PT  - JOURNAL ARTICLE
AU  - Shannon Gravely
AU  - Geoffrey T Fong
AU  - Pete Driezen
AU  - Mary McNally
AU  - James F Thrasher
AU  - Mary E Thompson
AU  - Marcelo Boado
AU  - Eduardo Bianco
AU  - Ron Borland
AU  - David Hammond
TI  - The impact of the 2009/2010 enhancement of cigarette health warning labels in Uruguay: longitudinal findings from the International Tobacco Control (ITC) Uruguay Survey
AID  - 10.1136/tobaccocontrol-2014-051742
DP  - 2016 Jan 01
TA  - Tobacco Control
PG  - 89--95
VI  - 25
IP  - 1
4099  - http://tobaccocontrol.bmj.com/content/25/1/89.short
4100  - http://tobaccocontrol.bmj.com/content/25/1/89.full
SO  - Tob Control2016 Jan 01; 25
AB  - Background Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines recommend that health warning labels (HWLs) should occupy at least 50% of the package, but the tobacco industry claims that increasing the size would not lead to further benefits. This article reports the first population study to examine the impact of increasing HWL size above 50%. We tested the hypothesis that the 2009/2010 enhancement of the HWLs in Uruguay would be associated with higher levels of effectiveness.Methods Data were drawn from a cohort of adult smokers (≥18 years) participating in the International Tobacco Control (ITC) Uruguay Survey. The probability sample cohort was representative of adult smokers in five cities. The surveys included key indicators of HWL effectiveness. Data were collected in 2008/09 (prepolicy: wave 2) and 2010/11 (postpolicy: wave 3).Results Overall, 1746 smokers participated in the study at wave 2 (n=1379) and wave 3 (n=1411). Following the 2009/2010 HWL changes in Uruguay (from 50% to 80% in size), all indicators of HWL effectiveness increased significantly (noticing HWLs: OR=1.44, p=0.015; reading HWLs: OR=1.42, p=0.002; impact of HWLs on thinking about risks of smoking: OR=1.66, p<0.001; HWLs increasing thinking about quitting: OR=1.76, p<0.001; avoiding looking at the HWLs: OR=2.35, p<0.001; and reports that HWLs stopped smokers from having a cigarette ‘many times’: OR=3.42, p<0.001).Conclusions The 2009/2010 changes to HWLs in Uruguay, including a substantial increment in size, led to increases of key HWL indicators, thus supporting the conclusion that enhancing HWLs beyond minimum guideline recommendations can lead to even higher levels of effectiveness.