Trends in Noticing and Responding to, Health Warning Labels on Cigarette Packages Among Adults Who Smoke: Findings from the ITC Four Country Surveys Between 2002 and 2022

Abstract

Introduction: We present data on 20-year (2002–2022) trends in reactions of smokers to Health Warning Label (HWL) changes (eg, increasing warning size, requiring graphic images, mandating standardized packaging) in Canada, England, and Australia, compared to the US where HWLs did not change. Methods: We analyzed weighted data from 16 waves of the International Tobacco Control Four Country Survey, comprising 99438 observations from 49034 adults (ages 18+) who smoked cigarettes (daily or non-daily), tracking indicators of HWL effectiveness including noticing HWLs and related thoughts about harms from smoking and quitting. Results: The first HWL change studied in each country (Canada-2001; Engl..