title: Impact of graphic pack warnings on adult smokers' quitting activities: Findings from the ITC Southeast Asia Survey (2005-2014).
abstract: Malaysia introduced graphic health warning labels (GHWLs) on all tobacco packages in 2009. We aimed to examine if implementing GHWLs led to stronger warning reactions (e.g., thinking about the health risks of smoking) and an increase in subsequent quitting activities; and to examine how reactions changed over time since the implementation of the GHWLs in Malaysia and Thailand where GHWL size increased from 50-55% in 2010. Data came from six waves (2005-2014) of the International Tobacco Control Southeast Asia Survey. Between 3,706 and 4,422 smokers were interviewed across these two countries at each survey wave. Measures included salience of warnings, cognitive responses (i.e., thinking about the health risks and being more likely to quit smoking), forgoing cigarettes, and avoiding warnings. The main outcome was subsequent quit attempts. Following the implementation of GHWLs in Malaysia, reactions increased, in some cases to levels similar to the larger Thai warnings, but declined over time. In Thailand, reactions increased following implementation, with no decline for several years, and no clear effect of the small increase in warning size. Reactions, mainly cognitive responses, were consistently predictive of quit attempts in Thailand, but this was only consistently so in Malaysia after the change to GHWLs. In conclusion, GHWLs are responded to more frequently, and generate more quit attempts, but warning wear-out is not consistent in these two countries, perhaps due to differences in other tobacco control efforts.
authors.affiliation: Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: National Poison Center, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia; College of Pharmacy, Qassim University, 51452 Buraidah, Saudi Arabia.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Fathelrahman
authors.affiliation: Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.affiliation: National Poison Center, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia.
authors.forename: Maizurah
authors.initials: M
authors.lastname: Omar
authors.affiliation: Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, M5G 1L7, Canada; School of Public Health and Health Systems, University of Waterloo, Ontario, N2L 3G1, Canada.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Fong
authors.affiliation: Department of Psychology, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada.
authors.forename: Anne C K
authors.initials: AC
authors.lastname: Quah
authors.affiliation: Institute for Population and Social Research, Mahidol University Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand.
authors.forename: Buppha
authors.initials: B
authors.lastname: Sirirassamee
authors.affiliation: Nigel Gray Fellowship Group, Cancer Council Victoria, Melbourne, Victoria 3004, Australia.
authors.forename: Hua-Hie
authors.initials: HH
authors.lastname: Yong
keywords: Malaysia; Thailand; health warnings; tobacco packaging