In March 2006, graphic health warnings were included on cigarette and other tobacco packs in Australia. In addition, and for the first time, the Australian Quitline number was printed on packets. Prior to 2006, Australia had text-based warnings. There was an infoline number printed in small text on the side of the pack. This number diverted to the Quitline.
Like the text-based warnings that preceded them, the graphic health warnings are mandated under Australia’s Trade Practices Act,1
which includes regulations to inform and protect consumers. Graphic images and explanatory messages cover 30% of the front and 90% of the back of the pack. The message “You CAN quit smoking. Call the Quitline 131 848, talk to your doctor or pharmacist, or visit www.quitnow.info.au
” is also included on the back of all packs. The Quitline number is also “stamped” on top of the graphic image on the backs of packs. Regulations prescribe the details of the size of the elements.1
There are 14 different warnings divided into 2 sets,2 3
rotated semi-annually. Many but not all of the messages and images were new to Australian smokers. Currently, there is no provision to update the messages or images on packets that were introduced to consumers in 2006.
A series of mass media campaign activities accompanied the introduction of the new cigarette packet warnings. The Australian Government screened an awareness raising campaign in February 2006.4
In addition, a collaboration of Australian state and territory-based non-government health agencies developed a campaign to reinforce the pack warnings and promote quitting. This quit campaign featured two television commercials (TVCs) linked directly to the new graphic cigarette packet warnings; “Amputation”,5
linked to the warning “Smoking causes peripheral vascular disease” and “Mouth Cancer”,5
linked to the warning “Smoking causes mouth and throat cancer”. “Amputation” first aired in May 2006 and “Mouth Cancer” first aired in July 2006.
Australia is not the first country to introduce a Quitline or smokers’ helpline number on cigarette packets. In 2002, a smoking cessation message and quit line number were included on Dutch cigarette packets, along with prominent text warnings. This led to a 3.5-fold increase in calls to the Dutch Quitline.6
In the UK, written pack warnings, accompanied by a smoking helpline number, were reported as the second largest driver of callers to the UK National Health Service Stop Smoking Helpline.7
However, to date, no data have been published on the impact of the graphic cigarette packet warnings, accompanied by a Quitline number, on demand for a Quitline service.
It is well established that television advertising to promote quitting can increase calls to Quitlines8–10
and, therefore, quitting itself.11
This study measures the impact of new style cigarette packets, which included graphic cigarette packet warnings and the Quitline number, on calls to the Australian Quitline, and the extent to which call volume exceeded that which would be expected from the usual mass media cessation advertising.