Rizals Life

The Effects of

Tobacco Graphic Health Warnings

on Smokers

Judy Ming Chuen Li

A thesis submitted for the degree of Doctor of Philosophy

Department of Public Health

University of Otago, Wellington, New Zealand

January 2015

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Abstract

In 2007, the New Zealand government announced a change in the legislation on tobacco on-pack

warning labels, requiring text-based warning labels to be replaced by graphic health warnings

(GHWs). According to this new regulation, GHWs must cover 30% of the front and 90% of the

back of all cigarette and tobacco packets that are manufactured for sale in New Zealand. These

new requirements took effect from 28 February 2008 with a six-month phase-in period. The aims

of this thesis were to assess the effects these new GHWs had on smokers, and explore issues

relating to the implementation of the new health warnings.

The thesis describes a multifaceted investigation in which four independent studies were

undertaken. Study One monitored the roll-out of GHWs in retail outlets before, during, and after

the phase-in period. Study Two reported on a secondary analysis of a large-sample cohort study,

in which smokers self-reported their knowledge of smoking-induced harms and responsiveness

towards the old text-based warnings and the new GHWs. The third study collected observational

data on smokers’ avoidance behaviours towards on-pack warnings in public places (pre- and

post-GHWs). Study Four involved a series of in-depth interviews with shopkeepers who sold

tobacco, and reported on their experience in distributing the new GHWs, their support for this

policy, and their observations of customers’ responses towards GHWs.

The data collected from Study One show that manufacturers were able to comply with the rollout timetable for introduction of the new GHWs. Further, participants in the retailers’ interviews

(Study Four) did not report any problems or direct financial cost associated with implementing

the new warnings. Study Two provides strong...