PMID- 24218057
OWN - NLM
STAT- MEDLINE
DCOM- 20141006
LR  - 20240109
IS  - 1468-3318 (Electronic)
IS  - 0964-4563 (Print)
IS  - 0964-4563 (Linking)
VI  - 23 Suppl 1
IP  - 0 1
DP  - 2014 Mar
TI  - Cigarette graphic warning labels and smoking prevalence in Canada: a critical 
      examination and reformulation of the FDA regulatory impact analysis.
PG  - i7-12
LID - 10.1136/tobaccocontrol-2013-051170 [doi]
AB  - BACKGROUND: The estimated effect of cigarette graphic warning labels (GWL) on 
      smoking rates is a key input to the Food and Drug Administration's (FDA) 
      regulatory impact analysis (RIA), required by law as part of its rule-making 
      process. However, evidence on the impact of GWLs on smoking prevalence is scarce. 
      OBJECTIVE: The goal of this paper is to critically analyse FDA's approach to 
      estimating the impact of GWLs on smoking rates in its RIA, and to suggest a path 
      forward to estimating the impact of the adoption of GWLs in Canada on Canadian 
      national adult smoking prevalence. METHODS: A quasi-experimental methodology was 
      employed to examine the impact of adoption of GWLs in Canada in 2000, using the 
      USA as a control. FINDINGS: We found a statistically significant reduction in 
      smoking rates after the adoption of GWLs in Canada in comparison with the USA. 
      Our analyses show that implementation of GWLs in Canada reduced smoking rates by 
      2.87-4.68 percentage points, a relative reduction of 12.1-19.6%; 33-53 times 
      larger than FDA's estimates of a 0.088 percentage point reduction. We also 
      demonstrated that FDA's estimate of the impact was flawed because it is highly 
      sensitive to the changes in variable selection, model specification, and the time 
      period analysed. CONCLUSIONS: Adopting GWLs on cigarette packages reduces smoking 
      prevalence. Applying our analysis of the Canadian GWLs, we estimate that if the 
      USA had adopted GWLs in 2012, the number of adult smokers in the USA would have 
      decreased by 5.3-8.6 million in 2013. Our analysis demonstrates that FDA's 
      approach to estimating the impact of GWLs on smoking rates is flawed. Rectifying 
      these problems before this approach becomes the norm is critical for FDA's 
      effective regulation of tobacco products.
FAU - Huang, Jidong
AU  - Huang J
AD  - Health Policy Center, Institute for Health Research and Policy, University of 
      Illinois at Chicago, , Chicago, Illinois, USA.
FAU - Chaloupka, Frank J
AU  - Chaloupka FJ
FAU - Fong, Geoffrey T
AU  - Fong GT
LA  - eng
GR  - P01 CA138389/CA/NCI NIH HHS/United States
GR  - P50 CA111236/CA/NCI NIH HHS/United States
GR  - R01 CA100362/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20131111
PL  - England
TA  - Tob Control
JT  - Tobacco control
JID - 9209612
SB  - IM
MH  - Adult
MH  - Canada/epidemiology
MH  - Humans
MH  - Prevalence
MH  - Product Labeling/*legislation & jurisprudence
MH  - Smoking/adverse effects/epidemiology/*legislation & jurisprudence
MH  - Smoking Cessation/statistics & numerical data
MH  - Tobacco Products/*adverse effects
MH  - United States/epidemiology
MH  - United States Food and Drug Administration
PMC - PMC4254709
MID - NIHMS588034
OTO - NOTNLM
OT  - Economics
OT  - Packaging and Labelling
OT  - Public policy
EDAT- 2013/11/13 06:00
MHDA- 2014/10/07 06:00
PMCR- 2014/12/03
CRDT- 2013/11/13 06:00
PHST- 2013/11/13 06:00 [entrez]
PHST- 2013/11/13 06:00 [pubmed]
PHST- 2014/10/07 06:00 [medline]
PHST- 2014/12/03 00:00 [pmc-release]
AID - tobaccocontrol-2013-051170 [pii]
AID - 10.1136/tobaccocontrol-2013-051170 [doi]
PST - ppublish
SO  - Tob Control. 2014 Mar;23 Suppl 1(0 1):i7-12. doi: 
      10.1136/tobaccocontrol-2013-051170. Epub 2013 Nov 11.