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Scary Images On Cigarette Packages Do Make People Think About Quitting

The World Health Organization (WHO) says graphic health warnings on tobacco packages are a powerful “best buy” in decreasing tobacco use and its many health consequences.

Photo by Bill Branson, National Cancer InstituteThe Centers for Disease Control and Prevention outlined the research in the MMWR.

The World Health Organization (WHO) created a treaty for tobacco product labels that many countries have ratified. Among other requirements, these warnings are expected to appear on at least 30%, and ideally 50% or more, of the package’s principal display areas, and preferably use pictures.

To assess how cigarette package labels impact quitting smoking, researchers used data from the Global Adult Tobacco Survey (GATS) in 14 countries from 2008 to 2010 that had ratified WHO’s tobacco control treaty. Current smokers of manufactured cigarettes were asked whether they had noticed health warnings on a cigarette package in the previous 30 days, and whether the label led them to think about quitting smoking.

Among men in 12 of the countries and women in seven countries, more than 90% of smokers reported noticing a package warning in the previous 30 days. The percentage of smokers thinking about quitting because of the warnings was more than 50% in six countries and more than 25% in men and women in all countries except Poland.

Among smokers who noticed a package warning, the percentage thinking about quitting because of the warning was more than 50% in six GATS countries (Bangladesh, Brazil, India, Thailand, Ukraine and Vietnam) and more than 25% for men and women in all countries except Poland. Older male smokers were less likely to think about quitting in India and Uruguay; no other age group differences were noted.

In all countries except India (78.4%) and Mexico (83.5%), more than 90% of men reported noticing a health warning on a cigarette package. Among women, the percentage who noticed warnings was more than 75% in all countries except China (60.1%) and India (18.9%), and more than 90% in seven countries.

Brazil and Thailand, countries with numerous prominent and graphic pictorial warnings in rotation, had the most smokers thinking about quitting because of the warnings, which had received WHO’s highest rating.

“These results indicate that package warnings can be effective for various populations and settings, including countries in which cigarette smoking prevalence currently is low,” the authors wrote. “Evidence indicates that warnings are more likely to be effective if they elicit strong emotions, such as fear, seem personally relevant, and increase confidence in the ability to quit.”

For example, a comparative analysis of responses to labels in Brazil, Mexico, and Uruguay found that the Brazilian warnings depicting human suffering had the strongest impact on thinking about quitting. Rotating warnings (another of WHO’s requirements) is important because the impact of an individual label will decrease over time.

Worldwide, a majority of countries now have warnings on cigarette packages. As of 2010, approximately 30 countries had pictorial warning labels covering at least 50% of the package, and more countries are developing them.

“WHO has identified price increases; smoke-free policies; bans on tobacco advertising, promotion, and sponsorship; and providing tobacco health information via mass media campaigns and graphic health warnings to the public as tobacco “best buys” because they can reduce tobacco initiation, help to prevent progression from initiation to addiction, increase cessation, decrease consumption, and change social norms,” the report concluded. “Providing information about the dangers of using tobacco products with package warnings is a simple and cost-effective strategy to motivate quit attempts, thus helping to prevent the life-threatening effects of tobacco use.”

*This blog post was originally published at ACP Internist*

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