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World No Tobacco Day — May 31, 2011 Cigarette Package Health

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World No Tobacco Day — May 31, 2011 Cigarette Package Health Morbidity and Mortality Weekly Report Weekly / Vol. 60 / No. 20 May 27, 2011 Cigarette Package Health Warnings World No Tobacco Day — and Interest in Quitting Smoking — May 31, 2011 14 Countries, 2008–2010 Tobacco use is the leading preventable cause of death; this year approximately 5 million persons worldwide will The World Health Organization (WHO) Framework die from tobacco-related heart attacks, strokes, cancers, Convention on Tobacco Control (FCTC) requires health warn- and other diseases (1). Sponsored by the World Health ings on tobacco product packages sold in countries that ratified Organization (WHO), World No Tobacco Day is observed the WHO FCTC treaty (1). These warnings are expected to 1) every year on May 31. describe the harmful effects of tobacco use; 2) be approved by This year, World No Tobacco Day highlights the WHO the appropriate national authority; 3) appear on at least 30%, Framework Convention on Tobacco Control (WHO and ideally 50% or more, of the package’s principal display FCTC) (1). Adopted as a resolution at WHO’s 1996 areas; 4) be large, clear, visible, and legible in the country’s World Health Assembly, WHO FCTC took effect in principal language(s); 5) have multiple, rotating messages; and 2005 and is maintained by the United Nations. A total of 6) preferably use pictures or pictograms. To assess the effects of 172 countries have adopted the treaty (2), making WHO cigarette package health warnings on interest in quitting smok- FCTC one of the most widely embraced evidence-based ing among smokers of manufactured cigarettes aged ≥15 years, treaties in United Nations history. this report examines 2008–2010 data from the Global Adult WHO FCTC urges all countries to ratify the treaty, fully Tobacco Survey (GATS) in 14 WHO FCTC countries. Among implement its provisions, and adopt its guidelines (1), and men, the prevalence of manufactured cigarette smoking ranged WHO provides country-level assistance for implementing from 9.6% in India to 59.3% in Russia. Among men in 12 of effective tobacco control measures (3). CDC has supported the countries and women in seven countries, >90% of smokers this effort by working with partners to provide technical assistance and infrastructure support for the creation of sustainable surveillance systems (the Global Adult Tobacco INSIDE Survey and the Global Youth Tobacco Survey). Additional 652 Human Jamestown Canyon Virus Infection — information is available at http://www.who.int/fctc/en/ Montana, 2009 index.html. 656 Contribution of Occupational Physical Activity Toward Meeting Recommended Physical Activity References Guidelines — United States, 2007 1. World Health Organization. WHO Framework Convention on 661 Recommendations for Use of a Booster Dose of Tobacco Control. Geneva, Switzerland: World Health Organization; Inactivated Vero Cell Culture-Derived Japanese 2011. Available at http://www.who.int/tobacco/wntd/2011/ Encephalitis Vaccine — announcement/en/index.html. Accessed May 19, 2011. 2. World Health Organization. Parties to the WHO Framework Advisory Committee on Immunization Practices, 2011 Convention on Tobacco Control. Geneva, Switzerland: World 664 Update on Japanese Encephalitis Vaccine for Health Organization; 2011. Available at http://www.who.int/fctc/ Children — United States, May 2011 signatories_parties/en/index.html. Accessed May 19, 2011. 666 Measles — United States, January–May 20, 2011 3. World Health Organization. WHO report on the global tobacco epidemic, 2008: the MPOWER package. Geneva, Switzerland: World 669 Announcement Health Organization; 2011. Available at http://www.who.int/tobacco/ 669 Notice to Readers mpower/2008/en/index.html. Accessed May 19, 2011. 671 QuickStats U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report reported noticing a package warning in the previous 30 days. health warnings on a cigarette package in the previous 30 The percentage of smokers thinking about quitting because of days, and whether the label led them to think about quitting the warnings was >50% in six countries and >25% in men and smoking.§ Responses were analyzed by sex and, within sex women in all countries except Poland. WHO has identified strata, by age and education level using bivariate analysis within providing tobacco health information, including graphic health individual countries. Differences in response estimates were warnings on tobacco packages, as a powerful “best buy” in com- considered statistically significant if 95% confidence intervals bating noncommunicable disease (2). Implementing effective did not overlap. Overall response rates ranged from 65.1% in warning labels as a component of a comprehensive approach can Poland to 97.7% in Russia. help decrease tobacco use and its many health consequences. The health warnings on cigarette packages in each country GATS is a nationally representative household survey at the time GATS was conducted were described according conducted among persons aged ≥15 years using a standardized to WHO FCTC guidelines (3,4). All GATS countries had questionnaire, sample design, data collection method, and warning labels on cigarette packages describing harmful effects analysis protocol to obtain measures on key tobacco control of smoking at the time their survey was conducted. Four of indicators and ensure comparability across countries.* GATS the 14 countries (Brazil, Egypt, Thailand, and Uruguay) had was conducted once in each of the 14 countries during pictorial warnings. A fifth country, India, introduced pictorial 2008–2010 by national governments, ministries of health, warnings in 2009, and had both text and pictorial warnings in survey-implementing agencies, and international partners. In circulation when GATS was conducted (Table 1). each country, a multistage cluster sample design is used, with In all 14 countries, men were more likely to be cigarette households selected proportional to population size. Data are smokers than women. Among men, prevalence of smoking weighted to reflect the noninstitutionalized population aged ranged from 9.6% in India to 59.3% in Russia (Table 2). ≥15 years in each country. For this analysis, current smokers of Among women, prevalence of smoking was <25% in all coun- manufactured cigarettes† were asked whether they had noticed tries and <2% in Bangladesh, China, Egypt, India, Thailand, and Vietnam. * Additional information and GATS country reports are available at http://www. cdc.gov/tobacco/global/gats. § † “In the last 30 days, did you notice any health warnings on cigarette packages?” Respondents who reported currently smoking manufactured (i.e., commercial) and “In the last 30 days, have warning labels on cigarette packages led you to cigarettes on a “daily” or “less than daily” basis. The term “smokers” in this report think about quitting?” refers to current smokers of manufactured cigarettes. Smokers of other tobacco products, such as bidis, kreteks, hand-rolled cigarettes, cigars, pipes, and waterpipes who did not also smoke manufactured cigarettes are not included in this analysis. The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested citation: Centers for Disease Control and Prevention. [Article title]. MMWR 2011;60:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science James W. Stephens, PhD, Director, Office of Science Quality Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office MMWR Editorial and Production Staff Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series John S. Moran, MD, MPH, Deputy Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist Robert A. Gunn, MD, MPH, Associate Editor, MMWR Series Malbea A. LaPete, Julia C. Martinroe, Stephen R. Spriggs, Terraye M. Starr Teresa F. Rutledge, Managing Editor, MMWR Series Visual Information Specialists Douglas W. Weatherwax, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors Information Technology Specialists MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA 646 MMWR / May 27, 2011 / Vol. 60 / No. 20 Morbidity and Mortality Weekly Report In all countries except India (78.4%) and Mexico (83.5%), warnings was ≥75% in all countries except China (60.1%) and >90% of men reported noticing a health warning on a cigarette India (18.9%), and >90% in seven countries. In Bangladesh package (Table 2). Among women, the percentage who noticed TABLE 1. Characteristics of health warning labels on cigarette packages — Global
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