Gravely S, Meng G, Hammond D, Driezen P, Thrasher JF, Fong GT, Craig LV, Chung-Hall J, Quah ACK, Ouimet J, Bansal-Travers M, and Cummings KM
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., Competing Interests: The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. S. Gravely, G. Meng, P. Driezen, G.T. Fong, L.V. Craig, J. Chung-Hall, A.C.K. Quah and J. Ouimet, report that since the initial planning of the work they were supported by grants from the US National Cancer Institute (P01 CA200512) and the Canadian Institutes of Health Research (FDN-148477). Furthermore, S. Gravely reports that in the past 36 months, was a paid consultant by Singapore’s Ministry of Health for a report on tobacco plain packaging. D. Hammond reports that in the past 36 months, grants were received from CIHR, NIH, and other non-profit funding agencies, and travel expenses and honoraria from non-profit public health agencies for talks. Finally, D. Hammond reports that in the past 36 months, he has served as a paid expert witness on behalf of governments and public health authorities in response to legal challenges from the tobacco, vaping, cannabis and food industries, and had leadership or fiduciary role in several non-profit public health agencies, unpaid. J.F. Thrasher reports that since the initial planning of the work, he received support for the present manuscript from the US National Cancer Institute/NIH (2-P01 CA200512) and in the past 36 months, grants or contracts from the US National Cancer Institute/NIH (R01 CA215466). G.T. Fong reports that in the past 36 months, received a Senior Investigator Award, from the Ontario Institute for Cancer Research (IA-004). K.M. Cummings reports that since the initial planning of the work and in the past 36 months, he received support from the US National Cancer Institute (P01 CA200512). Finally, he reports that in the past 36 months and currently, he continues to serve as a paid expert witness in litigation filed against cigarette manufacturers., (© 2023 Gravely S. et al.)