Challenging key assumptions embedded in Health Canada's cigarette packaging legislation: Findings from in situ interviews with smokers in Vancouver

OBJECTIVES: The main objective of this study was to utilize qualitative research methods in order to explore variations in how smokers respond to the government-mandated graphic health warnings and messages on their cigarette packets. METHODS: Sixty in situ interviews were carried out with people while they were smoking in public settings across the city of Vancouver, British Columbia. During the interviews, participants were asked to recall the warning label on their cigarette packet, and general questions about the effects the imagery and text have had on their smoking. RESULTS: The analysis of findings pointed to several ways that participants overlooked, dismissed or otherwise failed to accurately recall health messages and images on their cigarette packaging. In particular, a significant minority questioned the veracity of the content of the labels and highlighted their exaggerated nature. With regard to the health information inserts, participants identified them as rubbish to be discarded rather than messages to be read. Few smokers could remember the warning label on their packet and some described warning labels that do not currently exist. Finally, a substantial proportion of participants were not smoking cigarettes from a standard packet, raising questions about how universal exposure to the labels actually is. CONCLUSION: Prevailing assumptions about how cigarette packaging legislation works as a population-level tobacco control intervention appear to be based on flawed assumptions about how people interact with cigarette packets as they are used in their everyday lives. As such, continued efforts on the part of tobacco control to redevelop "bolder" or more "graphic" labels on tobacco packaging may require consideration.