Changes in Vietnamese Male Smokers' Reactions Towards New Pictorial Cigarette Pack Warnings Over Time

Abstract

Printing of pictorial health warnings (PHWs) on cigarette packages became obligatory by the Vietnam Law on Prevention and Control of Tobacco Harm in May 2013. Literature from high-income countries suggests that PHWs motivate smokers to quit smoking although their long-term effects have been questioned due to reduction of impact over time. This study aimed to assess the salience of PHWs and smokers' reactions towards PHWs over time. In May 2014 and May 2015, a cross-sectional questionnaire-based household survey was administered to respectively 1,462 and 1,509 Vietnamese male smokers aged 18 to 35. The result showed that salience of the PHWs 2 years after the implementation was higher than at the point of 1 year after the implementation. The proportion of respondents who tried to avoid noting the PHWs was reduced from 35% in wave 1 to 23% in wave 2. However, "Tried to avoid looking/thinking about the PHWs" increased 1.5 times the odds of presenting quit intention compared to those respondents who did not try to avoid looking/thinking about the PHWs (OR=1.5; 95%CI: 1.2-2.0). In conclusion, avoidance regarding PHWs may not work as a barrier when aiming at a higher level of quit intention. Salience of the PHWs may increase in the period shortly after their introduction onto packs but can be expected to decrease with time. In other words, it might be advisable to change or renew PHWs after a period of implementation to maintain their beneficial effects.

The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions

“…Developed countries evaluated include Australia ( n = 12) [ 32 , 34 ], the United States (n = 12) [ 35 , 36 ], Canada ( n = 11) [ 3 , 33 ], Europe ( n = 9) (five in the UK [ 1 , 35 ], three in Germany [ 37 – 39 ], one in France and the Netherlands [ 38 ], and one in Italy [ 40 ]. Interventions conducted in countries in development ( n = 10) included Asia ( n = 6) (five in Malaysia [ 5 , 41 ], three in Thailand [ 42 , 43 ], one in China [ 5 ], one in India [ 4 ] and one in Vietnam [ 44 ], Latin America ( n = 5) (four in Mexico [ 45 ], one in Uruguay [ 46 ] and one in Africa (in Mauritius [ 47 ]).…”

Quasi-experimental evaluation of Kenya’s pictorial health warnings versus Zambia’s single text-only warning: findings from the International Tobacco Control (ITC) Project

“…7 It is well established that PHWs are more effective than text-only warnings in communicating health risks of tobacco use. PHWs are more likely to: be noticed or read [8][9][10][11][12][13][14][15][16][17] ; better communicate the health risks of tobacco use [18][19][20] ; increase thoughts about the health risks of tobacco use and about quitting 8 11 13 21 ; be rated as more effective by tobacco users 12 22 23 ; encourage tobacco users to forgo a cigarette or avoid looking at the warning 8 11 ; increase motivation and intention to quit 24 ; increase cessation among adult smokers 25 26 ; be associated with more quit attempts among youth smokers and decreased uptake of tobacco use among non-smoking youth 12 and decrease adult smoking prevalence. 27 However, nearly all evidence regarding the effectiveness of PHWs has come from studies in high-income countries (HICs); few studies have been conducted in LMICs, where the advantages of graphical warnings may be even greater, due to lower literacy levels which make text-only warnings less effective.…”