Learning Objectives: Describe the components of the new Canadian graphic warning labels. Explain how the theoretical and empirical work on fear appeals predict that the new Canadian warning labels should have positive effects. Understand the importance of quasi-experimental designs in evaluation of public health policies. Describe our initial results of the quasi-experimental study comparing Canadian high school students to U.S. high school students. Understand the range of effects that might be expected from tobacco package warning labels.
Abstract:
Problem/Objective:
In December 2000, Canada became the first country to include vivid photographs on tobacco package warning labels, prompting calls for "Canadian-style" warning labels in many countries and within the Framework Convention for Tobacco Control. Yet there exist few in vivo studies of warning labels, and none that includes a control group. We conducted a quasi-experimental study to evaluate the psychosocial and behavioral effects of the new Canadian warning labels among high school students.
Methods:
The North American Student Smoking Survey (NASSS) is a longitudinal cohort survey of high school students in Canada (N=7,398) and the United States (N=4,920), with survey waves twice a year for 3 years. The first wave occurred before the new warning labels; the second wave occurred 5-6 months after their introduction. Measures included label-relevant variables (e.g., label noticing/salience, reduction behaviors attributed to the labels), psychosocial smoking variables (e.g., attitudes, perceived risk, quitting self-efficacy), and smoking behavior (e.g., smoking history, quit attempts).
Results:
The new Canadian warning labels led to large increases in nearly every label-relevant variable (e.g., salience, perceived effectiveness, forgoing a cigarette because of the labels) among Canadian smokers, compared to the American smokers over the same time period, controlling for age and gender. Although there were no differences in smoking behavior across the change in labels, Canadian smokers were more likely to have intentions to quit after the introduction of the labels (p<.005).
Discussion: This study provides strong support for the effectiveness of the Canadian graphic warning labels among youth, and highlights the potential of international studies to guide policymakers in selecting tobacco control policies of demonstrated effectiveness.
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