摘要：Objectives . We assessed the impact of graphic Canadian cigarette warning labels. Methods . We used a longitudinal telephone survey of 616 adult smokers. Results . Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up. Conclusions . Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes. In recognition of the growing health and economic burden of tobacco use, 1, 2 the World Health Organization recently adopted the world’s first public health treaty, the Framework Convention on Tobacco Control. This requires nations to implement a range of tobacco control policies, including important provisions for package labeling. The Framework Convention on Tobacco Control calls for large, clear health warnings “that may be in the form of a picture” and cover between 30% and 50% of the pack. Warning labels that meet and exceed these requirements were introduced on Canadian cigarette packages in December 2000. The Canadian labels feature 1 of 16 full-color, sometimes graphic, health warnings, covering more than 50% of the front and back of cigarette packages. Messages that provide more detailed health risk and cessation information appear on the inside of packages. Graphic warnings have been criticized on 4 general grounds: they will cause unnecessary or excessive emotional distress; smokers will simply avoid the warnings; graphic labels will undermine the credibility of the message; and, most notably, graphic or “grotesque” labels will cause reactance, or increases in consumption. 3, 4 However, at present, there are no published findings on the impact of graphic warning labels. The present study sought to assess emotional reactions, avoidant behaviors, and self-report measures of impact in response to the new Canadian warning labels. The study also examined to what extent, if at all, emotional responses and avoidant behaviors predicted cessation behavior at a 3-month follow-up.
