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Mass media campaigns designed to support new pictorial health warnings on cigarette packets: evidence of a complementary relationship
  1. Emily Brennan1,
  2. Sarah J Durkin1,
  3. Trish Cotter2,
  4. Todd Harper3,
  5. Melanie A Wakefield1
  1. 1Cancer Council Victoria, Carlton, Australia
  2. 2Cancer Institute New South Wales, Sydney, Australia
  3. 3VicHealth, Carlton, Australia
  1. Correspondence to Professor Melanie Wakefield, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 1 Rathdowne Street, Carlton, Vic 3053, Australia; melanie.wakefield{at}


Background In Australia, introduction of pictorial health warnings on cigarette packets was supported by a televised media campaign highlighting illnesses featured in two of the warning labels—gangrene and mouth cancer.

Methods Two studies examined whether the warnings and the television advertisements complemented one another. Population telephone surveys of two cross-sections of adult smokers measured changes in top-of-mind awareness of smoking-related health effects from before (2005; n=587) to after the pack warnings were introduced (2006; n=583). A second study assessed cognitive and emotional responses and intentions to quit after smokers watched one of the campaign advertisements, comparing outcomes of those with and without prior pack warning exposure.

Results Between 2005 and 2006, the proportion of smokers aware that gangrene is caused by smoking increased by 11.2 percentage points (OR=23.47, p=0.000), and awareness of the link between smoking and mouth cancer increased by 6.6 percentage points (OR=2.00, p=0.006). In contrast, awareness of throat cancer decreased by 4.3 percentage points, and this illness was mentioned in the pack warnings but not the advertisements. In multivariate analyses, smokers who had prior exposure to the warnings were significantly more likely to report positive responses to the advertisements and stronger post-exposure quitting intentions.

Conclusions Television advertisements and pictorial health warnings on cigarette packets may operate in a complementary manner to positively influence awareness of the health consequences of smoking and motivation to quit. Jurisdictions implementing pictorial warnings should consider the benefits of supportive mass media campaigns to increase the depth, meaning and personal relevance of the warnings.

  • Packaging and labelling
  • advertising and promotion
  • advocacy
  • mass media
  • pictorial health warnings

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  • Funding This study was funded by Quit Victoria and the Cancer Council Victoria.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Cancer Council Victoria.

  • Provenance and peer review Not commissioned; externally peer reviewed.