| Summary: | Introduction
In March 2020, the US Food and Drug Administration (FDA) finalized
new pictorial health warnings (PHWs), covering 50% of the front and back of the
pack; however, legal challenges from cigarette manufacturers have prevented the
new warnings from being implemented. About 70% of adults in the general US
population support PHWs. This study assessed support for PHWs in 2016, 2018
and 2020 among US adults (aged ≥18 years) who currently smoke or formerly
smoked cigarettes. We also assessed factors related to support.
Methods
Respondents included adults who currently or formerly smoked cigarettes
and participated in at least one wave of the US ITC Smoking and Vaping Surveys:
Wave 1 (2016, n=2557); Wave 2 (2018, n=2685); and Wave 3 (2020, n=1112).
We assessed changes in support for PHWs between 2016 and 2020, and assessed
factors related to support (support vs oppose/don’t know). Analyses were
conducted on weighted data.
Results
Overall, 38.0% of respondents supported PHWs in 2016, with a significant
increase to 44.7% in 2018 (p<0.001), and leveling off to 45.0% in 2020 (2018 vs
2020, p=0.91). Support was highest among former smokers and lowest among
daily smokers in all three survey years. Support for PHWs at all survey years was
significantly higher among those who formerly smoked, were younger (aged
18–39 vs ≥40 years), those who identified as Black (vs White), and planned to
quit smoking (vs not planning to quit). There were no differences by income
level, education level, or sex.
Conclusions
Nearly half of US adults who smoke cigarettes or quit smoking
supported PHWs in 2020, with support being higher among younger adults,
ethnic minorities, and those who formerly smoked. Support increased between
2016 and 2018, but not between 2018 and 2020. Similar to other studies, fewer
current and former smokers supported PHWs compared to the US adult general
population.
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