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On 1 May 2002, four months sooner than required by the European Union (EU), the new EU health warnings on cigarette packaging came into effect in The Netherlands. The warnings included the telephone number of the Dutch quit line. There are reports in the literature about the general impact of health messages,1 but very little about what this means for quit lines.
The front of the pack is required to have one of two health warnings, covering 30% of the surface. The back of the pack has one of 14 different health warnings. The cigarettes are distributed in such a way that all 14 messages are evenly mixed. One of these (translated from Dutch) states: “Ask for help with smoking cessation: DEFACTO 0900-9390 (0,10 Euro cent/min) or www.stoppen-met-roken.nl or consult your physician or chemist”. DEFACTO’s 0900 number is the national quit line. Following the introduction of the new packages, both the quality and quantity of the calls to the quit line changed dramatically. This increase is most likely due to the introduction of the packages, since there were no campaigns or policy changes in The Netherlands during the period of investigation that could have provided for an alternative explanation.
Figure 1 shows the increase in the number of callers starting in week 20 (second week of May). The increase started gradually, because it took several weeks before the supply of old packages was replaced. Also, manufacturers varied in their stock supplies. Whereas Marlboro cigarettes showed the new warnings very soon, after four months most Camel packages still had the old warnings. After a peak in week 24, the number of callers gradually stabilised around 700 per week, which is still 3.5 times higher than before.
We found that because of the telephone number on the packages, more callers phone during the evening or night. Consequently, we now have advisers working in the evening. Before the introduction, most callers were motivated smokers typically from middle socioeconomic groups in the preparation or action stage of quitting. After the introduction, we now receive a much broader group of smokers. Our impression is that we now get many more callers from lower socioeconomic groups who are still uncertain about whether they really want to quit smoking and whether they are able to quit smoking. Moreover, many contact us with questions about the truthfulness of the new health warnings. We also get callers who are not so serious or who are aggressive. Because our phone number is on the package, many think that our organisation is responsible for the health warnings. They call us for an explanation or just want to tell us that they are angry. Our counsellors have received additional training to be able to better cope with this and we have made a new archive with factual information pertaining to the various health warnings on the packages.
Despite the fact that we now have less serious callers, we find that about 90% can be persuaded to have an informative conversation about smoking cessation. Our experience is that even aggressive callers have an interest in hearing about how they can quit smoking. Overall, we are very pleased that our quit line is on the cigarette packages, because a much larger and broader group of smokers is now being reached.
Increase in the number of callers to the Dutch quit line, following the introduction of health warnings on cigarette packages bearing the quit line telephone number.