OBJECTIVES:The main objective of this study was to utilize qualitative research methods in order to explore variations in how smokers respond to the government-mandated graphic health warnings and messages on their cigarette packets.METHODS: Sixty in situ interviews were carried out with people while they were smoking in public settings across the city of Vancouver, British Columbia. During the interviews, participants were asked to recall the warning label on their cigarette packet, and general questions about the effects the imagery and text have had on their smoking.
RESULTS:The analysis of findings pointed to several ways that participants overlooked, dismissed or otherwise failed to accurately recall health messages and images on their cigarette packaging. In particular, a significant minority questioned the veracity of the content of the labels and highlighted their exaggerated nature. With regard to the health information inserts, participants identified them as rubbish to be discarded rather than messages to be read. Few smokers could remember the warning label on their packet and some described warning labels that do not currently exist. Finally, a substantial proportion of participants were not smoking cigarettes from a standard packet, raising questions about how universal exposure to the labels actually is.
CONCLUSION:Prevailing assumptions about how cigarette packaging legislation works as a population-level tobacco control intervention appear to be based on flawed assumptions about how people interact with cigarette packets as they are used in their everyday lives. As such, continued efforts on the part of tobacco control to redevelop "bolder" or more "graphic" labels on tobacco packaging may require consideration. T obacco product warning labels are a cornerstone of population-level tobacco control. The World Health Organization's Framework Convention on Tobacco Control recommends that: "warning messages should cover at least 50% of the principal display areas of the package," based on the assumption that the labels counteract smokers' tendency to "underestimate the full extent of the risk [of smoking] to themselves and others" 1(p. 18) and disrupt "the marketing value of the packages". 1(p. 22) In Canada, text-based warnings came into effect in 1989, with graphic warning labels mandated for use in 2000. Initially, 16 graphic warning labels were launched, along with 16 package inserts containing health information. In 2012, the Canadian government implemented an updated set of 16 labels for cigarette packaging.* The new labels are more visually graphic than their predecessors and their size has increased from 50% to 75% of the front and back of the pack, based on the premise that "bolder" labels are more effective. According to a 2012 press release by Health Canada: "Recent research has reminded us that young people are still very vulnerable to the attractions of tobacco use : : : We welcome the new, stronger warning labels for tobacco products as a critical step to deter Canada's youth...