Riassunto

Obiettivo: verificare l’impatto dei messaggi sui pacchetti di sigarette in termini di disassuefazione dall’abitudine al fumo e di riduzione del numero di sigarette fumate quotidianamente, considerando il grado di dipendenza e la volontà di smettere. Inoltre, confronta quale tipologia di avvertenze sui pacchetti impressioni di più:  forma testuale o con immagini realistiche di pazienti affetti da patologie derivanti dal fumo.
Disegno: studio di prevalenza (inchiesta).
Setting e partecipanti: interviste a un campione opportunistico di fumatori maggiorenni residenti nella provincia di Roma effettuate nelle sale d’attesa degli ambulatori di medicina generale di Morlupo e di ortopedia del Policlinico Umberto I di Roma (giugno e settembre 2010).
Principali misure di outcome: si è misurato l’effetto delle etichette in uso in Italia sull’abitudine al fumo con i quesiti autoriferiti sulla riduzione del numero di sigarette fumate quotidianamente, sul cambio di abitudini e sulla cessazione temporanea di fumare. Si è misurato il potenziale effetto delle etichette con immagini chiedendo ai fumatori se queste comunicassero maggiormente i danni alla salute e se cambierebbero marca nel caso venissero stampate sul proprio pacchetto.
Risultati: compilati 270 questionari. Grazie alle scritte sui pacchetti, il 95% dei fumatori ha recepito informazioni sui danni del fumo, il 14% (34) dichiara di aver diminuito temporaneamente il numero di sigarette fumate e il 5% (12) di aver tentato di smettere. Il 45% non conosce il reale impatto sulla salute delle sigarette leggere e il 49%, in seguito alle scritte, è passato a fumare quelle più leggere. Sono maggiormente influenzati dalle avvertenze sui pacchetti i fumatori più anziani (OR=2,54; IC95% 1,05-6,17), i più motivati a smettere (OR=2,92; IC95% 1,17-7,30), chi ha mostrato disagio per gli abiti maleodoranti di tabacco (OR=3,57; IC95% 1,41-9,00), chi reputa importanti i messaggi (OR=4,93; IC95%1,55-15,71), chi ha modificato le proprie abitudini a seguito degli avvertimenti (OR=3,31; IC95% 1,10-9,99).
Il 47% pensa che una combinazione di scritte e immagini sia più efficace e le donne più degli uomini cambierebbero marca se vi fossero immagini shock (OR=2,54; IC95% 1,41-4,56).
Conclusione: emergerono aspetti positivi legati all’introduzione delle etichette sui pacchetti: la quasi totalità dei fumatori ha recepito informazioni sui danni del fumo, il 14% ha ridotto il consumo di sigarette e il 5% ha tentato di smettere. La  conoscenza dell’effetto delle sigarette leggere, ritenute erroneamente meno dannose, è scarsa. E’ riconosciuta da oltre la metà dei fumatori l’importanza delle etichette nel comunicare i rischi per la salute dovuti al fumo. Le donne sono maggiormente impressionate dalle immagini sui pacchetti.

 Parole chiave: , ,

Abstract

Objective: the principal aim was to assess the impact of health warnings on cigarette packages in Italy, the reduction of daily number of cigarette smoked, in relationship to the tobacco-smoking dependence and motivation to quit. The second aim was to compare the impact of text warnings versus graphi depictions.
Design: cross-sectional study (survey).
Setting and participants: the study was conducted through interviews to an opportunistic sample of smokers. The subject enrolled were adult smokers (years ≥ 18), living in the province of Rome. Data were collected in two outpatient clinics located in Morlupo and Rome. Interviews were administered in the waiting rooms, to patients or to their relatives/ helpers. The survey was conducted in June-September 2010. The sample size (266 participants) was computed using a power of 80%, a confidence level of 95%, an expected frequency of smokers with a low motivation to quit who reduced number of cigarettes due to warnings of 15%, and a frequency of smokers with a higher motivation to quit who reduced number of cigarettes due to warnings of 30%.
Main outcome measures: the effect of the health warnings used in Italy on smoking reduction was measured with the following self-reported items: “Are you or have you been influenced by the health warnings on cigarettes packages (in relation to the daily number of cigarettes smoked)?”; “Have you changed your smoking habits due to the warnings (for example: don’t smoking after a coffee.)?”; “Have you ever stopped smoking due to the warnings?” The effect of labels that used shock images on cigarette boxes was measured using followed self-reported questions: “If shocking images were used on cigarette boxes, would they have greater effect than simple warning text currently used?”; “If your favourite cigarettes brand decide to change the look of its cigarette boxes with shocking images on smoking health damages, would you be driven to change it?”
Results: thanks to the health warnings, 95% of the 270 participants were informed on smoking damages, 14% (34 smokers) reduced the number cigarettes per day, and 5% (12 smokers) attempted to quit. Forty-five percent of smokers did not know the real impact of light cigarettes on their health, and 49% decided to smoke light cigarettes after having read the warnings. Women were more susceptible to immediate consequences of smoking (appearance of wrinkles; p<0.001), and were more prone to switch to light cigarettes (p=0.002). Smoking dependence, computed with Fagerström’s test, showed significant differences by age groups (higher in smokers aged 30-45 years; p=0.001), and in smokers who were not interested to deepen knowledge of smoking effects (p=0.009). Individuals more motivated to quit were younger smokers (p=0.012). Smokers aged ≥45 years (OR=2.54; 95%CI 1.05-6.17), more motivated to quit (OR=2.92; 95%CI 1.17-7.30), those who reported they do not like the smoking smell on their own clothes (OR=3.6; 95%CI 1.4-9.0), those who reported warning messages are important (OR=4.93; 95%CI 1.55-15.71), those who changed their own smoking behavior due the warnings (OR=3.31; 95%CI 1.10-9.99) were more likely to reduce daily number of cigarettes due the health warnings. Forty-seven percent thought that health warnings with text and images could have a higher impact in comparison to text-only warnings.
Moreover, women were more motivated to change cigarette brand if a brand should introduce pictorial warnings (OR=2.54; 95%CI 1.41-4.56).
Conclusion: our study showed some positive effects of the introduction of health warnings on cigarette packages. In fact, almost all were informed on tobacco effects, 14% of them reduced the amount of daily smoking, and 5% attempted to quit. Many smokers still believe that switching to lighter cigarettes (e.g. those with less nicotine and tar contents) reduces smoking-related diseases. More than 50% of smokers recognized the importance of health warnings in communicating health risks of smoking, while women were more impressed than men by shocking pictorial warnings.

 Keywords: , ,

 

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