烟草销售点控烟警示信息对吸烟者戒烟行为的影响研究

Impact of point-of-sale anti-smoking warnings on

smokers’ quit intentions and attempts

李林， Ron Borland, Hua-Hie Yong, et al

澳大利亚维多利亚州癌症研究所烟草控制中心Corresponding author: Lin Li, PhD; E-mail: lin.li@cancervic.org.au

Presentation at the 15th CATC National Conference on Tobacco Control, Xi’an, China, April 2011

报告的主要内容 Outline of presentation

• 研究背景和目的 Background and research objective

• 方法 Methods

• 主要结果及讨论 Main results and discussion

• 问题 Any questions?

研究背景及目的 Background and objective

• 烟草行业把烟草销售点 (point-of-sale ，或 POS) 的促销作为其营销烟草的主要策略之一，在其他烟草营销渠道已被禁止的国家和地区尤为如此。Point-of-sale (POS) tobacco promotion has become an important marketing channel for the tobacco industry as other marketing opportunities have been banned.

• 为了遏制此势头澳大利亚等一些国家政府在烟草销售场所引进控烟警示信息以保护消费者的健康。To address this serious problem some countries most notably Australia has introduced anti-smoking information at the retail to protect consumers’ health.

销售场所控烟警示信息的例子Examples of POS health warnings

• Eg,“Tobacco products are addictive and kill 1 out of every 2 long-term smokers” （烟草制品导致成瘾，长期吸烟者每 2 人中会有 1人因吸烟而死亡） ( 加拿大安大略省 Ontario, Canada,2006-)

• Eg,“Smoking seriously harms you and others around you” （吸烟严重伤害你及你身边的人） ( 英国 UK, 2004-)

• “Smoking is addictive. Call the Quitline 131 848” （吸烟会成瘾。拨打戒烟热线 131 848） ( 澳大利亚新南威尔士州 NSW, Australia, 1999-)

(See a real example in a supermarket in NSW. Source:

Simon Chapman)

销售场所控烟警示信息的例子Examples of POS health warnings

• Eg,“Smoking damages almost every organ” （吸烟损伤几乎所有器官） ( 澳大利亚维多利亚Victoria,Australia,2006-)

• Eg,“Smoking causes mouth cancer” （吸烟导致口腔癌）

( 澳大利亚塔斯马尼亚Tasmania,Australia,2004)

研究背景及目的 Background and objective

• 目前还很少有关于销售点控烟警示信息对成人吸烟者戒烟行为的影响的研究报道

Little has been documented about the impact of the POS anti-smoking information on adult smokers’ quitting behaviours.

• 本课题旨在研究四个西方国家的成人吸烟者暴露于销售场所控烟警示信息与其戒烟意愿 / 行为之间的关系，并与从中国得到的初步研究结果做比较。This paper aimed to examine the association between exposure to POS anti-smoking warning and quitting behaviours among adult smokers in four western countries and compare it with some preliminary findings from China.

方法 Methods

• 本课题使用的是来自“国际烟草控制政策评估项目中国问卷调查”（ International Tobacco Control Policy Evaluation China Survey ，即 ITC 中国问卷调查 ) 和 “ ITC 四国问卷调查”（包括澳大利亚、加拿大、美国、英国）的前瞻性队列研究数据。Longitudinal data from the International Tobacco Control Policy Evaluation China Survey (ITC China Survey) and the ITC Four Country Survey were used.

• 在 2006 年 4 月的第一轮问卷调查中，共计有 4732 名来自北京、沈阳、上海、长沙、广州和银川的成人吸烟者完成 ITC 中国问卷；其中， 3863 名调查对象在 2007 年年底开展的第二轮调查中被成功回访并完成问卷。In China, a total of 3,863 smokers who were first surveyed in 2006 and recontacted in 2007 were included in the study.

方法 Methods

• ITC 四国从 2002 年 -2008 年共调查了 7 轮（每年一次），共有 21613名成人吸烟者完成了至少一轮的调查，并纳入统计分析 。In ITC-4 countries (Australia, Canada, the UK and US) a total of 21,613 smokers who completed at least one of the seven waves of the Survey (from 2002-2008) were included in the analysis.

• 除单因素分析外，我们使用广义估计方程（ Generalized Estimating Equation, GEE ）分析探索对销售点控烟警示信息的暴露与戒烟意愿（ quit intentions) 和戒烟尝试行为（ quit attempts ）之间的关系。 Both bivariate and multivariate analyses (including generalized estimating equations (GEE) modelling) were employed to examine the associations between exposure to POS warnings and smokers’ quit intentions (cross-sectional) and quit attempts at follow-up using the cohort design across the whole study period.

结果 Results 澳大利亚的吸烟者在研究期间对销售点控烟警示信息的暴露水平远高于其他的 3 个西方国家smokers in Australia reported higher levels of noticing POS health warnings over the study period than did their counterparts in the other 3 western countries

 

Noticing POS health warnings in shops by wave in ITC-4 countries

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

W1-2002

W2-2003

W3-2004

W4-2005

W5-2006

W6-2007

W7-2008

Per

cen

t(ye

s) Australia

Canada

UK

USA

Canada - % Intended#

82.3 81.1 80.3 80.7 74.9 77.2 75.8 76.2 74.4 75.1 78.6 74.5 74.8 72.9

%Attempted##

45.8 43.2 46.5 43.9 43.0 42.9 43.4 42.8 41.9 42.6 45.5 46.9 - -

US - % Intended

71.4 75.6 68.4 72.0 69.0 69.2 64.2 69.9* 71.2 71.2 71.8 69.6 70.9 68.5

%Attempted

37.3 36.3 44.7 38.9 47.2 41.1 43.4 40.3 41.6 44.7 48.1 46.1 - -

UK - % Intended

59.0 65.5* 54.3 61.3* 58.0 63.0 66.9 63.9 79.9** 60.1 61.5 56.7 62.6* 57.9

%Attempted

30.2 31.8 34.3 38.3 44.1 44.9 39.0 41.1 40.5 41.3 40.0 40.8 - -

Australia -% Intended

76.9 75.3 75.6 72.3 77.5** 72.2 77.8** 70.9 76.7** 69.8 77.6*** 68.6 71.7** 64.9

 

Wave1 (2002) Wave2 (2003) Wave3 (2004) Wave4 (2005) Wave5 (2006)

Wave6 (2007) Wave7 (2008)

exposed not exp exposed not exp exposed

not exp exposed not exp exposed

not exp exposed not exp exposed not exp

%Attempted

34.6 34.1 47.4* 41.9 50.4** 41.9 50.6 47.5 46.1 46.7 49.6 49.1 - -

结果 Results 在澳大利亚，暴露于警示信息的吸烟者中有戒烟意愿的比例总的来说高于没有暴露的吸烟者。 类似的差异也出现在戒烟尝试的比例中（特别是第 2 、 3 轮中），即看到健康警示的更有可能采取行动。数据表明其他三个国家没有这种明显的趋势。Overall in Australia over the waves those exposed to POS warnings were more likely to report having quit intentions, and such a clear trend was not found in other 3 countries.

 

Quit intention rate over waves in Australia, by POS exposure status

55

60

65

70

75

80

Wave

1

Wave

2

Wave

3

Wave

4

Wave

5

Wave

6

Wave

7

Per

cen

t

exposed

not-exposed

结果 Results 广义估计方程分析结果 1 ：澳大利亚吸烟者对控烟警示信息的暴露与其戒烟意愿之间有统计学正相关( 同轮 / 横段面关联），但这种关联在其他 3 个西方国家没有统计学意义 In Australia (but not in the other three countries) there was a significantly positive association between exposure to POS health warnings and quit intentions (cross-sectional association)

 

  Adjusted Odds Ratio 调整比值比

95% CI p-value

Australia 澳

1.200 1.103~1.306

<.001

Canada 加

.994 .901~1.097 .907

UK 英 1.026 .928~1.135 .614

US 美 .945 1.861~1.037

.230

结果 Results 广义估计方程分析结果 2 ：仅在澳大利亚发现对警示信息的暴露与后来的戒烟尝试之间有统计学正相关 ( 纵向关联） In Australia (but not in the other three countries) there was a significantly positive association between exposure to POS health warnings and subsequent quit attempts (longitudinal association)

 

  Adjusted Odds Ratio 调整比值比

95% CI p-value

Australia 澳

1.181 1.090~1.279

<.001

Canada 加

.961 .875~1.055 .399

UK 英 .935 .841~1.039 .213

US 美 1.017 .925~.118 .727

结果 （续） Results

• ITC 中国初步结果表明，那些表示暴露于销售商店中的控烟警示信息的吸烟者比那些未暴露的更可能在第二轮表示有戒烟意愿（ 31% 比 26%, 调整的比值比 adjusted OR=1.27, p<0.05)* 。

In China, after similar adjustment for covariates, smokers who reported being exposed to anti-smoking information in stores were more likely to have subsequent intentions to quit than those who were not exposed (31% vs 26%,

adjusted odds ratio=1.27, p<0.05)*.

ITC中国第一、二轮戒烟意愿比例

29.60%33.70%

26.30% 27.70%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

Wave1 Wave 2

Per

cen

t

暴露组非暴露组

主要结果小结 Key results so far

• 研究结果显示澳大利亚的烟草销售商店中的控烟警示信息能提高成人吸烟者戒烟的意愿和尝试。

The results from Australia suggest that shop POS anti-smoking warnings can lead to increased quitting.

• 中国的数据也表明吸烟者注意到销售点控烟警示信息能预测他们今后的戒烟意愿。Noting POS warnings in China predicted future intentions.

讨论 Discussion 与西方四国相比较， (1) 中国吸烟者中有戒烟意愿的比例最低！提示有必要想方设法提高中国吸烟者的戒烟意愿 -- 因为我们的研究表明较强的戒烟意愿与戒烟行为紧密相连（ Li et al 2011).如何提高？销售点警示信息与戒烟意愿之间的正向关联的研究结果为此指出了方向。Compared to smokers in 4 western countries, smokers in China had lowest quit intention rate. Efforts need to be made to increase Chinese smokers’ quit intentions. But How? The findings that noticing POS warnings in China predicted future intentions has some important implications.  

五国第一轮戒烟意愿比较 Baseline quit intention rate

27%

76%81%

65%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

China Australia Canada UK US

Per

cen

t

讨论 Discussion (cont’) 与西方四国相比较， (2) 中国吸烟者中做戒烟尝试的比例也最低！“只有尝试才有可能成功”，有必要促使国人，尤其是烟民，采取行动。要使其行动，先让其“心动” – 销售场所控烟警示对此可有所作为。Compared to 4 Western countries, fewer smokers in China made quit attempts. It suggest that implementing strong shop warnings can be promising: it can reinforce smokers’ quit intentions, and enhanced intentions in turn will lead to more quit attempts, and hopefully with more smokers attempting to quit more of them may succeed.

第一、二轮调查期间尝试戒烟的比例Reported quit attempt rate between Waves 1 and 2

25.30%

31%34% 36%

44%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

中国China 英国UK 澳Australia 美国USA 加Canada

Per

cen

t

讨论及启示 Discussion ITC 四国的研究结果也不尽相同，其中澳大利亚销售场所警示信息的作用最为明显，因为澳大利亚的健康警示更显眼（包括要求的图片警示及其大小）、实施更全面（包括结合烟包、大众媒体等综合宣传警示信息），而且有不断加强的趋势。这些做法中国可以借鉴。The effect of POS anti-smoking warnings differed across the four western countries. Australia had the most obvious outcomes, mainly due to its more salient, comprehensive and consistent warning interventions (including on the packs and mass media).

 

Source:ASH Australia

结论 Conclusion

• 本项研究表明在有效实施醒目、综合的控烟警示干预的国家（澳大利亚），成人吸烟者对销售场所控烟警示信息的暴露与其戒烟意愿和戒烟尝试行为之间有正向关联；

• 结果提示在中国可以通过在烟草销售场所引入显眼而有效的控烟警示促使更多的烟民戒烟。

The results provide evidence to support policy initiatives that include more salient, comprehensive and consistent health warnings (as has been done in Australia) in order to encourage more smokers to take action to quit. The finding that noting POS in China predicted future intentions suggests that shop POS warnings would be likely to encourage more Chinese smokers to try to quit.

有必要及时采取行动！ Take actions now!

NO !

YES !

本文作者感谢 ITC 中国、 ITC 四国项目组其他成员的支持。 The authors would like to thank other members of the ITC China and ITC-4

teams for their supports. 经费来源 （ Sources of funding）

This work was funded by grants from the National Cancer Institute of the United States (P50 CA111326)(P01 CA138389)(R01 CA100362)(R01 CA125116)(P50 CA111236-05S1), Robert Wood Johnson Foundation (045734), Canadian Institutes of Health Research (57897 and 79551), National Health and Medical Research Council of Australia (265903 and 450110), Cancer Research UK (C312/A3726), and Canadian Tobacco Control Research Initiative (014578), with additional support from the Centre for Behavioural Research and Program Evaluation, National Cancer Institute of Canada/ Canadian Cancer Society, and Chinese Center for Disease Control and Prevention.

谢谢大家！ Thank you!

联系人 : 李林博士，具体联系信息如下： Lin Li, PhD

VicHealth Centre for Tobacco ControlThe Cancer Council Victoria( 澳大利亚维多利亚州癌症研究所烟草控制中心 )

100 Drummond Street, Carlton, Victoria 3053 Australia

T: +61 3 9635 5605 F: +61 3 9635 5440  

E-mail: Lin.Li@cancervic.org.au