Salience and Impact of Health Warning Label on Cigarette Packs in Vietnam: Findings From the Global Adult Tobacco Survey 2015

Effects of cigarette price and packaging on hypothetical quit-smoking behaviour: a discrete choice experiment among Vietnamese adults who smoke

INTRODUCTION

Raising cigarette prices, increasing graphic health warning label (HWL) coverage and requiring plain packaging could reduce cigarette smoking in Vietnam. This discrete choice experiment estimates the potential impact of these policies on smoking behaviour.

METHODS

In February-May 2022, we conducted a phone-based, cross-sectional survey of 1494 Vietnamese adults who smoke. Participants were randomly assigned to view four individual cigarette pack images, varied on price (15 000 (reference group); 20 000; 30 000 or 40 000 Vietnamese dong (VND)) and packaging (branded pack with 50% graphic HWL (reference group); branded pack with 85% graphic HWL; plain pack with 50% graphic HWL or branded pack without HWL). Participants responded if they would quit or continue smoking if they could only purchase the pack shown. We used binomial logistic regressions to estimate the relative risk (RR) of price and packaging on hypothetical quitting.

RESULTS

Participants were more likely to report they would quit when presented with 30 000 VND (RR 1.20, 95% CI 1.07 to 1.35) and 40 000 VND packs (RR 1.40, 95% CI 1.23 to 1.58) vs the 15 000 VND pack. Participants were also more likely to report they would quit when shown the branded pack with 85% HWL (RR 1.30, 95% CI 1.18 to 1.42) and plain pack with 50% HWL (RR 1.34, 95% CI 1.21 to 1.49) vs the branded pack with 50% HWL coverage. Participants had significantly lower quit likelihood (RR 0.41, 95% CI 0.35 to 0.48) when shown the branded pack without a HWL.

CONCLUSIONS

Results suggest raising cigarette prices to at least 30 000 VND, implementing larger graphic HWLs or plain packaging could decrease smoking rates in Vietnam.

Impact of Health Warning Labels on Cigarette Packs in India: Findings from the Global Adult Tobacco Survey 2016-17

Two rounds of Global Adult Tobacco Survey (GATS) were conducted in 2009-10 and 2016-17 in India. These two surveys provide national comparable data on tobacco usage and its related aspects in India. This study used the data from GATS 2016-17 to examine the salience and impact of cigarette pack pictorial health warnings (PHWs) on quit intention among current cigarette smokers in India. The nationally representative survey interviewed 74, 037 respondents aged ≥15 years with an overall response rate of 92.9% using a multi-stage sampling method. Results of multivariate analysis showed that the strongest predictor for quit intention because of health warnings was "ever made a quit attempt in the past 12 months" and buying cigarette packs instead of loose cigarettes. Compared to GATS 2009-10, GATS 2016-17 observed an increase in salience of cigarette health warnings by 16% and increase in the impact of PHWs on quit intention by 50%. PHWs have a significant impact on intention to quit among cigarette smokers in India with a rising trend. The efforts of Government of India in terms of periodic introduction of new PHWs and increase in the size of warning labels to 85% of the cigarette packs is laudable. The study results support ban on loose cigarettes and warrants stricter implementation of the act prohibiting sale of loose cigarettes.

Association between perceived harm of tobacco and intention to quit: a cross-sectional analysis of the Vietnam Global Adult Tobacco Survey

BACKGROUND

Perception of harm plays an important role in predicting intention to quit-an integral part of the cessation process. Perception on harm from bamboo waterpipe tobacco was unknown, even the predominant of this type of tobacco use. This study investigated the effects of perceived harm from cigarette and bamboo waterpipe tobacco on intention to quit among adult male Vietnamese tobacco users.

METHODS

From the nationally-representative 2015 Global Adult Tobacco Survey, we included 1,351 adult males (≥ 18 years old) who used cigarettes, bamboo waterpipes, or both. Demographic characteristics, tobacco use behaviors, perceived harm from tobacco use, and regulation/policy exposure were measured. Effects of perceived harm from cigarette and bamboo waterpipe tobacco on intention to quit were assessed by logistic regression.

RESULTS

Intention to quit prevalence was 59.0%, 55.0%, and 58.4% for cigarette, waterpipe, and dual users, respectively. Tobacco users who perceived that "using cigarettes and/or waterpipe could cause severe illness" and "waterpipe use is less harmful than cigarette smoking", had tobacco use bans at home, or were exposed to anti-smoking campaigns or encouragement to quit information were more likely to intend to quit. When analyzed by tobacco users, intention to quit was more likely for those users who perceived their tobacco product as more harmful than the other product type, although statistical significance was only observed for cigarette users.

CONCLUSIONS

Misperceptions regarding harm from tobacco use could negatively affect intention to quit. Dissemination of accurate information on the risks from all forms of tobacco use and enforcement of tobacco control policies are important for encouraging intention to quit.

Intention to Quit and Predictive Factors Among Current Smokers in Vietnam: Findings From Adult Tobacco Survey 2020

BACKGROUND

Smoking leads to many smoking-attributable diseases. The promotion of quitting tobacco smoking is urgent as it has significant and immediate health benefits and improves the impacts of other tobacco control strategies. Intention to quit smoking is considered the first step before quitting smoking.

METHODOLOGY

This paper used data from Vietnam provincial GATS 2020 on 80,166 participants who were 15-year-old or older. Data were collected from 34 provinces and cities throughout Vietnam and managed using REDCap.

RESULTS

Among those who were current smokers, 50.3% (95% CI: 49.1%–51.4%) had the intention to quit smoking. Some predictive factors found to be positively associated with the intention to quit smoking were age (from 45-64), education level, received information about harmful effects or encouragement to quit smoking from media channels (from 6 channels), hearing about the Tobacco Control Law and noticing health warnings on the cigarette package. There was no significant difference in intention to quit smoking between current smokers from urban and rural areas or among different age groups to start smoking.

CONCLUSIONS

Interventions or health promotion programs on smoking cessation should be focused on current smokers who have low education levels as they have a higher smoking rate and are less motivated to stop smoking. Received information about harmful effects or encouragement to quit smoking from media channels is also associated with stopping smoking in the future. The importance of health warning pictures on tobacco packages should be maintained and promoted as it has a specific effect on one’s intention to stop smoking.

Demographic characteristics associated with awareness of cigarette health warnings and thinking about quitting among current adult cigarette smokers in Zambia, 2017

INTRODUCTION

Noticing health warnings on cigarette packages has been associated with thinking about quitting. This study examined sociodemographic characteristics associated with awareness of health warnings on cigarette packages and thinking about quitting because of health warning labels among adults who currently smoked tobacco.

METHODS

We analyzed data from the 2017 Zambia WHO STEPS survey (STEPwise approach to surveillance) for noncommunicable disease risk factors. Descriptive analyses and logistic regression were performed to assess the association of select sociodemographic characteristics with awareness of health warnings and thinking about quitting because of health warnings.

RESULTS

Adults who currently smoked tobacco who were aged 30–44 years, of Chewa ethnicity, or with a formal education, were more likely to be aware of health warnings than those aged 18–29 years (adjusted prevalence ratio, APR=1.26; 95% CI: 1.02–1.54), of Bemba ethnicity (APR=1.43; 95% CI: 1.17–1.74), or with no formal education (APR: 2.61–5.95). Among all adults who currently smoked, those of Chewa ethnicity (APR=1.55; 95% CI: 1.03–2.35), or with a formal education (APR:1.80–4.38), were more likely to report thinking about quitting because of health warnings than those who were of Bemba ethnicity or with less than primary school education level. Women who currently smoked were 49% less likely (APR=0.51; 95% CI: 0.23–0.84) to report thinking about quitting than men. Among a subset of adults who currently smoked who were aware of health warning labels, no sociodemographic characteristics were significantly associated with thinking about quitting in unadjusted or adjusted models.

CONCLUSIONS

Sociodemographic characteristics such as sex, ethnicity, and education level were significantly associated with awareness of cigarette health warnings. Among cigarette smokers aware of health warnings, no sociodemographic differences in thinking about quitting were found. Tobacco control campaigns may need to target people of ethnicities with the highest smoking prevalence in the country.

Communicating risk: Status of health warning labels on various tobacco products in Indian market

BACKGROUND

Owing to the role of tobacco packaging as a strong medium of communication, display of health warnings on tobacco packs effectively impart health risks of tobacco consumption to those currently using or contemplating the use of tobacco.

METHODS

This community based cross-sectional analytical study was conducted among 2044 tobacco product packs, each collected from a different PoS, to estimate the non-compliance of section 7, 8 & 9 of COTPA among various tobacco products and its association with the PoS characteristics. Data were collected by observation of PoS by field investigators and then purchase of a unique product from each vendor followed by a brief interview of the tobacco vendor.

RESULTS

The study documented an absence of health warning label on 15.51% [95% CI: 13.99-17.13] of the total 2044 tobacco products collected. The non-compliance to 'quality of health warning picture' was lowest 5.96% [95% CI: 4.91-7.16] among the tobacco products with a health warning label. The multivariate regression model revealed that absence of health warning on tobacco product packs were higher among the PoS in rural area (aPR 1.38; 95% CI: 1.16-1.65; p < 0.001) and among street/mobile vendors (aPR 1.65; 95% CI: 1.22-2.24; p = 0.001). The PoS not displaying tobacco products (aPR 1.36; 95% CI: 1.08-1.72; p = 0.01), selling flavored chewable tobacco (aPR 1.67; 95% CI: 1.24-2.27; p = 0.001), not selling loose cigarettes (aPR 2.93; 95% CI: 1.94-4.43; p < 0.001) and with vendors not enquiring age proof (aPR 10.69; 95% CI: 1.59-72.09; p < 0.001) had higher proportion of tobacco products without health warning labels. A greater proportion of smokeless/local variety tobacco products (aPR 18.06; 95% CI: 12.31-26.51; p < 0.001) had absence of health warning label.

CONCLUSION

The data provided by us have clear policy implications. We recommend regular enforcement activities to monitor the presence of health warning labels on tobacco product packs along and accurate printing of the same with adherence to the Ministry of Health and Family Welfare templates.