Shang Ce, Huang Jidong, Cheng Kai-Wen, He Yanyun, Chaloupka Frank J
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA.
School of Public Health, Georgia State University, Atlanta, GA 30303, USA.
Int J Environ Res Public Health. 2017 Jan 21;14(1):98. doi: 10.3390/ijerph14010098.
The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment.
We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents' self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test.
At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases.
Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels.
世界卫生组织(WHO)《烟草控制框架公约》(FCTC)第11条实施准则要求香烟健康警示标签应包含图片,且占据主要展示面积的50%或更多。本研究考察了大幅图片警示(即覆盖包装正面和背面≥50%的警示)与吸烟率之间的关联如何因教育程度而异。
我们汇总了2008年至2013年期间18个国家全球成人烟草调查(GATS)中的个体层面烟草使用数据,并将其与同一时期MPOWER数据库中的警示标签要求以及有关警示的报告相联系。根据教育程度对受访者自我报告的警示接触情况进行了考察。进一步采用逻辑回归分析大幅图片警示与吸烟率之间按教育程度划分的关联,并使用交互检验考察这种关联是否因教育程度而异。
在调查时,18个国家中有8个国家实施了覆盖包装≥50%的图形警示标签。这些警示与未受过中等教育或未接受过正规教育的成年人中吸烟率降低10.0%(比值比[OR]=0.89;95%置信区间[CI]:0.81,0.97;P≤0.01)相关,但在至少受过中等教育的受访者中并非如此。在所有18个国家中,受教育程度较低的受访者接触警示的可能性也较小。如果受教育程度较低的受访者对警示的接触增加,那么强烈警示与较低吸烟率之间的关联可能会更强。
显著的图片警示标签有可能减少不同教育水平人群因吸烟导致的健康差异。