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Exposure to graphic warning labels is associated with lower cigarettes per day among persons in drug abuse treatment


Sunday, November 1, 2015

Joseph Guydish, PhD, MPH, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Barbara Tajima, EdM, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Thao Le, MPH, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Catherine Henderson, BA, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Shilpa Dutta, MPH, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
Background: The Tobacco Control Act of 2009 gave the FDA authority to regulate tobacco, and also mandated new warning labels for U.S. cigarette packs.  The FDA planned to implement graphic warning labels (GWLs) in 2012, but was stopped by R.J. Reynolds v. FDA which observed, in part, a lack of evidence that GWLs change smoking behavior.

Methods:  Working in residential drug abuse treatment programs, this study recruits smokers into cohorts that received 30 day exposure to either the FDA GWLs (experimental) or to clear stickers (control) placed onto their own cigarette packs.  After 30 days, expired carbon monoxide is measured along with self-report smoking behavior, nicotine dependence, intention to quit, and thoughts about health risks. In preliminary analyses using the first 110 cases, experimental and control cohorts were compared at follow up.

Results:  At 30 day follow-up, and compared to controls, GWL participants smoked fewer cigarettes per day (9.1 v. 11.8, p < .05) and had lower nicotine dependence (1.8 v. 2.3, p < .05).  There were no group differences for the proportions who made a recent quit attempt (36% v. 35%) or in the proportion who expressed interest in smoking cessation services (50% v. 48%).  Although not statistically significant, GWL participants expressed more intent to quit in the next month (42.6% v. 34.6%), thought more about the health risks of smoking (56% v. 46%), and thought that GWLs made them more likely to quit smoking (52% v. 44%)

Conclusions: This is one of few studies to experimentally examine whether prolonged (30-day) exposure to GWLs is associated with changes in smoking behavior.  Preliminary findings are mixed, but show small group differences which, if reliable, are meaningful at a population level. While findings are preliminary, the study will report results for over 400 cases at the time of the APHA convention.

Learning Areas:

Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Explain whether, and in what ways, cigarette graphic warning labels affect smoking behavior.

Keyword(s): Tobacco Use, Drug Abuse Treatment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator of multiple federally funded grants focusing on drug abuse treatment, treatment outcomes, and the intersection of tobacco and other drug use. Among my scientific interests has been the development of strategies to more effectively address the persistent high rates of smoking among persons enrolled in drug abuse treatment.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.