It’s not the first study to show that images on cigarette packages dissuade people from lighting up — but this one could make the concept a reality.
“Pictorial warnings made people reflect on the health harms of smoking and talk about these harms with other people,” study authors noted.
A new study in JAMA Internal Medicine backs up previous evidence that graphic images on cigarette packages — showing the dangers of the habit — help smokers trying to break the addiction.
“Studies have consistently found that people simply pay more attention to pictorial warnings than text-only warnings, likely because of their visual and immediate visceral impact,” Marissa G. Hall, a doctoral candidate at University of North Carolina, Chapel Hill, said. Hall was involved in the study.
Twenty-eight countries currently require images on packs of cigarettes, according to The World Health Organization — so why aren’t we seeing them in the U.S.?
It’s very simple. The 2009 Family Smoking Prevention and Tobacco Control Act requires pictorial warnings — but a 2012 lawsuit by the tobacco industry stalled implementation. The U.S. Court of Appeals for the District of Columbia Circuit ruled against nine pictorial warnings proposed by the U.S. Food and Drug Administration, saying there was no evidence the warnings reduced smoking.
Picture Worth a Thousand Words?
Dr. Noel T. Brewer, an associate professor at the University of North Carolina, Chapel Hill, conducted a randomized clinical trial to see if pictorial warnings on the front and back sides of cigarette packages would reduce smoking.
The authors used four pictorial warnings that contained text required by the Tobacco Control Act and a picture illustrating the harm of smoking from the FDA’s originally proposed set of images. In addition, four text-only warnings were also used — they contained just the U.S. surgeon general’s warning statements that have been on packages since 1985.
During a four-week trial, 1,901 adult smokers from California and North Carolina were randomly assigned to receive either text-only or pictorial warnings on their cigarette packs.
Forty percent of smokers with graphic warnings tried to quit, versus 34 percent of smokers with text-only warnings.
As a result, 40 percent of smokers who had graphic warnings tried to quit, while 34 percent of smokers who had packages with text-only warnings tried to quit. Also, 5.7 percent of smokers who received pictorial warnings had quit smoking for at least a week by the end of the trial — compared to 3.8 percent of smokers in the text-only warning group.
The authors note the effects “appear modest, but they could have a substantial benefit across the population of U.S. smokers.”
“Implementation of pictorial cigarette pack warnings in the United States is on hiatus. Our trial findings provide timely and important information as the United Sates and other countries consider requiring pictorial cigarette pack warnings,” the authors wrote.
“Our study also found that pictorial warnings made people reflect on the health harms of smoking and talk about these harms with other people,” Hall added. “All of these mechanisms may help to explain why pictorial warnings appear to help smokers quit.”
The standardized plain packaging was implemented in Australia in 2012. England and France are preparing for the changeover as well — the details of which are laid out in this news clip.
[lz_ndn video=30905191]
Back to Court We Go?
Hall said the study provides “strong experimental evidence that we believe the court will find compelling.”
Researchers also conducted a meta-analysis and several systematic reviews to add more evidence, she said. “At this point, we believe the research conducted to date should justify the use of pictorial warnings in the U.S. and in other countries,” she said.
The research strongly supports of images on packaging, said Dr. Joanna Cohen, director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. Tobacco companies are putting labels on cigarette packs in other countries and should do the same for Americans.
“It is definitely time to get picture warnings on tobacco packs,” she told LifeZette.
Related: The Drinking-Smoking Connection
Dr. Michael Steinberg, director of the Tobacco Dependence Program at Rutgers University in New Jersey, agreed.
“It is a disgrace that the U.S. lags behind countries such as Indonesia and Uruguay in promoting public health and addressing the leading cause of preventable death,” he said.
He said pressure from tobacco companies has caused the U.S. to retain “impotent” text warnings. “It is time for the U.S. to join the rest of the world with 21st-century public health initiatives,” said Steinberg.
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