1. Differences in Responses to Text Health Warnings by Ethnicity: A Possible Benefit of Indigenous Language Usage? Judy Li, 1 Nick Wilson, 1 Deepa Weerasekera, 1 Richard Edwards, 1 Janet Hoek 2 1 Department of Public Health, University of Otago, Wellington, New Zealand 2 Department of Marketing, University of Otago, Dunedin, New Zealand

2. Background New Zealand (NZ) is one of 15+ countries involved in the ITC Project. At the time of the first NZ survey, only text warnings were required on tobacco products. However, all of these had a Maori language component (see photo, third line of label). We aimed to determine if there were differences in responses to warnings by ethnicity.

3. Methods Between March 2007 and February 2008 we surveyed by telephone a national sample of 1376 New Zealand adult (18+ years) smokers. We asked standard ITC Project questions relating to salience, cognitive processing and behavioural responses relating to health warnings on tobacco products. Further detail on the survey methods is available (Methods Report at: http://www.wnmeds.ac.nz/ITCProject.html).

4. Results: Salience & cognitive processing Note: Self-reported responses with all results weighted to the national population of smokers and adjusted for complex sample design. Variable Maori (mean score, 95%CI) (n=607) Pacific (mean score, 95%CI) (n=90) “Other” (European/ Other/ Asian) (mean score, 95%CI) (n=679) Differences in mean scores between Maori & Pacific Differences in mean scores between Maori & “Other” Salience of warnings Noticing of health warnings (5-point scale of: “Never” = 1 to “Very often” = 5) 3.62 (3.47–3.76) 3.44 (3.09–3.80) 3.22 (3.08–3.35) 0.18 p=0.374 0.40 p<0.0001 Looked closely at the warnings (5-point scale as above) 3.01 (2.86–3.16) 3.40 (3.06–3.74) 2.83 (2.69–2.96) -0.39 p=0.043 0.18 p=0.072 Cognitive responses Thinking about the health risks of smoking because of the warning (4-point scale: “Not at all”=1 to “A lot”=4). 2.19 (2.08–2.29) 2.38 (2.04–2.73) 2.04 (1.94–2.13) -0.19 p=0.279 0.15 p=0.040 Thinking about how the warning labels on cigarette packs “make you more likely to quit smoking?” (4-point scale as above) 1.82 (1.71–1.92) 2.18 (1.87–2.48) 1.67 (1.58–1.75) -0.36 p=0.030 0.15 p=0.033

5. Results: Behavioural responses Note: Self-reported responses with all results weighted to the national population of smokers and adjusted for complex sample design. Variable Maori (95%CI) (n=607) Pacific (95%CI) (n=90) “Other” (95%CI) (n=679) Odds ratio for Maori (Pacific as reference group) Odds ratio for Maori (Other as reference group) Any foregoing cigarettes as a result of the warnings (coded “Ever” versus “Never”) 83.4% (79.1–87.8) 87.8% (79.9–95.8) 78.7% (74.6–82.8) OR=0.70 (0.31–1.57) OR=1.37 (0.91–2.04) Any avoidance of warnings (based on four kinds of avoidance behaviours: covering-up warnings, keeping warnings out of sight, using a cigarette case, or avoiding particular warnings. From these a binary variable, “no avoidance-any avoidance”, was computed). 17.9% (13.9–22.0) 38.5% (25.6–51.3) 13.9% (10.5–17.4) OR=0.35 (0.19–0.64) OR=1.35 (0.90–2.01)

6. Preliminary Summary Results are suggestive that these text warnings elicit higher salience and stronger cognitive responses among Maori smokers than non- Maori/non-Pacific smokers. Pacific smokers had significantly higher responses than Maori in categories of salience, cognitive responses and behavioural responses (suggesting that using Pacific languages as well as Maori language might be worth considering). Further work is required to determine if these differences by ethnicity are partly attributable to demographics (eg, age distribution), smoking patterns, or different quitting intentions. Acknowledgements: The ITC Project New Zealand team thank: the interviewees who kindly contributed their time; the Health Research Council of New Zealand which has provided the core funding for this Project; and our other project partners such as the Ministry of Health (see: http://www.wnmeds.ac.nz/itcproject.html). http://www.wnmeds.ac.nz/itcproject.html Contact email: judy.li@quit.org.nz