New Studies Show Effectiveness of Large Cigarette Health Warnings

Mar. 20 2007

Washington, DC — Two new scientific studies provide powerful evidence of the effectiveness of large health warnings on cigarette packs, which are required of nations that have ratified the World Health Organization's tobacco control treaty, the Framework Convention on Tobacco Control.

The studies indicate that the large health warnings, especially when picture-based, are much more effective at getting the attention of smokers, communicating the health risks of smoking and motivating smokers to quit. The studies provide additional scientific support for the large, pictorial health warnings that are being implemented or considered by countries including China, India, the Czech Republic, South Africa, Malaysia and Mexico.

"Countries that are considering stronger health warnings should take action on the results of these reports," said Damon Moglen, Vice President of International Programs at the Campaign for Tobacco Free Kids. "By effectively implementing their commitments under the tobacco control treaty, these countries can become global leaders in public health and address a leading cause of premature death and disease."

The tobacco control treaty requires ratifying countries to implement warnings that cover at least 30 percent of the front and back of the cigarette pack and recommends that warnings cover at least 50 percent of both panels and include pictorial or graphic images. The treaty has been signed by 168 countries and ratified by 145 countries. The new studies indicate that countries will benefit from implementing the health warning provisions of the treaty.

One of the studies, published in the March issue of the American Journal of Preventive Medicine, found that larger, more comprehensive warnings were more likely to be noticed and rated as effective by smokers surveyed. The study surveyed smokers in the United States, Canada, the United Kingdom and Australia, four countries with widely varying cigarette warnings ranging from large, graphic depictions of smoking-related disease in Canada to the small text warnings on the side of packs in the U.S.

Smokers in Canada were the most likely to report thinking about the health risks of smoking, to stop from having a cigarette, and to think about quitting because of the health warnings. Smokers in the U.S. reported the lowest levels of effectiveness for almost every measure recorded at each point of the four-stage survey, which was conducted between 2002 and 2005. The UK in 2003 switched from six text warnings covering only six percent of the package face to 16 rotating text warnings that cover 30 percent of the front and 40 percent of the back of the package, a change associated with significantly greater effectiveness.

The second study, released today by the Annenberg Public Policy Center and published in the April issue of Nicotine and Tobacco Research, evaluated the reactions of smokers and non-smokers in the United States to Canadian and U.S.-style warning labels. The Canadian labels were a much more effective tool in engaging smokers and communicating the harms of tobacco use. Study participants exposed to the Canadian labels spent more time looking at the labels and had more negative feelings toward smoking upon viewing the labels. This effect was significant among young non-smokers most vulnerable to becoming smokers. This emotional reaction to the warnings helps explain why other studies have shown the larger warnings are more effective at communicating health risks and increasing smokers' intentions to quit.

"Large health warnings on cigarette packs are a highly effective means of educating smokers about the risks of smoking because they are seen at the time of smoking," said Moglen. "Someone smoking a pack of cigarettes per day will potentially be exposed to health warnings 7,000 times per year."

Worldwide, about five million people will die of tobacco-related diseases this year. If current trends continue, tobacco is projected to kill 10 million people by the year 2020, and 70 percent of those deaths will occur in developing countries.


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