Pictures effective in warning against cigarette smoking
Health warning labels (HWLs) on cigarette packages that use pictures to show the health consequences of smoking are effective in reaching adult smokers, according to the results of a new study published in the December issue of the American Journal of Preventive Medicine. Although previous studies have demonstrated that HWLs with pictorial imagery are more effective than HWLs with only text in increasing knowledge about smoking dangers and promoting the benefits of quitting, this new research shows which kind of pictures appears to work best among adult smokers in the U.S., including smokers from disadvantaged groups where smoking rates are highest.
“More than 40 countries have implemented pictorial health warning labels. The U.S. was scheduled for implementation in 2012, but tobacco industry litigation has delayed implementation by claiming that the pictorial warnings the FDA proposed violate the industry’s right to free speech. To inform future warning label policy development and implementation, more data are needed on U.S. consumer responses to various kinds of warning label content,” says lead investigator James F. Thrasher, PhD, of the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health at the University of South Carolina in Columbia, SC. “The current study addresses this issue, while focusing on responses among smokers from low income populations where smoking remains prevalent because previous tobacco control interventions have been less successful in reaching this group than higher income populations.”
With financial support from the South Carolina Clinical & Translational Research Institute residing at the Medical University of South Carolina CTSA, the National Institute of Drug Abuse, and the U.S. National Cancer Institute, Dr. Thrasher and his research team conducted field experiments with nearly 1,000 adult smokers from July 2011 to January 2012.
To be eligible for the study, these smokers had to have smoked at least 100 cigarettes in their lifetimes and to be currently smoking on a daily basis. They were recruited for the study at public places, including supermarkets, flea markets, and sporting events, in low- and middle-income areas in South Carolina. The population was randomly split at a 1:4 ratio into two groups: a control group and an experimental condition group.
The control group of 207 smokers rated each of the four HWLs that are currently on cigarette packs, which warn about lung cancer, heart disease, emphysema, pregnancy complications, and carbon monoxide inhalation. The experimental condition group evaluated nine different pictorial labels, representing a variety of health topics, including cancer, heart disease, and lung disease caused by second-hand smoke. Each message combined text with an image depicting either a graphic image of diseased organs, imagery of human suffering, or an abstract symbol, including both imagery that the FDA has recommended for warning labels in the US and alternative imagery used in other countries.
(CNN) - Five tobacco companies, including some of the largest in the United States, filed a lawsuit against the federal government on Tuesday, alleging that government-mandated graphic warning labels on cigarette packages unconstitutionally infringe on the companies’ rights.
“The primary complaint is that we think it violates the First Amendment for the government to require people who produce a lawful product to essentially urge prospective purchasers not to buy it,” says Floyd Abrams, a prominent First Amendment case expert who’s representing the plaintiffs.
The lawsuit, filed in the U.S. District Court for the District of Columbia, pits R.J. Reynolds, Lorillard, Commonwealth, Liggett, and Santa Fe Natural Tobacco against the Food and Drug Administration, its chief, Margaret Hamburg, and Health and Human Services Secretary Kathleen Sebelius.
Respondents in both groups assessed their reactions to the messages according to a 10-point scale for credibility, personal relevance, and perceived effectiveness.
“The present study provided the first direct test of the hypothesis that pictorial health warning labels work better than text-only labels among people with low health literacy,” explains Dr. Thrasher. “Ratings of the personal relevance and effectiveness of pictorial labels compared to textual labels were no different for smokers in high- compared to low-health literacy groups. However, smokers with low-health literacy rated pictorial labels as more credible than text-only warnings, whereas no difference was found among smokers with high health literacy.”
WARNING: Tobacco smoke causes fatal lung disease in nonsmokers.
Nonsmokers who are exposed to secondhand smoke are inhaling many of the same cancer-causing substances and poisons as smokers. Nonsmokers who are exposed to secondhand smoke increase their risk of developing lung cancer by 20–30 percent.
WARNING: Smoking can kill you.
More than 1,200 people a day are killed by cigarettes in the United States alone, and 50 percent of all long-term smokers are killed by smoking-related diseases. Tobacco use is the cause of death for nearly one out of every five people in the United States, which adds up to about 443,000 deaths annually.
WARNING: Smoking during pregnancy can harm your baby.
Smoking during pregnancy can increase the risk of miscarriage, stillborn or premature infants, infants with low birth weight and an increased risk for sudden infant death syndrome (SIDS).
WARNING: Cigarettes cause strokes and heart disease.
More than 140,000 deaths from heart disease and stroke in the United States are caused each year by smoking and secondhand smoke exposure. Compared with nonsmokers, smoking is estimated to increase the risk of coronary heart disease and stroke by 2 to 4 times.
WARNING: Cigarettes cause cancer.
Smoking causes approximately 90 percent of all lung cancer deaths in men and 80 percent of all lung cancer deaths in women. Smoking also causes cancers of the bladder, cervix, esophagus, kidney, larynx, lung, mouth, throat, stomach, uterus, and acute myeloid leukemia. Nearly one-third of all cancer deaths are directly linked to smoking.
The reaction to the specific type of imagery used in the pictorial HWL also varied by study participants’ health literacy and race. HWLs with abstract imagery produced the greatest differences between these two groups, although this type of HWL imagery produced the weakest responses overall. Across the board, participants rated the graphic HWLs as the most effective and most likely to influence them.
“These results suggest that the FDA should consider implementing warning labels with more graphic imagery in order to maximize the impact of warnings across different populations of adult smokers, including more disadvantaged smokers,” Dr. Thrasher notes.
A cost-effective means of intervention, pictorial labels and specifically graphic imagery have the potential to significantly influence adult smokers to understand the range and magnitude of smoking-related risks, while encouraging them to quit.
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Beverly Lytton
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Elsevier Health Sciences