITC）欧洲调查两轮调查中吸烟者的纵向数据。在法国和英国，两轮调查期间在香烟包装背面实施了带有图片的警示标签。在德国和荷兰，文字警示标签没有变化。
在法国，两次调查之间警示显著性降低（OR = 0.81，p = 0.046），在英国有不显著的增加（OR = 1.30，p = 0.058）；在英国认知反应增加（OR = 1.34，p < 0.001），在法国降低（OR = 0.70，p = 0.002）；在英国放弃吸烟增加（OR = 1.65，p < 0.001），在法国降低（OR = 0.83，p = 0.047）；在法国避开警示增加（OR = 2.93，p < 0.001），在英国也增加（OR = 2.19，p < 0.001）。在德国和荷兰，警示显著性和认知反应降低，在这些国家放弃吸烟没有变化，在德国避开警示增加。总体而言，这些警示标签反应的变化不因教育程度而异。然而，在英国，避开警示在低学历（OR = 2.25，p = 0.001）和中等学历吸烟者中尤其增加（OR = 3.21，p < 0.001）。
2010年在法国和2008年在英国实施的在香烟包装一侧带有图片的警示标签未能成功提高警示显著性，但确实增加了避开警示的情况。这些标签没有增加继续吸烟者之间的教育不平等。
