The more graphic the better is the conclusion of a new study of warnings on cigarette packages. A team at the University of South Carolina in the United States analyzed what kind of warning labels deter adults from smoking.
“Smokers rated warning labels with pictures and text to be stronger in terms of their believability, their relevance to smokers themselves and in terms of their effectiveness than the warnings that only contain text,” said the lead investigator, James Thrasher of the Department of Health Promotion, Education and Behavior at the university's Arnold School of Public Health.
The team's findings will appear in the December issue of the American Journal of Preventive Medicine.
More than 40 countries have implemented health warning labels with pictures. “The warnings that were more graphic, that show physical damage of smoking on the body were more effective than other kinds of imagery, such as showing human beings suffering the impacts of smoking or more symbolic or abstract imagery like, for example, showing tombstones to represent death that could be caused by smoking,” Thrasher said.
Pictures are the key
Smokers with low literacy rated pictorial labels as more credible than text-only warnings -- a major finding for developing countries with high illiteracy and smoking rates.
But researchers also found that smokers eventually become desensitized to even the most graphic imagery on packages, such as photographs of diseased organs.
“These warnings wear out over time, no matter what kind of content you have on them -- whether they're text only or whether they include these more graphic images or more symbolic, abstract images,” explained Thrasher. “The WHO [i.e., World Health Organization] recommends that the warnings are refreshed on a regular basis, about every two years or so. We're beginning to conduct the research to try to figure out what is the best period of rotation.”
Australia has taken matters a step farther. It recently became the first country to mandate plain packaging. That move is being hailed by WHO Director General Margaret Chan. Speaking at a six-day global tobacco control conference in Seoul, Chan urged civil societies in other countries to get their governments to require packaging without brand logos. “It peels off the glamour of a package full of harm and replaces it with the truth. It will have vast benefits for health,” she said Monday at the opening of the Fifth Session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control.
Price trumps labels
Anti-smoking advocates say that even more important than labeling to prevent smoking, is making tobacco products more expensive.
“The price of tobacco products in most countries in the world is still incredibly low,” said Francis Thompson, director of policy and advocacy at the Geneva-based Framework Convention Alliance. “And that's the single biggest thing that countries could do to bring back [i.e., reduce] consumption rapidly and deal with this really quite rapid rise in tobacco-caused deaths around the world.”
The Seoul meeting on Tuesday discussed guidelines on pricing and tax measures to reduce the demand for tobacco.
Delegates from 170 countries on Monday unanimously approved a treaty to crack down on illicit cigarette manufacturing and distribution. The accord will require non-removable tracing mechanisms on cigarettes and other tobacco products. Smuggling and counterfeiting of cigarettes account for an estimated 11 percent of global tobacco trade.
The Framework Convention on Tobacco Control has been ratified by 176 countries since coming into force in 2005. The The United States, a leading producer of tobacco, and seven other countries have signed, but not ratified the treaty. Ten countries have not signed it, including Indonesia -- a major tobacco consumer with an estimated 57 million smokers.