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The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS)

Author

Listed:
  • Ce Shang

    (Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA)

  • Jidong Huang

    (School of Public Health, Georgia State University, Atlanta, GA 30303, USA)

  • Kai-Wen Cheng

    (Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA
    School of Public Health, Georgia State University, Atlanta, GA 30303, USA
    Department of Economics, University of Illinois at Chicago, Chicago, IL 60607, USA)

  • Yanyun He

    (Department of Economics, University of Illinois at Chicago, Chicago, IL 60607, USA)

  • Frank J. Chaloupka

    (Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA
    Department of Economics, University of Illinois at Chicago, Chicago, IL 60607, USA)

Abstract

Introduction: The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment. Methods: We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents’ self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test. Results: At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; p ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases. Conclusions: Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels.

Suggested Citation

  • Ce Shang & Jidong Huang & Kai-Wen Cheng & Yanyun He & Frank J. Chaloupka, 2017. "The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS)," IJERPH, MDPI, vol. 14(1), pages 1-16, January.
  • Handle: RePEc:gam:jijerp:v:14:y:2017:i:1:p:98-:d:88438
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    References listed on IDEAS

    as
    1. Ce Shang & Jidong Huang & Kai-Wen Cheng & Qing Li & Frank J. Chaloupka, 2016. "Global Evidence on the Association between POS Advertising Bans and Youth Smoking Participation," IJERPH, MDPI, vol. 13(3), pages 1-10, March.
    2. World Health Organization, 2015. "WHO report on the global tobacco epidemic, 2015: Raising taxes on tobacco," University of California at San Francisco, Center for Tobacco Control Research and Education qt1fh1f32m, Center for Tobacco Control Research and Education, UC San Francisco.
    3. Gruber, Jonathan & Sen, Anindya & Stabile, Mark, 2003. "Estimating price elasticities when there is smuggling: the sensitivity of smoking to price in Canada," Journal of Health Economics, Elsevier, vol. 22(5), pages 821-842, September.
    4. Deliana Kostova & Frank Chaloupka & Ce Shang, 2015. "A duration analysis of the role of cigarette prices on smoking initiation and cessation in developing countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 279-288, April.
    5. Jennifer Cantrell & Donna M Vallone & James F Thrasher & Rebekah H Nagler & Shari P Feirman & Larry R Muenz & David Y He & Kasisomayajula Viswanath, 2013. "Impact of Tobacco-Related Health Warning Labels across Socioeconomic, Race and Ethnic Groups: Results from a Randomized Web-Based Experiment," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-11, January.
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    Cited by:

    1. Thanh Cong Bui & Phonepadith Xangsayarath & Daovieng Douangvichith & Latsamy Siengsounthone & Khatthanaphone Phandouangsy & Ly Thi-Hai Tran & Michael S. Businelle, 2020. "Factors Associated with Cigarette Smoking Cessation in Lao People’s Democratic Republic: Results from the 2015 National Adult Tobacco Survey," IJERPH, MDPI, vol. 17(14), pages 1-14, July.
    2. Anh Ngo & Kai-Wen Cheng & Ce Shang & Jidong Huang & Frank J. Chaloupka, 2018. "Global Evidence on the Association between Cigarette Graphic Warning Labels and Cigarette Smoking Prevalence and Consumption," IJERPH, MDPI, vol. 15(3), pages 1-9, February.

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