Introduction For the past 20 years, there have been no changes to the text-only cigarette warning labels in the United States. During this same time period, other countries placed large graphic warning labels on cigarette packages. The purpose of this study was to investigate the reactions of U.S. young adult smokers and nonsmokers aged 18 to 24 years to Canadian cigarette label text and graphic warnings. The study focused on determining their perceptions and the potential impact of Canadian labels on smoking, and study participants were asked for suggestions for modifications of U.S. cigarette warning labels so they would be effective for smoking deterrence and cessation. Methods During January and February 2002, 11 focus groups consisting of 54 smokers and 41 nonsmokers were conducted in the Detroit metropolitan area. Current smokers were defined as those who had smoked a cigarette within the past 30 days. Participants were asked about their knowledge and perceptions of current U.S. cigarette warning labels and their impressions of Canadian cigarette warning labels. Analysis A content analysis and a word index were applied to the transcripts of all focus groups to identify and clarify themes and domains that appeared in group discussions and to compare results across different groups. Results Focus group participants reported that Canadian cigarette warning labels were more visible and informative than U.S. cigarette warning labels. Messages perceived to be relevant to smokers were considered effective. Education level did not appear related to how participants responded to warning labels. There were some differences for warning labels that had sex-specific messages. Discussion Warning labels are one component of comprehensive tobacco control and smoking cessation efforts. Stronger warnings on cigarette packages need to be part of a larger U.S. public health educational effort.

Despite negative financial conditions in recent years, several states were able to successfully maintain funding for tobacco prevention and control, which provided an opportunity to understand the factors associated with success. One explanation may be the level of long-term program sustainability in some states. According to a model developed by Saint Louis University researchers, the five elements critical to tobacco control sustainability are state political and financial climate; community awareness and capacity; program structure and administration; funding stability and planning; and surveillance and evaluation. Five states (Nebraska, New York, Indiana, Virginia, and Colorado) maintained funding for their tobacco control programs. Four of these states gained additional legislative appropriations or prevented a massive reduction; Colorado used a statewide ballot initiative to increase funding. On the basis of the sustainability framework, case studies, and prior research, the major lessons learned for maintaining funding were the importance of (1) strong and experienced leadership, (2) broad and deep organizational and community ties, (3) coordinated efforts, (4) strategic use of surveillance and evaluation data, (5) active dissemination of information about program successes, and (6) policy maker champions. The sustainability framework and lessons learned may provide valuable insights for other public health programs facing funding threats.

Potentially reduced exposure products (PREPs) have continued to enter the market during the 1990s and first part of the 21st century. Attempts by the tobacco industry to develop and market products with implied reductions in adverse health effects (i.e., harm reduction) are not new. Over the last half of the 20th century, the tobacco industry developed and marketed several products that purported to reduce the health risks associated with smoking cigarettes. Among these were filtered cigarettes in the 1950s and light and ultra-light cigarettes in the 1970s and 1980s. This review summarizes published and unpublished research that is directly relevant to the marketing, advertising, and communication about PREPs. The marketing strategies for these new products do not appear to differ from those used by the tobacco industry for light and ultra-light cigarettes. Although smokers report not using the new products in large numbers because of dissatisfaction with taste, they are interested in using products with reduced risk. Despite the absence of explicit health claims by the industry for PREPs, many smokers believe that these products are safer based on the advertising claims of reduced exposure and a belief that claims are approved by the government. No data are available to indicate that PREPs are useful for prevention or cessation of smoking, nor does specific research exist to suggest what health communication messages will provide smokers with accurate information about these products.

BACKGROUND:In 1984, the United States Congress enacted legislation requiring four new warning labels for cigarettes; warning labels in the United States have not changed since then. Other countries, such as Canada, have taken a more active and aggressive approach. The purpose of this study was to examine how U.S. smokers and former smokers might respond to stronger and more graphic warnings for U.S. cigarettes packages.METHODS:Data were collected in 2003 and analyzed in 2004. The perceived impact and effectiveness of the more-explicit Canadian labels was examined among young adult smokers (n=572) and former smokers (n=191) between the ages of 18 and 24 years in the United States, using a web-based survey that allowed participants to view both the text-only and the text-plus-graphic warning labels.RESULTS:Both current and former smokers thought that cigarette warning labels with text plus graphics were substantially more of a deterrent than text-only labels. The perceived effectiveness of these labels was not only higher overall, but also for the specific areas of smoking-related health effects, prevention, cessation, and maintenance of abstinence. Few differences were noted by gender.CONCLUSIONS:The findings from this study support previous research that has found that text-plus-graphic warning labels are more salient and potentially more effective than text-only labels.