Department of Economics, Concordia University, S-H 1155-11, Henry F. Hall Building, 1455 De Maisonneuve Blvd. W, Montreal, Canada.
School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.
Harm Reduct J. 2021 Apr 16;18(1):43. doi: 10.1186/s12954-021-00487-3.
Graphic Health Warnings (GHWs) on cigarette packages were first introduced in Canada in 2001 and will become mandatory in the US as of January 2022. While previous studies have evaluated the impacts of GHWs, the data used in these studies have several shortcomings. The objective of this paper was to investigate the likely impact of such warnings in the US based upon the experience of Canada using hitherto unexplored monthly cigarette sales data, and to explore if alternative approaches involving risk-reduced products might be more successful in reducing smoking.
We used quasi-experimental segmented regression and difference-in-differences analyses. Data on monthly sales (i.e., shipments) of cigarettes from Canadian manufacturers to Canadian retailers during 1995-2005 were obtained from Statistics Canada.
We found that GHWs did not have a significant impact on the sales of cigarettes in Canada. We propose an alternative type of graphical health messaging that actively combines information on how to quit with the legally required messaging. The novelty of the proposal is that it is incentive compatible for the supply side of the market and if adopted in several states, the measure could be tested by using a suitable treatment-control design.
Our findings imply that we should not expect any notable decline in sales or consumption as a result of implementation of GHWs in the US. The main impact of GHWs will be to add to the anti-smoking culture that has grown steadily over several decades, and this may impact smoking in the longer term.
加拿大于 2001 年首次在香烟包装上引入图形健康警示（GHW），并将于 2022 年 1 月起在美国强制实施。尽管之前已有研究评估了 GHW 的影响，但这些研究中使用的数据存在几个缺陷。本文的目的是利用加拿大迄今为止尚未被探索的每月香烟销售数据，根据加拿大的经验，研究此类警示在美国可能产生的影响，并探讨涉及降低风险产品的替代方法是否更有可能成功减少吸烟。
我们使用了准实验分段回归和差异中的差异分析。从加拿大统计局获得了 1995-2005 年加拿大制造商向加拿大零售商销售香烟的每月（即发货）销售数据。
我们发现 GHW 对加拿大香烟销售没有显著影响。我们提出了一种替代类型的图形健康信息传递方式，该方式积极结合了有关戒烟方法和法定要求信息的传递。该提议的新颖之处在于，它对市场供应方具有激励相容性，如果在美国的几个州采用，该措施可以通过使用合适的处理-对照组设计进行测试。
我们的研究结果表明，我们不应期望由于美国实施 GHW 而导致销售或消费出现显著下降。GHW 的主要影响将是增加过去几十年中稳步增长的反吸烟文化，这可能会对长期吸烟产生影响。
