Abstract
Health warnings are an effective strategy for communicating the health harms of smoking, encouraging quitting, and preventing smoking initiation. This study examines the effectiveness of existing text-only health warnings, identifies key predictors of warning effectiveness, and assesses support for pictorial warnings in Japan. Data are from the 2018 International Tobacco Control (ITC) Japan Survey, a cohort survey of adult cigarette smokers (n = 3306), dual users of cigarettes and heated tobacco products (n = 555), and non-cigarette smokers (n = 823). Weighted multivariable logistic regression models were used to assess predictors of warning effectiveness and support for pictorial warnings. Overall, 15.6% of respondents noticed warnings, and 7.9% read or looked closely at warnings. Overall, 10.3% of smokers and dual users said the warnings stopped them from having a cigarette, and 7.2% avoided warnings. Overall, 27.5% of respondents said the warnings made them think about health risks of smoking, but only 2.7% of smokers and dual users said the warnings made them more likely to quit. Overall, 57.6% of respondents supported pictorial warnings. The weak effectiveness of Japan’s text-only warnings is consistent with that in other countries with similar warnings. There is majority support for pictorial warnings in Japan, although the level of support is lower than in other countries.
Highlights
Smoking is a major cause of premature mortality in Asia, accounting for approximately 2 million deaths in 2004 [1]
We examined the level of public support for pictorial warnings in Japan
The present study found that the majority of respondents (57.6%) want the Japanese government to implement pictorial warnings on cigarette packs, which is lower than public support in Russia (87.0%)
Summary
Smoking is a major cause of premature mortality in Asia, accounting for approximately 2 million deaths in 2004 [1]. Japan is among the top ten countries with the largest smoking populations, where more than 20 million people smoke [2,3]. Smoking-related diseases such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease are leading causes of premature death in Japan [4,5]. Res. Public Health 2020, 17, 952; doi:10.3390/ijerph17030952 www.mdpi.com/journal/ijerph
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