Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial.
Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial.
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DOI：
10.1001/jamainternmed.2016.2621
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发表时间：
2016-07-01
影响因子：
39
通讯作者：
Ribisl KM
中科院分区：
文献类型：
--
作者：
Brewer NT;Hall MG;Noar SM;Parada H;Stein-Seroussi A;Bach LE;Hanley S;Ribisl KM
香烟包装上的图片警告引起人们的注意并增加戒烟意愿，但它们对吸烟行为的影响仍然不确定。评估在香烟包装的正面和背面添加图形警告的效果。这项为期4周的参与者间随机临床试验在加州和北卡罗来纳州进行。我们从2014年9月至2015年8月从普通人群中招募了一个方便的成年吸烟者样本。在2149名参加试验的吸烟者中，88%完成了试验。没有参与者因不良事件退出。我们随机分配参与者在他们的香烟盒上接受4周的纯文本警告（美国卫生局局长目前在香烟盒侧面使用的警告之一）或图片警告（《家庭吸烟预防和烟草控制法》要求的文本警告和图片之一，在香烟盒的正面和背面的上半部分显示吸烟的危害）。主要试验结果是在研究期间尝试戒烟。我们假设随机接受图片警告的吸烟者比随机接受仅文字的外科医生警告的吸烟者更有可能在研究期间报告戒烟尝试。在开始试验的2149名参与者中（男性1039人，女性1060人，变性人34人;平均[SD]年龄，纯文字警告为39.7 [13.4]岁，图片警告为39.8 [13.7]岁），1901人完成。（n = 2149），在为期4周的试验中，包装上有图片警告的吸烟者比包装上只有文字警告的吸烟者更有可能尝试戒烟（40% vs 34%;比值比[OR]，1.29; 95% CI，1.09-1.54）。研究结果在任何人口统计学群体中都没有差异。在试验结束前戒烟至少7天的吸烟者中，接受图片警告的吸烟者比仅接受文字警告的吸烟者更常见（5.7% vs 3.8%; OR，1.53; 95% CI，1.02-2.29）。图片警告也增加了放弃香烟，戒烟的意图，负面情绪反应，思考吸烟的危害，以及关于戒烟的对话。图片警告有效地增加了戒烟的意图，放弃香烟，戒烟尝试，并成功戒烟超过4周。我们的试验结果表明，在美国实施香烟包装上的图片警告将阻止吸烟。clinicaltrials.gov标识符：NCT 02247908
Pictorial warnings on cigarette packs draw attention and increase quit intentions, but their effect on smoking behavior remains uncertain. To assess the effect of adding pictorial warnings to the front and back of cigarette packs. This 4-week between-participant randomized clinical trial was carried out in California and North Carolina. We recruited a convenience sample of adult cigarette smokers from the general population beginning September 2014 through August 2015. Of 2149 smokers who enrolled, 88% completed the trial. No participants withdrew owing to adverse events. We randomly assigned participants to receive on their cigarette packs for 4 weeks either text-only warnings (one of the Surgeon General’s warnings currently in use in the United States on the side of the cigarette packs) or pictorial warnings (one of the Family Smoking Prevention and Tobacco Control Act’s required text warnings and pictures that showed harms of smoking on the top half of the front and back of the cigarette packs). The primary trial outcome was attempting to quit smoking during the study. We hypothesized that smokers randomized to receive pictorial warnings would be more likely to report a quit attempt during the study than smokers randomized to receive a text-only Surgeon General’s warning. Of the 2149 participants who began the trial (1039 men, 1060 women, and 34 transgender people; mean [SD] age, 39.7 [13.4] years for text-only warning, 39.8 [13.7] for pictorial warnings), 1901 completed it. In intent-to-treat analyses (n = 2149), smokers whose packs had pictorial warnings were more likely than those whose packs had text-only warnings to attempt to quit smoking during the 4-week trial (40% vs 34%; odds ratio [OR], 1.29; 95% CI, 1.09–1.54). The findings did not differ across any demographic groups. Having quit smoking for at least the 7 days prior to the end of the trial was more common among smokers who received pictorial than those who received text-only warnings (5.7% vs 3.8%; OR, 1.53; 95% CI, 1.02–2.29). Pictorial warnings also increased forgoing a cigarette, intentions to quit smoking, negative emotional reactions, thinking about the harms of smoking, and conversations about quitting. Pictorial warnings effectively increased intentions to quit, forgoing cigarettes, quit attempts, and successfully quitting smoking over 4 weeks. Our trial findings suggest that implementing pictorial warnings on cigarette packs in the United States would discourage smoking. clinicaltrials.gov Identifier: NCT02247908