Department of Oncology, Cancer Prevention & Control Program, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Tob Control. 2017 Nov;26(6):649-655. doi: 10.1136/tobaccocontrol-2016-053087. Epub 2016 Nov 2.
While many countries have adopted prominent pictorial warning labels (PWLs) for cigarette packs, the USA still requires only small, text-only labels located on one side of the cigarette pack that have little effect on smoking-related outcomes. Tobacco industry litigation blocked implementation of a 2011 Food and Drug Administration's (FDA) rule requiring large PWLs. To inform FDA action on PWLs, this study provides research-based estimates of their public health impacts.
Literature was reviewed to identify the impact of cigarette PWLs on smoking prevalence, cessation and initiation. Based on this analysis, the model was used to estimate the effect of requiring PWLs in the USA on smoking prevalence and, using standard attribution methods, on smoking-attributable deaths (SADs) and key maternal and child health outcomes.
Available research consistently shows a direct association between PWLs and increased cessation and reduced smoking initiation and prevalence. The model projects that PWLs would reduce smoking prevalence by 5% (2.5%-9%) relative to the status quo over the short term and by 10% (4%-19%) over the long term. Over the next 50 years, PWLs are projected to avert 652 800 (327 000-1 190 500) SADs, 46 600 (17 500-92 300) low-birth-weight cases, 73 600 (27 800-145 100) preterm births and 1000 (400-2000) cases of sudden infant death syndrome.
Requiring PWLs on all US cigarette packs would be appropriate for the protection of the public health, because it would substantially reduce smoking prevalence and thereby reduce SADs and the morbidity and medical costs associated with adverse smoking-attributable birth outcomes.
虽然许多国家已经在香烟包装上采用了醒目的图形警示标签（PWLs），但美国仍只要求在香烟包装一侧使用小型、仅含文字的标签，这些标签对吸烟相关结果几乎没有影响。烟草业诉讼阻止了美国食品和药物管理局（FDA）在 2011 年实施的一项规定，要求使用大型 PWLs。为了为 FDA 在 PWLs 方面的行动提供信息，本研究提供了基于研究的 PWLs 对公共卫生影响的估计。
文献综述旨在确定香烟 PWLs 对吸烟流行率、戒烟和起始吸烟的影响。基于该分析，使用模型来估计在美国要求 PWLs 对吸烟流行率的影响，并使用标准归因方法来估计吸烟归因死亡（SADs）和主要母婴健康结果。
现有研究一致表明，PWLs 与戒烟率增加以及吸烟起始率和流行率降低之间存在直接关联。模型预测，与现状相比，PWLs 将在短期内将吸烟流行率降低 5%（2.5%-9%），在长期内降低 10%（4%-19%）。在未来 50 年中，PWLs 预计将避免 652800 例（327000-1190500）SADs、46600 例（17500-92300）低出生体重病例、73600 例（27800-145100）早产和 1000 例（400-2000）婴儿猝死综合征病例。
要求在美国所有香烟包装上使用 PWLs 是保护公众健康的适当措施，因为它将大幅降低吸烟流行率，从而减少 SADs 以及与吸烟相关的不良出生结局相关的发病率和医疗费用。
