The impact of including cessation resource information on health warnings on standardized tobacco packaging on awareness and use: A longitudinal online survey in the United Kingdom

Abstract

Introduction Since May 2017, all cigarettes and roll-your-own (RYO) tobacco in the UK must be sold in standardised packs with pictorial warnings displaying, for the first time, a stop-smoking website. Methods Data comes from three waves of a longitudinal online survey with smokers and ex-smokers conducted pre- and post-standardised packaging, with Wave 1 (W1) in April-May 2016, Wave 2 (W2) in October-November 2017, and Wave 3 (W3) in May-June 2019. Only smokers are included in the analysis: W1 (N=6233), W2 (N=3629) and W3 (N=2412). We explored any change in citing warnings on packs as a source of information about a stop-smoking website, and whether citing warnings as a source was associated with use of a stop-smoking website. As the warnings, and therefore the stop-smoking website, are larger on RYO packs than on cigarette packs due to the larger pack size, we explored differences in awareness of a stop-smoking website among exclusive cigarette smokers (W1=3142, W2=1884, W3=1247) and exclusive RYO smokers (W1=2046, W2=1119, W3=814). Results Among smokers recalling seeing information about a stop-smoking website, citing warnings as a source increased between waves (W1=14.0%, W2=24.2%, W3=25.1%) and was associated with having visited a stop-smoking website (OR=11.81, 95% CI 8.47-16.46). Citing warnings as a source of a stop-smoking website increased among exclusive RYO smokers at each wave (W1=15.5%, W2=26.3%, W3=32.1%), while for exclusive cigarette smokers it only increased at W2 (W1=10.5%, W2=22.4%, W3=19.9%). Conclusions Warnings are an important source of cessation resource information. Making this information more prominent may help sustain awareness. Implications The findings support the inclusion of a stop-smoking website on warnings as awareness among smokers increased and citing warnings as a source of information about a stop-smoking website was associated with having visited a stop-smoking website. We also explored whether the stop-smoking website on warnings on RYO packs, which is larger than on cigarette packs as a function of the larger size of RYO packs, would have any impact on awareness of this information. That exclusive RYO smokers were more likely than exclusive cigarette smokers to notice a stop-smoking website on warnings suggests that this information should be more prominent.