Graphic warnings on tobacco product were introduced in New Zealand on 28 February 2008 and retailers had up to six months to comply. The warnings cover 30% of the front and 90% of the back of the packaging. Each warning label contains a picture depicting health effect(s) caused by smoking, and is enhanced by a warning message printed in both English and te reo Māori (the language of the indigenous people of New Zealand). Another positive aspect of the new warnings is a supportive cessation message included on the back of the packaging with the quitline number.

The aim of this analysis is to determine whether the new warnings prompted an increase in new registrations with the national quitline. It focuses on the six months before and six months after the introduction of graphic warnings. The outcome variables are the change in (1) number of new registrations; (2) percentage of new callers who obtained the quitline number from tobacco products packaging. Data for the latter were collected by quitline advisers during the registration call. A standard question “where did you obtain the quitline number?” was asked and only one answer was permitted.

The results indicate that the average number of new monthly registrations increased from 1517 before the introduction of the new warnings to 1729. Furthermore, from January 2008 onwards, there was a continuous increase in the percentage of new callers obtaining the quitline number from tobacco product packaging (fig 1). The increase was notable in March 2008 (p<0.001), when the rate doubled from 12% in February to 27% and continued at around 30% for the following months.

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Figure 1 Percentage of new quitline callers who obtained the quitline number from television advertising and tobacco product packaging, September 2007–August 2008.

TV advertising had been the most popular information source for new callers obtaining the quitline number, until it was superseded by tobacco product packaging from June 2008. The level of quitline TV advertising was substantially lower before the introduction of graphic warnings (a monthly average of 258 target audience rating points versus 374 following the warning’s introduction). This rejects the alternative explanation for the increase in percentage of quitline registrations from packaging and the decline in percentage of registrations from TV advertising being a result of lower TV advertising activities.

It is of interest to note that the increase in the proportion of new callers obtaining the number from tobacco packaging began in January 2008, before the official introduction of the graphic warnings. This may be explained by two reasons: (1) some tobacco brands adopted the new warnings before the official date; (2) media coverage on the new warnings before the official date may have increased awareness of the quitline number printed on the old packs.

The new graphic warnings promote the quitline number effectively, encouraging smokers who have not previously contacted the quitline to register for the first time. The new warnings could be working in two ways: (1) they prompt a quit attempt; (2) they are an easily accessible source of the quitline number while the actual quit attempt may have been originally prompted by another source.