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.
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."