Canada: Increased support among smokers for the measurement of health warnings on cigarettes

In 2024, Canada became the first country in the world to impose health warnings directly on cigarettes. This unprecedented measure aims to increase consumer awareness of the dangers of tobacco while influencing social norms around cigarette consumption. A study published in Tobacco Control examined the level of support for these product warnings among Canadian adults who smoke, before the policy was announced and during the transition period.[1].

In 2001, Canada had already been a pioneer in imposing graphic health warnings on cigarette packages, a measure quickly followed by other countries and considered one of the best practices in terms of consumer information and prevention for non-smokers. One hundred and thirty-eight countries or territories have followed Canada's lead and now affix photo warnings on cigarette and other tobacco product packaging.

The Canadian Product Warnings Study followed an open cohort, collecting data in seven waves between February 2023 and August 2024, from Canadian adults who smoke. Participants, recruited through an online panel, were selected based on specific criteria: age 18 or older, lifetime history of smoking at least 100 cigarettes, and current smoking of manufactured or rolled cigarettes.

An unprecedented measure in the world

Since January 2024, bilingual messages such as “Cigarettes damage your organs” or “poison in every puff” have been displayed on the filters of king-size cigarettes, representing 70 %s on the Canadian market. These warnings will be replaced every two years by a new series of six warnings, to ensure that the messages are “impactful, noticeable and memorable.” This requirement will extend to regular-size cigarettes and little cigars by April 2025. The goal is to integrate health messages into every consumption gesture, beyond the packaging, while exposing non-smokers to these warnings.

This measure is the result of a long reflection on the effectiveness of traditional warnings on cigarette and other tobacco product packages. Although these messages proved their initial effectiveness in increasing the perception of risks and reducing the attractiveness of the products, their impact has diminished over time due to consumers becoming accustomed to them.

Membership still limited, but promising

The results show that support for the new measure among Canadian smokers remained relatively low, fluctuating between 23% and 29% during the study period. This reluctance is partly explained by the psychological reactance of smokers, who often perceive these warnings as intrusive, or even guilt-inducing, according to the study authors. This rejection is particularly marked among older or heavily addicted demographic groups, where consumption habits are strongly ingrained.

Despite this, a gradual increase in support was observed over the course of implementation. This trend toward stronger support is observed for other tobacco control measures. For example, Canada's initially controversial public smoking ban eventually gained widespread acceptance due to a better understanding of the health benefits. This suggests that policies that are unpopular in the short term can become socially accepted as their effectiveness is confirmed.

Demographic and behavioral disparities

The study found significant differences by age, gender and smoking behaviour. Young adults (18-34 years) were more supportive of the measure, likely due to increased awareness of the risks of smoking and more frequent willingness to quit. In contrast, women and older smokers showed less support, which may reflect cultural perceptions and/or deeply rooted smoking habits.

Another notable point concerns smokers who use roll-your-own cigarettes. They are more supportive of the measure, possibly because it does not yet apply directly to their consumption. This raises questions about the fairness of the policy and its possible extension to roll-your-own cigarettes.

A lever to influence social norms

The potential impact of this measure goes beyond smokers themselves. Warnings printed on cigarettes expose these messages to people in the smoker's immediate environment, such as friends, family or colleagues. This increased visibility could contribute to a further denormalization of tobacco use, making it less acceptable, according to the study authors.

In addition, young people, who are often exposed to cigarettes in certain, more precarious social contexts, could be dissuaded from starting to smoke. The warnings would then act as an additional psychological barrier, like other prevention measures.

A Canadian model that should be exported to other countries

 While Canada is leading the way, other countries are following closely behind this initiative. Australia, for example, has expressed its intention to introduce such a measure. The authors of the study recommend that Canadian policy makers implement targeted awareness campaigns to raise awareness of this measure, emphasizing the public health benefits. They also recommend tailoring warnings based on the demographic and cultural characteristics of groups. Finally, it would be necessary to gradually extend this measure to hand-rolled cigarettes and other tobacco products for more equitable coverage.

©Tobacco Free Generation

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[1] Hackworth EE, Petillo SL, Sun Y, et al Pre-post implementation policy support for warnings on cigarette filters in Canada among adults who smoke cigarettes Tobacco Control Published Online First: 23 December 2024. doi: 10.1136/tc-2024-059007

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