title: Cigarette packet warning labels can prevent relapse: findings from the International Tobacco Control 4-Country policy evaluation cohort study.
abstract: OBJECTIVE
  To investigate the links between health warning labels (WLs) on cigarette packets and relapse among recently quit smokers.
  
  
  METHODS
  Prospective longitudinal cohort survey.
  
  
  METHODS
  Australia, Canada, the UK and the USA.
  
  
  METHODS
  1936 recent ex-smokers (44.4% male) from one of the first six waves (2002-2007) of the International Tobacco Control 4-Country policy evaluation survey, who were followed up in the next wave.
  
  
  METHODS
  Whether participants had relapsed at follow-up (approximately 1 year later).
  
  
  RESULTS
  In multivariate analysis, very frequent noticing of WLs among ex-smokers was associated with greater relapse 1 year later (OR: 1.52, 95% CI 1.11 to 2.09, p<0.01), but this effect disappeared after controlling for urges to smoke and self-efficacy (OR: 1.29, 95% CI 0.92 to 1.80, p=0.135). In contrast, reporting that WLs make staying quit 'a lot' more likely (compared with 'not at all' likely) was associated with a lower likelihood of relapse 1 year later (OR: 0.65, 95% CI 0.49 to 0.86, p<0.01) and this effect remained robust across all models tested, increasing in some.
  
  
  CONCLUSIONS
  This study provides the first longitudinal evidence that health warnings can help ex-smokers stay quit. Once the authors control for greater exposure to cigarettes, which is understandably predictive of relapse, WL effects are positive. However, it may be that ex-smokers need to actively use the health consequences that WLs highlight to remind them of their reasons for quitting, rather than it being something that happens automatically. Ex-smokers should be encouraged to use pack warnings to counter urges to resume smoking. Novel warnings may be more likely to facilitate this.
authors.affiliation: VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Carlton, Victoria, Australia.
authors.forename: Timea Reka
authors.initials: TR
authors.lastname: Partos
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.forename: Hua-H
authors.initials: HH
authors.lastname: Yong
authors.forename: James
authors.initials: J
authors.lastname: Thrasher
authors.forename: David
authors.initials: D
authors.lastname: Hammond
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011356:Product Labeling / Q000379:methods*; D019064:Product Packaging; D011594:Psychometrics; D012008:Recurrence; D020377:Self Efficacy; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D012923:Social Class; D062789:Tobacco Products