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New Studies Show Effectiveness of Large Cigarette Health Warnings Like Those Required by Legislation Granting FDA Authority Over Tobacco

Statement of Matthew L. Myers President, Campaign for Tobacco-Free Kids
March 20, 2007

Washington, DC — Two new scientific studies provide overwhelming evidence that larger, more visible health warnings on cigarette packs have a dramatic impact on communicating health risks to smokers and nonsmokers. This makes it even more important that Congress enact legislation (S. 625/H.R. 1108) that would give the U.S. Food and Drug Administration (FDA) authority to require major changes in health warnings and require that they cover at least the top 30 percent of the front and back of cigarette packs. The legislation would also allow the FDA to increase the warning size to 50 percent of the front and back panels and adopt graphic or pictorial warnings, as Canada and several other countries have already done.

Warning labels on U.S. cigarettes have not changed since 1984 and appear in small black and white print on the side of cigarette packs. The new studies indicate that current U.S. warnings are woefully ineffective at getting the attention of smokers, communicating health risks or motivating smokers to quit. These studies provide important, additional scientific support for the large health warnings that would be required by the legislation before Congress.

Importantly, this legislation gives the FDA the authority to revise the warnings without additional congressional approval. This will allow the FDA to update the warnings based on the latest science and adapt to the ever-innovative marketing tactics of the tobacco companies, which spend more than $15 billion each year - more than $40 million per day - to promote their deadly and addictive products. In addition to the larger warnings, the legislation would give FDA the authority to crack down on tobacco marketing and sales to kids, stop tobacco companies from misleading the public about the health risks of their products and require changes in tobacco products, such as the reduction or removal of harmful constituents.

One new study, published in the March issue of the American Journal of Preventive Medicine, 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 disease in Canada to the small text warnings on the side of packs in the U.S. 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.

Canada requires the rotation of 16 warnings that cover 50 percent of the front and back of the cigarette pack and include color pictures. Australia rotates six black and white text warnings that cover 25 percent of the front and 33 percent of the back of the pack. 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. The U.S. requires four rotating warnings in black and white on the side of the pack.

The study found that larger, more comprehensive warnings were more likely to be noticed and rated as effective by smokers. 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. The change in the U.K. warnings was associated with significantly greater effectiveness. After being revised, the U.K. warnings were more likely to be noticed and read by smokers than similarly sized warnings in other countries, indicating the importance of periodically revising warnings to capture smokers’ attention.

A 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 U.S. 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. The Annenberg 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.

These studies also indicate that countries ratifying the World Health Organization (WHO) tobacco control treaty, the Framework Convention on Tobacco Control (FCTC), will benefit from implementing the health warning provisions of the treaty. The 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. Countries have three years after ratifying the treaty to put the new warnings in place. The treaty has been signed by 168 countries and ratified by 145 countries. The United States has signed the treaty but has failed to send it to the Senate for ratification.

Tobacco use is the leading preventable cause of death in the United States, claiming more than 400,000 lives and costing the nation more than $96 billion in health care bills each year. Worldwide, about five million people 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.