The impact of Australia’s new graphic cigarette packet warnings on smokers’ beliefs and attitudes Caroline L. Miller a,b,⇑ , David J. Hill c , Pascale G. Quester d , Janet E. Hiller b,e a Cancer Council South Australia, South Australia, Australia b Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, South Australia, Australia c Cancer Council Victoria, Victoria, Australia d Business School, University of Adelaide, South Australia, Australia e Australian Catholic University, Victoria, Australia article info Article history: Available online 23 June 2011 Keywords: Pack warnings Theory of Reasoned Action Smoking Intention to quit abstract In 2006 Australia introduced graphic health warnings (GHW) on cigarette packets, depicting a range of tobacco-related pathology. This intervention, controlling the appearance of a consumer product, was designed to raise consumers’ awareness of the harms of tobacco use, motivate quitting, and discourage uptake of smoking. This study applies the reasoned action approach to assess the relevance of GHW-related beliefs and attitudes to smokers’ behavioural intentions and smoking behaviour. A sample of 587 smokers was recruited through a random representative population survey in 2005, prior to the introduction of new warnings. A subset of 158 was followed up a year later. The results show that GHW-related beliefs and attitudes were predictive of intention to quit smoking. Intentions to quit were, in turn, predictive of quitting behaviour as measured in the follow up stage. New GHW warnings, smokers are presumed to have been exposed to, were also associated with changes in beliefs over time. Ó 2011 Australian and New Zealand Marketing Academy. Published by Elsevier Ltd. All rights reserved. 1. Introduction In Australia and New Zealand alike, non-communicable dis- eases including cancer and heart disease place a huge personal, so- cial and economic burden on the community (Australian Institute of Health and Welfare, 2009). While the determinants of health outcomes are complex and diverse, much of the morbidity and mortality burden associated with such diseases is preventable, and tobacco smoking is one of the most important contributors (Australian Institute of Health and Welfare, 2009). Around 17% of the Australian adult population smoke (Australian Institute of Health and Welfare, 2008) and every year, 15,000 Australians die prematurely from a wide range of tobacco-related illnesses (Begg et al., 2007); 10 times the number of deaths as occur from acci- dents on Australia’s roads. Opponents of tobacco control regulation and legislation often frame smoking as a ‘‘personal’’ and ‘‘rational’’ choice to use a ‘‘legal product’’ (Ministerial Council on Drug Strategy, 2005). This posi- tion has three major flaws. First, the extent to which most consum- ers’ choice about using tobacco products is rational, is debatable. Economic theory presumes that people’s behaviour can be under- stood as the rational pursuit of self-interest (Parkin, 1990). The concept of rational choice refers to people choosing the best course of action, for their preferences, at a given time, having weighed up the information that they have when the choice is made. Implicit in the argument of rational choice, as it is applied to tobacco con- sumption, is the assumption that people genuinely understand and weigh up the costs (health, economic, social) versus the bene- fits (physiological pleasure, social) of smoking, and choose to con- tinue to smoke. In the absence of perfect information, consumers’ rational choice is severely impeded. While it is true that virtually all smok- ers are aware that smoking is harmful to health, far fewer accu- rately estimate the risk of disease or disability, or understand the breadth of illnesses tobacco causes or the possible consequences in middle age (Mullins et al., 1996; Tan et al., 2000; Weinstein et al., 2004, 2005). The fact that smoking causes lung cancer and heart disease is widely known, but that smoking also causes cancer of the mouth and oropharynx, stomach, liver, pancreas, cervix, bladder, and leukaemia (for those aged over 30 years) (Begg et al., 2007) is far less well understood. There is evidence in tobacco company documents that tobacco companies have known for a long time about the effects of tobacco and have failed to disclose or denied this information from consumers (Waxman, 2003). 1441-3582/$ - see front matter Ó 2011 Australian and New Zealand Marketing Academy. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ausmj.2011.05.004 ⇑ Corresponding author at: Cancer Council South Australia, P.O. Box 929, Unley BC, South Australia 5061, Australia. Tel.: +61 8 8291 4111; fax: +61 8 8291 4268. E-mail address: cmiller@cancersa.org.au (C.L. Miller). Australasian Marketing Journal 19 (2011) 181–188 Contents lists available at ScienceDirect Australasian Marketing Journal journal homepage: www.elsevier.com/locate/amj