Winning Abstracts from the 2011 Medical Student Abstract Competition: Cigarette Package Labeling In 12 Countries
Author:Hassan Mir, University of Western Ontario, Class of 2012
Introduction: With increasing restrictions on cigarette advertising, the cigarette package has become a primary marketing tool. Health warnings are associated with decreased cigarette use while promotional labels minimize perceptions of the harm caused by cigarettes, thus increasing initiation and reducing quit rates. In many developing countries, smoking rates are already high and increasing further. The Framework Convention on Tobacco Control (FCTC) contains guidelines on labeling that have been incorporated into domestic legislation in many countries. In this study, we assess compliance with FCTC guidelines and domestic legislation of cigarette packets from 12 countries at different levels of economic development.
Methods: Researchers from 12 countries were asked to send packs of at least 5 different types of commonly consumed cigarettes between December 2007 and April 2008. The countries from high income regions were - Australia, Germany, Canada; high middle income - Chile, Brazil, Argentina, Malaysia, Colombia, Iran; and low middle income - China, India, and Pakistan. A total of 115 packets were inspected and all health warnings and promotional labels were counted and evaluated for content, location, and size using a structured data collection instrument.
Results: Health warnings were present on all packages but in only 68% of boxes were they on the front or back panels (defined collectively as the principal display area [PDA]), the remainder being on the side panels. Only in Australia, Germany, Canada, and Chile did health warnings meet or exceed the FCTC recommended size of 30% or more of the packets PDA. Iran and India had the largest discrepancies between the legislated requirements (50% of PDA) and the observed label size – 2% and 4% respectively. Cigarette packages from high income countries had an average of 3.0 warning labels per package compared to 1.4 warning labels per package in low income countries. Promotional labels were widespread, found on packets from all countries and more numerous (although not necessarily larger) than health warning labels in all countries except in Canada and Chile. The average number ranged from 1.4 labels/package (Argentina) to 5.4 labels/package (Iran). Deceptive terms such as “light” and “mild” were observed on 42% of all packages examined.
Conclusion: Cigarette packages are widely used to promote smoking and deceive smokers about health risks. Furthermore, legislation on health warnings is poorly enforced and FCTC guidelines are flaunted, particularly in lower income countries. It is essential to monitor not only the existence of legislation but also to evaluate its implementation. There is a need to address promotional labeling, as its existence undermines the effects of health warnings on cigarette packages. Mandatory plain packaging offers a potential solution but will be opposed strongly by the tobacco industry.
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