Pre-post implementation policy support for warnings on cigarette filters in Canada among adults who smoke cigarettes

Canada has become the first country in the world to require warnings to be displayed on cigarette sticks. Tobacco companies were given a transition period, from 30 April to 31 July 2024 to ensure that all king size cigarettes sold in the country included warnings on the filter of each cigarette stick. Warnings on the filter of regular size cigarettes will be implemented from April 2025.

We used an online panel provider to recruit an open cohort of adults in Canada who smoked factory-made or roll-your-own cigarettes. Seven waves of data were collected at 3-month intervals between February 2023 to August 2024, with 10 521 observations across 4310 participants. Participants were asked about support for the inclusion of warnings on cigarette filters, accompanied by an image of one of the six prescribed warnings (eg, 'Cigarettes damage your organs'). Smoking behaviours and sociodemographic characteristics were also queried.

Generalised estimated equations were used to estimate support at each wave. At W1 (February 2023, prior to the policy announcement), 25% of participants reported supporting printed health messages on cigarette sticks, significantly increasing to 27% by W7 (August 2024, at the end of the implementation transition period). Participants were more likely to support the policy if they used other nicotine/tobacco products, roll-your-own cigarettes, had a recent quit attempt, intended to quit, or had higher risk perception of smoking harms, and less likely if they were older, female, white or reported greater reactance to warnings on cigarette packs.

Just as increased support has been found for a range of tobacco control policies post-implementation, we found increased support for warnings on cigarettes during the transition period. However, support for this policy among people who smoke remains low. Other countries considering implementing this policy may consider these findings.