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US adult smokers' perceptions of Australia's cigarette warning labels: variance by warning content and consistency across socio-demographic sub-segments
  1. Eric C Leas1,
  2. John P Pierce1,2,
  3. Claudiu V Dimofte3,
  4. Adriana Villaseñor1,2,
  5. David R Strong1,2
  1. 1Department of Family Medicine and Public Health, University of California, San Diego, California, USA
  2. 2UC San Diego Moores Cancer Center, University of California, San Diego, California, USA
  3. 3Department of Marketing, San Diego State University, San Diego, California, USA
  1. Correspondence to Dr John P Pierce, Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, USA; jppierce{at}

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The implementation of Australia's aggressive plain-packing policy in 2012, mandating the removal of all tobacco industry branding and replacement with photographic warnings on 80% of packaging, was associated with a significant decline in smoking prevalence.1 Could Australia's plain-packaging model have a similar effect on US-adult cigarette users who have not yet been exposed to graphic warning labels on their cigarette packs?

To generate evidence for this, we obtained a license from the Commonwealth of Australia to use up to eight of their current warning images (figure 1). Our randomised trial, entitled California smokers in Australia (CASA), will enrol 450 cigarette users who are not ready to quit and randomise them to purchase cigarettes that have been repackaged into either plain packs, current Australian packs or to a no-change control, for a period of 3 months.2 Warning labels on cigarette packs can cue cognitions on health consequences each time the consumer reaches for a cigarette, until he or she becomes desensitised. Accordingly, rotating multiple warnings is needed to increase the time before any particular warning ‘wears out’.3 ,4 Because of cost concerns of manufacturing new cigarette packs in our trial, we decided to rotate only three of the graphic images in our study. In this letter, we report results from a stated preference methodology that allowed US-adult …

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