Abstract
BackgroundHealth warnings labels (HWLs) have the potential to effectively communicate the health risks of smoking to smokers and non-smokers, and encourage smokers to quit. This study sought to examine whether non-smokers in China notice the current text-only HWLs and whether they support adding more health information and including pictures on HWLs.MethodsAdult non-smokers (n = 1324) were drawn from Wave 4 (September 2011–November 2012) of the International Tobacco Control (ITC) China Survey. The proportion of non-smokers who noticed the HWLs, and supported adding more health information and pictures to the HWLs was examined. Additionally, the relation between non-smokers’ demographic characteristics, including whether they had a smoking partner, their number of smoking friends, and noticing the HWLs and support for adding health information and pictures was examined. Because the HWLs changed during the survey period (April 2012), differences between non-smokers who completed the survey before and after the change were examined.Results12.2% reported they noticed the HWLs often in the last month. The multivariate model, adjusting for demographics showed that respondents with a smoking partner (OR = 2.41, 95% CI 1.42–4.13, p = 0.001) noticed the HWLs more often. 64.8% of respondents agreed that the HWLs should have more information, and 80.2% supported including pictures. The multivariate model showed that non-smokers who completed the survey after the HWLs were implemented (OR = 0.63, 95% CI 0.40–0.99, p = 0.04) were less likely to support adding more health information. The multivariate model showed a significant relation between having a smoking partner and supporting pictorial HWLs (OR = 2.03, 95% CI 1.24–3.33, p = 0.005).ConclusionsThe findings indicate that the Chinese HWLs are noticed by a minority of non-smokers and that non-smokers strongly support strengthening the Chinese warning labels with more health information and pictures. Additionally, because the HWLs are noticed more often by non-smokers with a smoking spouse/partner, HWLs could be used to communicate the dangers of smoking and secondhand smoke exposure to non-smokers.
Highlights
Health warnings labels (HWLs) have the potential to effectively communicate the health risks of smoking to smokers and non-smokers, and encourage smokers to quit
The aim of this study was to examine: (1) whether non-smokers in China notice the HWLs on cigarettes, (2) whether nonsmokers with smoking spouses or partners and friends notice the warnings more often, and (3) whether nonsmokers support adding more information and pictures to the current text only HWLs
In the bivariate logistic regression analysis, non-smokers who had a smoking spouse/partner (OR = 2.06, 95% Confidence interval (CI) 1.24–3.42 p = 0.006), with 5 vs. 0 smoking friends (OR = 2.72, 95% CI 1.09–6.82, p = 0.033), and surveyed after the new HWLs were implemented (OR = 2.09, 95% CI 1.20–3.63, p = 0.010) were more likely to notice the HWLs more often
Summary
Health warnings labels (HWLs) have the potential to effectively communicate the health risks of smoking to smokers and non-smokers, and encourage smokers to quit. Due to the high prevalence of smoking, approximately 72.4% of non-smokers in China were exposed to secondhand smoke at least weekly, with 38% reporting daily exposure [3]. This is cause for concern as secondhand smoke exposure can cause significant health problems including adult heart disease, and lung diseases in children [3,4,5]. Large pictorial health warnings have been shown to be more effective than smaller text-only HWLs and are important for informing people about the health risks of smoking and encouraging smokers to quit [8,9,10,11,12]
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