Educational differences in the impact of pictorial cigarette warning labels on smokers. Findings from the International Tobacco Control (ITC) Europe Surveys.

G.E. Nagelhout*, M.C. Willemsen, H. de Vries, U. Mons, S.C. Hitchman, A.E. Kunst, R. Guignard, M. Siahpush, H.H. Yong, B. van den Putte, G.T. Fong, J.F. Thrasher

*Corresponding author for this work

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Objective To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level.

Methods Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change.

Findings Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p

Conclusions The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers.

Original languageEnglish
Pages (from-to)325-332
Number of pages8
JournalTobacco Control
Issue number3
Early online date14 Jan 2015
Publication statusPublished - May 2016


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