The use of cigarette package inserts to supplement pictorial health warnings: An evaluation of the Canadian policy

Abstract

Background: Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt.  Methods: Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18–64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n= 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave.  Results: At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts.  Conclusions: HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers.