Support for pictorial health warning labels on cigarette packages in the United States among adults who currently smoke or quit smoking: Findings from the ITC US Smoking and Vaping Surveys

Shannon Gravely; Gang Meng; David Hammond; Pete Driezen; James F Thrasher; Geoffrey T Fong; Lorraine V Craig; Janet Chung-Hall; Anne C K Quah; Janine Ouimet; Maansi Bansal-Travers; K Michael Cummings

doi:10.18332/tid/166001

Support for pictorial health warning labels on cigarette packages in the United States among adults who currently smoke or quit smoking: Findings from the ITC US Smoking and Vaping Surveys

Tob Induc Dis. 2023 Jun 23:21:84. doi: 10.18332/tid/166001. eCollection 2023.

Authors

Affiliations

¹ Department of Psychology, University of Waterloo, Waterloo, Canada.
² School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
³ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States.
⁴ Ontario Institute for Cancer Research, Toronto, Canada.
⁵ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States.
⁶ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States.

Abstract

Introduction: In March 2020, the US Food and Drug Administration (FDA) finalized new pictorial health warnings (PHWs), covering 50% of the front and back of the pack; however, legal challenges from cigarette manufacturers have prevented the new warnings from being implemented. About 70% of adults in the general US population support PHWs. This study assessed support for PHWs in 2016, 2018 and 2020 among US adults (aged ≥18 years) who currently smoke or formerly smoked cigarettes. We also assessed factors related to support.

Methods: Respondents included adults who currently or formerly smoked cigarettes and participated in at least one wave of the US ITC Smoking and Vaping Surveys: Wave 1 (2016, n=2557); Wave 2 (2018, n=2685); and Wave 3 (2020, n=1112). We assessed changes in support for PHWs between 2016 and 2020, and assessed factors related to support (support vs oppose/don't know). Analyses were conducted on weighted data.

Results: Overall, 38.0% of respondents supported PHWs in 2016, with a significant increase to 44.7% in 2018 (p<0.001), and leveling off to 45.0% in 2020 (2018 vs 2020, p=0.91). Support was highest among former smokers and lowest among daily smokers in all three survey years. Support for PHWs at all survey years was significantly higher among those who formerly smoked, were younger (aged 18-39 vs ≥40 years), those who identified as Black (vs White), and planned to quit smoking (vs not planning to quit). There were no differences by income level, education level, or sex.

Conclusions: Nearly half of US adults who smoke cigarettes or quit smoking supported PHWs in 2020, with support being higher among younger adults, ethnic minorities, and those who formerly smoked. Support increased between 2016 and 2018, but not between 2018 and 2020. Similar to other studies, fewer current and former smokers supported PHWs compared to the US adult general population.

Keywords: cigarettes; health warning labels; support; tobacco.