Effectiveness of text versus pictorial health warning labels and predictors of support for plain packaging of tobacco products within the European Union.
BACKGROUND
Tobacco product warning labels are a key health communication medium with plain packaging noted as the next step in the evolution of tobacco packaging. We assessed the self-reported impact of text versus pictorial health warnings and the determinants of support for plain packaging of tobacco products in the European Union (EU).


METHODS
The Special Eurobarometer 385 survey was analyzed for 26,566 adults from 27 EU countries in 2012. The self-reported impact of warning labels (text or pictorial) and determinants of EU-wide support for plain packaging were assessed using multivariate logistic regression.


RESULTS
Current smokers in countries where cigarette pictorial warnings were implemented had higher odds of reporting that health warning labels had any effect on their smoking behavior (making a quit attempt or reducing number of cigarettes smoked per day) compared to respondents in countries with text-only warning labels (adjusted odds ratio, aOR = 1.31; 95% confidence interval, 95% CI: 1.10-1.56). Population support for plain packaging of tobacco packs was higher in countries where cigarette pictorial warnings already existed (aOR = 1.17; 95% CI: 1.07-1.28).


CONCLUSIONS
These findings indicate that the implementation of pictorial warnings at an EU level may have a positive behavioral impact among smokers and pave the way for population support for plain packaging in the EU.
Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Mass., USA.
Israel T
IT
Agaku
Filippos T
FT
Filippidis
Constantine I
CI
Vardavas
D000293:Adolescent; D000328:Adult; D005062:European Union; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011356:Product Labeling; D019064:Product Packaging; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062789:Tobacco Products; D064424:Tobacco Use / Q000517:prevention & control / Q000523:psychology; D020340:Tobacco Use Cessation / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult