The estimated effect of graphic warning labels on smoker’s intention to quit in Shanghai, China: a cross-sectional study

Abstract

Background Tobacco consumption is the leading cause of death worldwide. Overwhelming studies demonstrate graphic warning labels (GWLs) on cigarette packs are effective in eliciting negative response to tobacco smoking, modifying beliefs about tobacco dangers, and increasing reported intention to quit, but the estimated effect of GWLs on smoking cessation intention among smokers is still limited in China. In this study, we aim to understand the smoking intensity, smoking duration and smoking cessation intention among current smokers, and to explore how their smoking cessation intention would be influenced by the GWLs in Shanghai. Methods From January to June 2021, we totally recruited 1104 current smokers in Songjiang district and Fengxian district of Shanghai by multistage sampling design. We used Android pad assisted electronic questionnaire for data collection, and then implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore how smoking cessation intention would be influenced by the GWLs among current smokers. Results One thousand one hundred four current smokers included 914 males (82.79%), with an average age of 43.61 years. 58.06% of current smokers reported smoking cessation intention due to GWLs. Logistic regression indicated a higher percentage of smoking cessation intention due to GWLs was among female smokers [OR = 2.41, 95% CI (1.61–3.59)], smokers with smoking intensity < 20 cigarette/day [OR = 1.92, 95% CI (1.44–2.55)], smokers with tobacco burden < 20% [OR = 1.94, 95% CI (1.35–2.79)], and among smokers had plan to quit in a year [OR = 6.58, 95% CI (4.71–9.18). Smokers with higher individual monthly income had lower percentage of smoking cessation intention (OR were 0.35, 0.46 and 0.41). Meanwhile, among 642 current smokers without plan to quit in a year, approximately 40% of them reported smoking cessation intention due to GWLs. Conclusions Smoking cessation intention due to the assumed GWLs on cigarette packs is high among current smokers in Shanghai, especially in female smokers, smokers with light tobacco burden and mild nicotine dependence. Incorporating smoking intensity as well as smoking burden into the implementation of GWLs as tobacco control measures would discourage smoking in China.

Prevalence of non-communicable diseases and its association with tobacco smoking cessation intention among current smokers in Shanghai, China

“…Multistage sampling method was employed to recruit current smokers among the 15 sub-districts in Songjiang district and the 12 sub-districts in Fengxian district, Shanghai. detailed information for smoker recruitment by multistage sampling can be found in our previous published works 25 , 26 . A total of 1104 smokers completed the interview and were included in the final data analysis.…”

“…We employed an electronic questionnaire for data collection 25 , 26 . The electronic questionnaire has an audio record function which allows data entry quality inspection and is convenient for paperless data input.…”

“…In this study, a current smoker was defined as a person who smoked ≥100 cigarettes in a lifetime and still smoked at the time of investigation 25 , 26 . Smoking duration was defined as the time interval between investigation time and smoking initiation time in current smokers 25 , and then classified it into <20 and ≥20 years. We defined smoking intensity as the number of cigarettes smoked per day and then categorized it as <20 and ≥20 cigarettes/day.…”

The estimated influence of assumed physicians’ advice for tobacco smoking cessation among current smokers in Shanghai, China: A cross-sectional study

“…Fourth, a complete list of home addresses in each selected residential community was compiled previously, and 100 households were extracted randomly from the list without replacement. Fifth, 100 enumerated households were randomly ordered, and current smokers were then approached, following the randomized order, until 50 smokers were selected in each selected residential block 36 . Finally, a total of 1200 current smokers were proposed to be investigated.…”

“…We applied an Android pad-assisted electronic questionnaire to collect data, and the whole audio recording process was convenient for subsequent data quality inspection. The split-half reliability coefficient of this questionnaire was 0.87 and a content validity coefficient of 0.85 was validated in a pilot study 36 . The questionnaire included four parts 36 : 1) demographic characteristics (age, sex, marriage status, education level, and vocation); 2) eight types of non-communicable diseases (NCDs); 3) tobacco use information (number of years as a smoker, daily tobacco consumption, cigarette retail price, previous smoking cessation history); and 4) two questions for tobacco smoking cessation intention (‘Do you have a plan to quit smoking in a year ?, and ‘Do you have a plan to stop smoking if a physician advised you to quit?, with response options, 1=Yes, 2=No).…”