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Addiction, Health Policy, Public Health

A conversation about the FDA’s new graphic health warnings for cigarettes

A conversation about the FDA's new graphic health warnings for cigarettes

The U.S. Food and Drug Administration is using a little shock factor today, unveiling new graphic warning labels that must appear on cigarette packaging by October 2012. Tobacco use is the leading preventable cause of death and disease in the U.S., claiming more than 400,000 lives each year – and 5 million worldwide. With the new labels, the FDA hopes to curtail new smokers and get current ones to kick the habit.

The new warnings are part of a requirement from the Family Smoking Prevention and Tobacco Control Act, which was signed into law by President Obama in 2009 and provided the FDA with the authority to regulate the content, marketing and sale of tobacco products. The labels, which depict the negative health consequences of smoking, must cover at least 50 percent of the front and the back of all cigarette packages and at least 20 percent of all cigarette ads.

Just how effective will these be in the war against smoking? I contacted Robert Jackler, MD, professor and chair of otolaryngology, who collects with his wife old magazine ads that used pseudoscience and medical imagery to promote cigarette smoking. The “Not a Cough in a Carload: Images from the Campaign by the Tobacco Industry to Hide the Hazards of Smoking” collection has more than 10,000 original magazine and newspaper tobacco ads, which the Jacklers donated to the National Museum of American History at the Smithsonian Institution. (You can see the collection of ads, which spans from the 1890s through the present day, here). Below he shares his thoughts on the new warning labels.

Health warnings on cigarette products were first introduced 45 years ago. How are these new labels different?

When they first appeared on the side of U.S. cigarette packs in 1965, the phrasings were relatively tepid: “Cigarette smoking may be hazardous to your health.”  These “Surgeon General Warnings” take the form of a government admonition – a format hardly ideal for a measure intended to influence rebellious teens who instinctively withdraw from authority figures.

For the past 45 years, messages appeared in small black print placed inconspicuously on the side of the cigarette pack. In print advertisements, art designers effectively camouflaged the warnings by cleverly deflecting the consumers eye towards more visually striking promotional elements. While the language was made more definitive in tone in 1984, the formatting made them easily overlooked and, for the most part they were ignored by consumers.

Although the U.S. was the first nation to place labels on its cigarette packs, over the last decade many nations have adopted much more effective strategies than the small print, text-only U.S. warnings…

Is there a particular country that has done a good job of preventing teens/young adults from smoking and helping others kick their nicotine habit?

While more than 30 countries require pictorial warnings, Australia leads the world in effective cigarette package labeling. Soon [the country] will require cigarettes to be sold in generic packs, kept out of view in under-counter storage. These must have large graphic health warnings covering almost their entire surface. The product name can appear only in a small, generic font with no logos or company branding of any kind permitted. Even under the new U.S. regulations, companies can still exert psychologically potent messing through cigarette pack design. For example, studies have shown that consumers relate a white or light colored pack to a milder and, by dubious inference, a safer product…

While the new graphic images are a vast improvement over the previous text-only warnings, the proposed images are visually less impactful than those of other countries such as Canada, Australia and Brazil. The images of greatest effectiveness are those which depict human faces in pain and suffering due to tobacco caused disease.

The FDA’s warning labels do contain some graphic imagery (corpses, rotting teeth and blackened lungs). How effective do you think they will be at affecting behavior?

Because a constant stream of shocking images may desensitize people over time, a variety of images will be employed for each of themes. The categories are: addictiveness, cancer, stroke and heart disease, lung disease, lung disease in non-smokers, harm to children, pregnancy, “can kill you,” and “quitting reduces risk.” Interestingly, the U.S. topic list does not include impotence, a feature in other campaigns which is of particular poignancy to young males…

These pictograms not only alert users to potential health dangers, they also help to take the glamour out of smoking. Cigarette packs are considered “badge” products with smokers associating themselves with their brand’s image. Identities may include masculinity and virility (Marlboro), femininity and independence (Virginia Slims), and “Coolness” (Kools). With the new intensely disturbing images, most smokers will be less likely to sport a pack in their shirt pocket or displayed proudly under a rolledup up shirt sleeve nestled against the biceps.

How might these new labels affect point-of-sale purchases?

American corner grocery stores and gas stations have become virtual tobacco emporia with signs in windows and banners hung from the ceilings. This is especially true for those located near high schools and college campuses. Such displays will now require a graphic warning occupying not less than 20 percent of the advertisement’s surface. This will help to counter the effectiveness of point of sale marketing and denormalize tobacco products as consumer goods.

Many states, due to their present financial distress, are cutting their anti-smoking program budgets. After years of steady decline, the rate of youth smoking in the U.S. has plateaued over the last few years. Hopefully, new FDA policies will help to restore the trend of decreasing smoking initiation by the youth of America.

Previously: Cigarette ads turn teens on to smoking, Massachusetts stores may be required to post graphic anti-smoking signs, Australia enacts world’s first ban on branded cigarette packaging and NPR’s Picture Show highlights Stanford collection of cigarette ads
Photo by Courtney Emery

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