ABSTRACT
Aims This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries. Design A prospective multi-country cohort design was employed. Setting Australia, Canada, the UK and the US. Participants 21,613 adult smokers who completed at least one of the seven waves (2002-2008) of the International Tobacco Control Four Country Survey were included in the analysis. Measurements Reported exposure to POS anti-smoking warnings and smokers’ interest in quitting at the same wave and quit attempts over the following year. Findings Compared to smokers in Canada, the UK and the US, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting (adjusted odds ratio = 1.139, 95% CI 1.039∼1.249, p < 0.01) and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114∼1.327, p < 0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information, and awareness of anti-smoking material from channels other than POS. Conclusions Point-of-sale health warnings about tobacco are more prominent in Australia than US, UK or Canada and appear to act as a prompt to quitting.