| Summary: | Background
China's health warnings do not meet the FCTC
Article 11 guidelines. They are small (< 35% of the pack) and do not include
pictorial images, which research has shown to have greater impact. Four rounds
of warnings have been implemented between 1992-2016. This study examines
warning impact over 9 years (2006-15), including the third round (April 2012),
which increased font size while maintaining overall warning size and replaced
the English text with Chinese on the back.
Methods
Data are from Waves 1-5 (2006-15) of the
International Tobacco Control (ITC) China Survey, a cohort survey of 800 adult smokers
in each of five cities, adding five rural areas at Wave 5 (2013-15) (total
N=8000). GEE logistic regression models tested changes in key indicators of
warning impact over time.
Results
Over 9 years, there has been little change in impact of the
Chinese warnings. Indeed, the percentage of smokers who noticed warnings
'often' actually DECREASED from 51% (2006) to 38% (2013-15) ( p < .001), and fewer than one-third of
smokers reported cognitions or behaviours related to quitting because of the
warnings. The April 2012 revision did not improve any of the warning impact indicators.
Warning noticing/salience did not differ between cities and rural areas, but
rural smokers were more likely to think 'a lot' about harms of smoking (17% vs
11%, p < .001) and about quitting
(14% vs 6%, p < .001) because of the
warnings.
Conclusions
China's text-only warnings continue to be extremely
weak. The minor changes in 2012 did not increase warning impact. Global
evidence is clear that large pictorial warnings depicting specific harms of
cigarettes would greatly enhance warning impact in China, including increasing
knowledge and motivation to quit among the 300M Chinese smokers. These benefits
would be especially important for the large rural population, where there are fewer
other sources of health information.
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