Evaluating Canada's innovative policy for health warnings on cigarette sticks: A pre/post assessment among adults who smoke

Abstract

Objective: Evaluate Canada’s innovative policy mandating warning messages on cigarette sticks. Methods: We analyzed data from an open cohort of Canadian adults who smoke, surveyed every 3 months (February 2023-November 2024; n=11,487 observations from 4,716 individuals). Participants reported: liking the look of their cigarette sticks (1-Dislike a lot to 7-Like a lot); feelings when looking at sticks (1-Very bad to 7-Very good); frequency of thinking about smoking-related harms due to sticks (1-Not at all to 5-Extremely); and forgoing cigarettes they normally smoke due to the look of sticks (no vs. yes). Linear and logistic generalized estimating equations regressed these outcomes on implementation period (i.e., pre-policy 2023 surveys [ref.] vs post-policy 2024 surveys), adjusting for covariates and post-stratification weights. Analyzing participants followed to the next survey (n=6,959 observations, 2,356 individuals), separate adjusted mixed-effects logistic models regressed quit attempts in the 3-month interval since the prior survey on each stick measure from the prior survey (coded: neutral [ref.], dislike, like; neutral [ref.], bad, good; no forgoing [ref.], forwent cigarettes). Results: From pre- to post-policy periods, liking and feelings about sticks became more negative (B=-0.15, 95%CI=-0.22, -0.08; B=-0.07, 95%CI=-0.13, -0.01) and forgoing cigarettes increased (AOR=1.18, 95%CI=1.06, 1.32). Those who felt bad (vs. neutral) when looking at sticks were more likely to try to quit by the next survey (AOR=1.31, 95%CI=1.05, 1.62), as were those who forwent cigarettes (AOR=1.73, 95%CI=1.40, 2.15). Conclusions: Countries should consider expanding cigarette labeling to include on-cigarette warnings, which appear to have increased outcomes that predict quit attempts in Canada.