In 2008 the law required tobacco packaging in New Zealand to include pictorial health warnings (PHWs) and the national Quitline number.1 Previously, text-only health warnings provided a telephone number, but did not explicitly link this to the “Quitline”. Research indicated that New Zealand smokers became more aware of the Quitline number on packs since PHWs were introduced,2,3 and there was an immediate increase in the proportion of new callers who registered with the Quitline following the introduction of PHWs.4 We investigated whether Quitline callers’ use of packaging to source the Quitline number continued beyond the initial introduction of PHWs.

Methods—The national free-phone Quitline service in New Zealand routinely collects data on where new callers sourced the Quitline number (i.e., a standardised question asked of all new callers). The Quitline service provided us with data on the proportion of new callers who reported obtaining the Quitline number from cigarettes packaging before and after the introduction of PHWs (i.e. for the three-year period March 2007 to February 2010). These data were compared to the proportion of callers who cited television advertising as the source of this number (which was the major source at the start of the study period). We reviewed monthly “target audience rating points” (TARPs) data on the reach and frequency of television advertising for smoking cessation advertisements (most of them showed the Quitline number).

Results and discussion—During the 12-month pre-PHWs period (March 2007 to February 2008), 7.5% and 34.9% of new callers (out of n=19,558 total callers), cited tobacco packaging and television advertising respectively as their source for the Quitline number (Figure 1). However, in the first full year of the new PHWs (March 2008 to February 2009), the proportions reporting tobacco packaging as the source increased to 26.4% and television advertising declined to 27.1% (out of n=20,152 total callers). The same pattern was still evident in the subsequent 12-month period at 22.9% and 23.3% respectively (n=18,309 for the period March 2009 to February 2010).

The proportions of Māori and Pacific callers citing tobacco packaging were similar to that for the overall caller population (i.e., for the last of the three time periods: 21.3% for Māori, 25.9% for Pacific and 23.2% for European/Other callers).

These findings suggest that promoting the Quitline number more clearly on tobacco packaging increases its long-term salience for smokers of different ethnic groups in New Zealand. In terms of stimulating quitline calls, these New Zealand data are consistent with the experience in Australia,5 Brazil,6 and Singapore,7 where such calls also increased after PHWs featured a quitline number. Similar experiences have also been reported when new text-warnings featured a quitline number in the Netherlands8 and the United Kingdom.9

Interestingly, the results observed in New Zealand occurred despite the relatively small size of both the Quitline numbers on the packaging i.e. the one in the text and the one superimposed on the picture (see photographs of the warnings10 and a comparison with the larger quitline number on Australian packs2).

Furthermore, the current PHWs arguably suffer from visual clutter and other suboptimal design features. Improving the warning design, including increasing the size of the front-of-pack PHW and placing the Quitline number on the front of tobacco packages, could further facilitate smokers’ use of this zero-cost means of promoting cessation. Such steps could be taken when New Zealand next upgrades its PHWs so that they better match state-of-the-art developments in terms of size, impact and design simplicity (e.g. as per recent PHWs from Brazil11).