Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents
T. N. Robinson and J. D. Killen
Department of Pediatrics, Stanford University School of Medicine, Calif, USA.
OBJECTIVE: To examine the association between adolescents knowledge of
cigarette warning labels and actual smoking behavior. DESIGN: Cohort
analytic study. SETTING: Four public high schools in northern California.
SUBJECTS: Seventeen hundred forty-seven ninth graders (mean age, 14.9
years). Students from 2 of the schools (n = 803) were observed for
approximately 3 months. MAIN OUTCOME MEASURES: Self-reported knowledge of
warning labels was assessed at baseline. Self-reports of smoking behavior
were completed at baseline and at follow-up. RESULTS: Greater knowledge of
cigarette package warning labels was significantly associated with higher
levels of smoking. Knowledge of warning labels on magazine and billboard
advertisements did not differ significantly by level of smoking. In the
longitudinal sample, greater knowledge of cigarette package warning labels
was significantly associated with a subsequent increase in smoking,
controlling for the baseline level of smoking, sex, ethnicity, and
knowledge of warning labels on cigarette advertisements (odds ratio [OR],
1.22; 95% confidence interval [CI], 1.02-1.46). Knowledge of warning labels
on cigarette advertisements was not associated with a significant change in
smoking behavior (OR, 1.06; 95% CI, 0.82-1.35). CONCLUSIONS: Sizable
proportions of adolescent smokers are not seeing, reading, or remembering
cigarette warning labels. In addition, knowledge of warning labels on
cigarette packages and advertisements is not associated with reduced
smoking. The current warning labels are ineffective among adolescents.
