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Graphic Warning Labels on Cigarettes Help Smokers Remember Dangers

The views expressed are those of the author and are not necessarily those of Scientific American.


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graphic cigarette warning label smoker recall message

Courtesy of A. Strasser

This September, cigarette packs in the U.S. will be getting a lot more colorful. And a lot more disturbing. By then, tobacco companies will be required to display one of nine graphic health warnings on each pack, to comply with the Tobacco Control Act of 2009.

The U.S. has followed dozens of other countries in placing such graphic reminders on their packs. And research in other countries has suggested that these often-gruesome depictions are effective in encouraging people to quit. But how well will it work in the U.S.?

Pretty well, it seems. A new study shows that U.S. smokers are more likely to recall the health message on a pack of cigarettes if it is displayed with a graphic warning than in traditional text alone.

cigarette graphic warning label smoker recall

Courtesy of A. Strasser

cigarette graphic warning label smoker recall

Courtesy of A. Strasser

Researchers recruited 200 current smokers ages 21 to 65, who were not currently trying to quit. Half of the study group saw a standard Marlboro Lights ad, with a bucking horse and cowboy that had the standard Surgeon General’s warning (“quitting smoking now greatly reduces serious risks to your health”) in a boxed area printed on the ad. The other half saw the same ad, but the old warning had been replaced with a larger, graphic warning (in this case an image of a man on a hospital ventilator and warning borrowed from Canada: “Cigarettes cause lung cancer. Every cigarette you smoke increases your chance of getting lung cancer.”).

After viewing the ad for 30 seconds, participants were distracted by being asked to describe what they thought of the ad in general. Then they were asked to describe the message from the warning label. About half of the group who saw the ad with the standard text box recalled the warning message. But 83 percent of those who viewed the ad with a graphic warning remembered the message. The findings were published online June 15 in the American Journal of Public Health.

“An important step in evaluating the true efficacy of the warning labels is to demonstrate if smokers can correctly recall its content of message,” Andrew Strasser, of the University of Pennsylvania’s psychiatry department and co-author of the new paper, said in a prepared statement.

The researchers also tracked participants’ eye movements and attention while they were viewing the ad. The participants who saw the graphic warning label looked much longer at that element than the Surgeon General’s Warning text box and looked to it much sooner—within 1.7 seconds of viewing the ad.

The image of a man on a ventilator was no doubt disturbing,  but extra viewing time might also have resulted from the novelty of the display. These seasoned, mostly Marlboro smokers, having all been smoking for an average of 12.8 years, were likely well accustomed to the traditional ad with a text-box warning. And, as the researchers pointed out in their paper, that does not “explain why they could not recall the text” as well as those in the graphic  group.

This extra attention on the warning also might detract from the overall time someone spends looking at the content of the ad itself.

The goal of the new warning labels is to “provide current and potential smokers with clear and truthful information about the risks of smoking,” Margaret Hamburg, commissioner of the FDA, said in a prepared statement last year when the new requirements were announced. Tobacco use is still the leading cause of preventable deaths in the U.S. and burns some $200 billion each year in medical and lost productivity costs.

But the proof will be on the pack—and in the ads. As Strasser noted, “we’re hopeful that once the graphic warning labels are implemented, we will be able to make great strides in helping people to be better informed about their risks, and to convince them to quit smoking.”

Katherine Harmon Courage About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. roj2003 12:14 pm 06/15/2012

    No-one, least of all medics and politicians, state that lung cancer in non-smokers is around 25 per 100,000, and in smokers is around 45 per 100,000.
    Of the 100,000, about 20% to 25% are smokers. That means there are at least 20,950 smokers per 100,000 whose statistics are hidden.
    Do they live normal lives?
    Do they live at all, with all this tension from politicians and doctors? Tension is known to contribute to heart attacks. Are politicians not getting their tax returns and striking back at us smokers? Think about it.

    Link to this
  2. 2. JamesDavis 12:58 pm 06/15/2012

    Here comes the lying B.S. again. You must have forgot that using tobacco, in different forms, have been around for, maybe, several thousand years, and using tobacco as a medical product for the lungs, pain in the gums, and to stop bleeding have been around for about the same length of time. It wasn’t until the middle of the last century, when tobacco companies started putting over 700 different chemicals into tobacco to make it more addictive that it became dangerous to our health. Putting warning labels on cigarettes slowed the sale down a little bit, but then it picked back up and even increased world wide. Putting a picture on cigarettes will probably have the same effect as the print warning label had.

    I smoke a cigar the size of a cigarette that is flavored with natural cherry and there is no chemicals in it, and it is not addictive. I was in the hospital for three weeks and I did not have not one craving for a cigarette and I have been smoking since I was five years-old (I am half Shawnee Indian and we start everything young), and I, nor any member of my tribe, have any tobacco related illness. So, how do you explain that, and do you think that a ugly picture is going to stop me from smoking my, non chemical laden, cigars or stop the young generation from picking up that first pack? Come out of your fairy world into the real world and join the rest of us.

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  3. 3. tucanofulano 3:19 pm 06/15/2012

    SA’s string of pseudo-science continues with this “nanny” hit-piece.

    Re-write this piece to acceptable English/Scientific Method standards in order to attempt regaining credence.

    Link to this
  4. 4. Russell Seitz 3:30 pm 06/15/2012

    Miss Harmon’s dopamine depleted prose suggests she is unaware that many smokers will never view these sadistic advertisements.

    Why let the neoprohibitionist nanny state assault your eyes and rape your purse when you can roll your own cigarettes to fit your taste, not Washington’s?

    Link to this
  5. 5. NYC2012 4:22 pm 06/15/2012

    Although implementing graphic pack warnings would surely help make youth think twice about starting smoking and help some smokers quit, the tobacco industry has filed multiple lawsuits to block them. At this time, it seems highly unlikely that graphic pack warnings will reach your local store shelf this September.

    Link to this
  6. 6. woodswoman1 5:15 pm 06/15/2012

    Don’t waste your time. I live in Canada and they have been covering half the pack of cigarettes with vivid color photos of smoke ridden lungs and hearts. They are now doing commercials on TV with live sick people who look like “Night of the Living Dead” zombies that tell us all about their cancers caused from smoking and it hasn’t changed anything. I smoke and I don’t even notice these photos anymore. The truth of the matter is; nicotine is the most addict drug in the world and the government is responsible for it’s population being addicted to it and should pay for any product or therapy needed to help them.

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  7. 7. tucanofulano 7:32 pm 06/19/2012

    Cigarette taxes pay for schools! “Think of the CHILDREN!” If you quit you’re depriving them.

    Link to this
  8. 8. RickRay 11:19 pm 06/19/2012

    More and more non-smokers are choosing not to associate with smokers. I grew up around smokers and as a non-smoker, about 10% of us, had to put up with second hand smoke to our chagrin. Smelly hair and stinky clothes. We chose not to say anything because we were in the minority. Now that we non-smokers are the majority, it’s time to give you some of your own medicine. DIE ! It’s a horrible death. I know, I watched both my parents die from smoking. A nicer way would be to tell you to get help as there are a lot of programs out there. Your choice! Die in disgusting agony, or add a few more years to your life and the loved ones around you. However, keep your smoke inside your own lungs and don’t expose mine to these toxic chemicals.

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  9. 9. jgrosay 10:15 am 06/21/2012

    A tobacco warning joke: somebody enters a tobacconist and pays for a pack of cigarettes. The pack has a box label that says: “To Smoke produces sexual impotence”. The customer becomes upset and asks to the person in the shop: “Would you have a package of cigarettes that just kills?”

    Link to this

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