Updated 07 June 2016

Gruesome cigarette pack images do encourage quitting

Images like smoke emerging from a hole in the neck, smoke-ravaged lungs, badly stained teeth, or a patient near death do change smoking behaviour, according to new research.


Ghastly smoking-relating photos on cigarette packs do encourage smokers to quit, a new study finds.

Habit-changing images

"This is the first top-quality evidence available that these warnings do change behaviour," said lead researcher Noel Brewer. He is an associate professor of health behaviour at the University of North Carolina in Chapel Hill.

Such habit-changing images show smoke emerging from a hole (stoma) in the neck, smoke-ravaged lungs, badly stained teeth, or a patient near death.

In a four-week trial, Brewer's team found that 40 percent of smokers who had these visual warnings were likely to try to quit, compared with 34 percent of those whose packs had only print warnings. By the end of the trial, nearly 6 percent of the picture-pack group had quit for a week, compared with about 4 percent of the others.

Read: Warning: Poison

Brewer said the labels worked because smokers couldn't get the pictures out of their minds. "They didn't feel any more at risk. They didn't think that smoking was any more dangerous, but they were a little more worried, and they couldn't stop thinking about the harms of smoking," he said.

The US Tobacco Control Act of 2009, which gave the US Food and Drug Administration authority over tobacco products, mandated photo warning labels on cigarette packs.

Chief cause of preventable death

The FDA proposed several images, but tobacco companies filed a lawsuit against the agency in 2012. A federal appeals court struck down the visual packaging requirement, ruling that the FDA had not provided evidence to show the explicit images would deter smoking.

"The FDA is undertaking research to support a new rule-making consistent with the Family Smoking Prevention and Tobacco Control Act," said agency spokesman Michael Felberbaum. "Unfortunately, I don't have any timeline to share."

Read: Pricey cigarettes mean fewer teens smoke

Brewer said the new study results should bolster the FDA's case.

"I believe the FDA is now in a very good position to return to this issue," Brewer said. "They really have no choice in the matter; they're required to."

Smoking is the chief cause of preventable death worldwide, and anti-smoking advocates welcomed the new findings.

"This new study adds to the extensive evidence from around the world that large, graphic health warnings are most effective at informing consumers about the health risks of smoking, discouraging children and other non-smokers from starting to smoke, and motivating smokers to quit," said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

Four graphic images

"The United States needs to update its woefully outdated and nearly invisible cigarette warnings and catch up with the more than 89 countries that now require graphic warnings," he said.

Those countries include Canada, Australia and nations in the European Union.

A tobacco researcher agreed.

"If this [new study] isn't enough evidence to blast the FDA and the Obama administration off their behinds, nothing is," said Stanton Glantz, director of the Centre for Tobacco Control Research and Education at the University of California, San Francisco.

Read: Tobacco controls will save 7.4 million lives

For the study, Brewer and his colleagues used four graphic images from the FDA's original proposal. They included text warnings required by the Tobacco Control Act, such as "Cigarettes cause fatal lung disease" or "Cigarettes are addictive".

The four text-only packs carried the standard US Surgeon General's warning statements mandated since 1985.

For the trial, more than 2,000 smokers in California and North Carolina were randomly assigned to receive packs with text warnings alone or packs with photo warnings on the fronts and backs. According to the study, 1,900 people completed the trial.

The report was published online in the journal JAMA Internal Medicine.

Read more:

Effects of anti-smoking images

More countries add graphic warnings to cigarette packs

SA to ban brand names on cigarette packs


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