Shock and awe or incentive-compatible harm reduction? Graphic health warnings on tobacco packages

Ian Irvine,Hai V Nguyen

doi:10.1186/s12954-021-00487-3

Ian Irvine, Hai V Nguyen

Open Access

https://doi.org/10.1186/s12954-021-00487-3

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Abstract

BackgroundGraphic Health Warnings (GHWs) on cigarette packages were first introduced in Canada in 2001 and will become mandatory in the US as of January 2022. While previous studies have evaluated the impacts of GHWs, the data used in these studies have several shortcomings. The objective of this paper was to investigate the likely impact of such warnings in the US based upon the experience of Canada using hitherto unexplored monthly cigarette sales data, and to explore if alternative approaches involving risk-reduced products might be more successful in reducing smoking.MethodsWe used quasi-experimental segmented regression and difference-in-differences analyses. Data on monthly sales (i.e., shipments) of cigarettes from Canadian manufacturers to Canadian retailers during 1995–2005 were obtained from Statistics Canada.ResultsWe found that GHWs did not have a significant impact on the sales of cigarettes in Canada. We propose an alternative type of graphical health messaging that actively combines information on how to quit with the legally required messaging. The novelty of the proposal is that it is incentive compatible for the supply side of the market and if adopted in several states, the measure could be tested by using a suitable treatment–control design.ConclusionsOur findings imply that we should not expect any notable decline in sales or consumption as a result of implementation of GHWs in the US. The main impact of GHWs will be to add to the anti-smoking culture that has grown steadily over several decades, and this may impact smoking in the longer term.

Highlights

The World Health Organization’s Framework Convention on Tobacco Control requires its members to use Graphic Health Warnings (GHWs) on tobacco packaging
The US Food and Drug Administration (FDA), with the power given to it under the Tobacco Control Act (TCA), recently required that such warnings be put in place on US cigarette packages
The purpose of this paper is to investigate the likely impact of such warnings in the US based upon the experiences of Canada, and to explore if alternative approaches involving risk-reduced products (RRPs) might be more successful in reducing smoking

Summary

Results

The coefficients are negative for the level effect and positive for the slope effect but not statistically significant for either sales or smoking prevalence outcomes These results indicate that we cannot reject the null hypothesis of a zero impact of the GHWs. Placebo test We re-estimated the segmented regression with US sales as an outcome. We cannot find a specification that yields a credible role either to a dummy variable that shifts the intercept at the beginning of 2001, or to a dummy that impacts the slope of the trend in a significant and theoretically correct manner Considered together, these regressions fail to provide evidence favoring the Incentive compatible messaging for 2022: a proposal The failure of GHWs to detectably impact cigarette sales was influenced by three factors. Policies designed to reduce smoking further could adopt a harm-reduction approach through a judicious process that informs the public of the relative risks associated with consuming nicotine in different forms.

Conclusions

Introduction

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