Response of mass media, tobacco industry and smokers to the introduction of graphic cigarette pack warnings in Australia

Background: In the year 2006, Australia introduced graphic cigarette packet warnings. Previous warnings were text only. New warnings include one of 14 pictures, many depicting tobacco-related pathology. Methods: This study monitored the roll-out of the health policy initiative using multiple methodologies. Print media coverage of new pack warnings was observed over 3 years. Story content was coded as positive (supportive of pack warnings), neutral or negative. An observational study of small random sample of metropolitan stores (n = 16) over 7 months measured the pace of the roll-out in shops. Once new packs were readily available in stores, smokers (n = 152) were intercepted in city streets and asked about their reactions. Results: Of the 67 media stories, 85% were positive or neutral about the new warnings and 15% were negative. Supportive content presented health benefits. Unsupportive content presented industry arguments. After the legislative change, it took 2 months before any new packs appeared in stores. After 6 months, the majority carried them. Newest images had highest recall among smokers. About 60% said new warnings detracted from the look of their brand. About 51% felt the increased risk of dying from smoking-related illness. About 38% felt motivated to quit. Conclusion: Plans by government to introduce graphic warnings were delayed up to 2 years, apparently by heavy industry lobbying. Actual widespread appearance in shops occurred several months after the implementation date. While media coverage of the new warnings reported the industry arguments against them, the balance of coverage was overwhelmingly positive. Smokers’ initial reactions were in line with tobacco control objectives.Caroline L. Miller, David J. Hill, Pascale G. Quester and Janet E. Hille