Tobacco package health warnings: a global success story

Cunningham, Robert

doi:10.1136/tobaccocontrol-2021-056560

Cited by 29 publications

(7 citation statements)

References 87 publications

(129 reference statements)

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“…Two countries (United States and Pakistan) accounted for most of this reduction with a one-step strengthening of the policy to best practice demonstrating the benefit of making this final change in populous countries. These results provide further evidence of the success of this policy implementation globally [ 46 ] and while there are numerous reasons of why warnings have been so successful, one of note is that the cost of warnings is paid by industry which is attractive to all governments [ 45 ]. It should also be noted that while a larger number of countries have achieved this level, the increased SADs is also due to an increase in the effect sizes applied to model for this policy for the periods after 2014 [ 36 ].…”

Section: Discussionmentioning

confidence: 90%

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Lyle,

Hendrie

2024

Global Health

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Background In response to the harm caused by tobacco use worldwide, the World Health Organization (WHO) World Health Assembly actioned the WHO Framework Convention on Tobacco Control (FCTC) in 2005. To help countries meet their FCTC obligations, the WHO introduced in 2008 the MPOWER policy package and by 2020 the FCTC had been ratified by 182 parties. The package consists of six evidence-based demand reduction smoking cessation policies to assist countries to achieve best practice. We used published evaluation results and replicated the published model to estimate current policy achievement and demonstrate the impact and equity of the MPOWER policy package in reducing the global number of smokers and smoking-attributable deaths (SADs) between 2007 and 2020. Methods We replicated an evaluation model (the Abridged SimSmoke model) used previously for country impact assessments and validated our replicated reduction in SADs for policies between 2014 and 2016 against the published results. The replicated model was then applied to report on the country level SADs averted from achieving the highest level of implementation, that is best practice in MPOWER policies, between 2016 and 2020. The latest results were then combined with past published results to estimate the reduction in SADs since the commencement of the MPOWER policy package. Country level income status was used to investigate the equity in the uptake of MPOWER policies worldwide. Results Identical estimates for SADs in 41 out of 56 MPOWER policies implemented in 43 countries suggested good agreement in the model replication. The replicated model overestimated the reduction in SADs by 159,800 (1.5%) out of a total of 10.5 million SADs with three countries contributing to the majority of this replication discrepancy. Updated analysis estimated a reduction of 8.57 million smokers and 3.37 million SADs between 2016 and 2020. Between 2007 and 2020, 136 countries had adopted and maintained at least one MPOWER policy at the highest level which was associated with a reduction in 81.0 million smokers and 28.3 million SADs. Seventy five percent of this reduction was in middle income countries, 20% in high income and less than 5% in low income countries. Conclusions Considerable progress has been made by MPOWER policies to reduce the prevalence of smokers globally. However, there is inequality in the implementation and maintenance, reach and influence, and the number of SADs averted. Future research to modify the model could provide a more comprehensive evaluation of past and future progress in tobacco control policies, worldwide.

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Section: Discussionmentioning

confidence: 90%

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Lyle,

Hendrie

2024

Global Health

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“…The underlying mechanism lies in negative emotional stimuli such as fear, disgust, discomfort, and worry, which are triggered by warnings [67]. Other aspects accounting for its relevance include the wide public support that it seems to enjoy as well as costs being borne by companies, not governments, its ability to affect a very large population, and its proneness to modifications and improvements [71].…”

Section: Discussionmentioning

confidence: 99%

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

Nurchis

Pumpo

Perilli

et al. 2023

IJERPH

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Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations.

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“…Pictorial warnings identified for our study were primarily from the UK, Canada and Jamaica. Like Canada, which was the first country to implementation photographic pictorial warnings, 30 the UK and Jamacia signed and ratified with the WHO FCTC early in 2004 and 2005, respectively (see online supplemental table A ). Therefore, it is understandable that these countries would have a wide variety of unique pictorial warnings.…”

Section: Discussionmentioning

confidence: 99%

“…24 25 Finally, use of the marker word 'WARNING' on warning labels appears more impactful than labels without a marker word. 26 While research exists that examines WHO FCTC implementation, [27][28][29] and historical evolution and diffusion of warnings, 30 no published research describes current tobacco warning characteristics globally and to what extent they meet WHO guidelines. 3 Though research indicates graphic warnings can produce unpleasantness for non-smokers and increase smokers' intentions to quit, 31 the ideal type of health effect or number of health effects to include has not been examined on tobacco warnings.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

How do current tobacco warnings compare to the WHO FCTC guidelines: a content analysis of combustible tobacco warnings worldwide

et al. 2023

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ObjectiveMany countries have adopted warning labels for combustible tobacco products, yet little research exists describing tobacco warning characteristics globally and to what extent they meet the WHO Framework Convention for Tobacco Control (FCTC) Guidelines. This study evaluates characteristics of combustible tobacco warnings.DesignWe conducted a content analysis to describe the overall landscape of warnings using descriptive statistics and compared to the WHO FCTC Guidelines.SettingWe searched existing warning databases for combustible tobacco warnings from English-speaking countries. We compiled warnings meeting inclusion criteria and coded for message and image characteristics using a pre-defined codebook.Primary and secondary outcomes measuresCharacteristics of combustible tobacco warning text statements and warning images were the primary study outcomes. There were no secondary study outcomes.ResultsWe identified a total of 316 warnings from 26 countries or jurisdictions worldwide. Of these warnings, 94% included warning text and an image. Warning text statements most often described health effects to the respiratory (26%), circulatory (19%) and reproductive systems (19%). Cancer was the most frequently mentioned health topic (28%). Fewer than half of warnings included a Quitline resource (41%). Few warnings included messages about secondhand smoke (11%), addiction (6%) or cost (1%). Of warnings with images, most were in colour and showed people (88%), mostly adults (40%). More than 1 in 5 warnings with images included a smoking cue (ie, cigarette).ConclusionsWhile most tobacco warnings followed WHO FCTC guidance on effective tobacco warnings, such as communicating health risks and inclusion of images, many did not include local Quitline or cessation resources. A sizeable minority include smoking cues that could inhibit effectiveness. Full alignment with WHO FCTC guidelines will improve warnings and better achieve the WHO FCTC objectives.

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Tobacco package health warnings: a global success story

Cited by 29 publications

References 87 publications

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Global smoking-related deaths averted due to MPOWER policies implemented at the highest level between 2007 and 2020

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

How do current tobacco warnings compare to the WHO FCTC guidelines: a content analysis of combustible tobacco warnings worldwide

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