Ben Wade and Dr. Gordon B. Lindsay, Department of Health Science
Gennadiy Onishchenko, Russia’s chief state public health officer, labeled Russia’s tobacco problem “the nicotine genocide of the Russian people” (Moscow News, 2008). The Russian Federation has emerged from the socio-economic pressures of communism and its downfall to become the 4th largest consumer of cigarettes per capita worldwide (Myers, 2008). According to the World Health Organization [WHO] (2008a), in 2005 70% of Russian males smoked and almost 27% of females smoked, totaling a staggering 1 in every 2 Russians smoking. Russia also boasts a forebodingly high adolescent smoking prevelance (30.1% of adolescent males and 24.4% of adolescent females smoke), signifying that the “nicotine genocide” will continue unless robust tobacco policies are soon adopted.
One of the tobacco industry’s most critical links to consumers is the cigarette pack (Slade J., 1997). Cigarette packages are unique in that, while other products’ packages are discarded upon opening, the packs are kept on the smoker’s person or nearby until the product is gone. Furthermore, with each new cigarette, the smoker takes out the pack and often leaves it on public display during use, creating a portable advertisement (Koten, 1980). As advertising regulations have increasingly been placed upon the tobacco industry, it has responded by shifting its marketing focus from mass media to point-of-sale marketing, as evidenced by US tobacco firms allocating 85% of their promotional budget to point-of-sales marketing in 2001 (Federal Trade Commission, 2007). The tobacco pack has become one of the industry’s final marketing mediums to promote brand image.
The first public health efforts to reduce the impact of cigarette pack marketing came with the introduction of the health warning label “Cigarette Smoking May be Hazardous to Your Health” in the United States in 1965. Though progressive improvements in size and nature of text over the years did reap some benefit, cigarette warning labels remained largely mute up until December 2000 when Canada unveiled the most comprehensive labels yet, occupying 50% of both the back and front sides with warnings accompanied by graphic images and including constituents and emmissions labeling; the labels also prohibited misleading terms such as “light” and “mild” from appearing on the packages (Hammond). Shortly thereafter several countries followed in Canada’s wake and 166 others have now committed to similar policies, united under the worlds first global public health treaty, the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) (WHO, 2009a).
Article 11 of the FCTC recommends that graphics or pictures be used in addition to text warning labels on tobacco packaging. One immediate benefit of pictorial warning labels is that they detract from the attractiveness of the cigarette company’s package design (WHO, 2009b). Additionally, once graphics are added to the text, warning labels become more conspicuous, thus being more efficacious in their goal to educate and affect behavior change (O’Hegarty et al., 2006). Graphic warning labels (text + graphic) are perhaps even more vital in low income and middle income countries and countries where two or more languages are spoken, as they overcome low-literacy obstacles by communicating health messages through images (Jha & Chaloupka, 2000).
The Russian Federation ratified the FCTC on April 25, 2008. Current Russian warning labels cover only 4% of the front of the pack, and proposed warning labels are to cover 30% of the front surface and 50% of the back. The extent to which Russia implements the FCTC depends solely on the Russian government, and several experts are doubtful much will happen. The purpose of this study was to measure the Russian population’s acceptance and preference of graphic tobacco warning labels.
I was able to collaborate with David Hammond from the University of Waterloo, a top expert in the field, in developing an appropriate survey tool. In May 2009 I was able to conduct a pilot study in Moscow, Russia as well as develop a relationship with a Russian partner organization, The Open Health Institute. The pilot study revealed important revisions to be made before the survey could be launched nation-wide. The ORCA grant contributed to contracting The Russian Public Opinion Research Center (VCIOM) to run a national representative survey of 1600 respondents in the middle of October 2009. The results of our survey confirmed our hypotheses that the public would prefer more graphic warning labels and would want the government to mandate such improvements (almost 88% of participants). I am now working with faculty to submit a scholarly journal article for publication and am planning on presenting our findings at the American Public Health Conference, fall 2010. Additionally, the study results will be relayed to our Russian partner organization that will use the information to influence government legislation of graphic tobacco warning labels in Russia.