Abstract
INTRODUCTIONNoticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco.METHODSWe analyzed data from the 2017 Zambia WHO STEPS survey (STEPwise approach to surveillance) for noncommunicable disease risk factors. Descriptive analyses and logistic regression were performed to assess the association of select sociodemographic characteristics with awareness of health warnings and thinking about quitting because of health warnings.RESULTSAdults who currently smoked tobacco who were aged 30–44 years, of Chewa ethnicity, or with a formal education, were more likely to be aware of health warnings than those aged 18–29 years (adjusted prevalence ratio, APR=1.26; 95% CI: 1.02–1.54), of Bemba ethnicity (APR=1.43; 95% CI: 1.17–1.74), or with no formal education (APR: 2.61–5.95). Among all adults who currently smoked, those of Chewa ethnicity (APR=1.55; 95% CI: 1.03–2.35), or with a formal education (APR:1.80–4.38), were more likely to report thinking about quitting because of health warnings than those who were of Bemba ethnicity or with less than primary school education level. Women who currently smoked were 49% less likely (APR=0.51; 95% CI: 0.23–0.84) to report thinking about quitting than men. Among a subset of adults who currently smoked who were aware of health warning labels, no sociodemographic characteristics were significantly associated with thinking about quitting in unadjusted or adjusted models.CONCLUSIONSSociodemographic characteristics such as sex, ethnicity, and education level were significantly associated with awareness of cigarette health warnings. Among cigarette smokers aware of health warnings, no sociodemographic differences in thinking about quitting were found. Tobacco control campaigns may need to target people of ethnicities with the highest smoking prevalence in the country.
Highlights
Noticing health warnings on cigarette packages has been associated with thinking about quitting
In the adjusted model, being in the 30–44 age group (APR=1.26; 95% confidence intervals (CIs): 1.02–1.54), Chewa ethnicity (APR=1.43; 95% CI: 1.17–1.74) and education: without formal schooling (APR=0.41; 95% CI: 0.20–0.82), primary school (APR=1.77; 95% CI: 1.31–2.93), junior secondary school (APR=2.10; 95% CI: 1.57–2.79) and secondary high school (APR=1.98; 95% CI: 1.41–2.78) remained significantly more or less likely to be aware of health warnings
When restricted to current smokers who were aware of health warning labels, the prevalence of thinking about quitting was 70.4% among those aged 18–29 years, 76.4% among those of Chewa ethnicity, 70.5% and 69.9%, respectively, among those who had completed primary and junior secondary schools, and 69.7% among those who were married (Table 2)
Summary
Noticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco. The WHO FCTC outlines six proven measures toward tobacco demand reduction, including warning about the dangers of tobacco[11]. Article 11 of the WHO FCTC requires the adoption of health warnings on tobacco packages with specific recommendations that the warnings be large (i.e. cover at least 50% and no less than 30% of the principal display areas), clear, and legible, and include both pictures and words to enhance their effectiveness[8]
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