Graphic health warnings on cigarette packages losing their impact, study shows

By | May 24, 2019

Graphic health warnings on cigarette packages, such as those that depict rotting teeth, diseased mouths and throat cancer, are losing their impact as smokers become increasingly desensitized to them, according to the results of an international study.

Experts say the findings highlight a need for governments to introduce more “variety” and “novelty” in their messaging if they want to encourage smokers to break the habit.

Canada, for instance, has been using the same set of 16 health warnings on cigarette packages since 2012, said Ron Cunningham, policy analyst with the Canadian Cancer Society.

“That’s too long,” Cunningham said. “Package health warnings are effective, but the messages have to be refreshed. If they’re not, they become stale.”

A cigarette pack sold in East Timor. Handout/Canadian Cancer Society

A research team at James Cook University in Australia carried out an online survey of nearly 700 adult smokers in four countries — Australia, Canada, the United Kingdom and the United States. The results were recently published in the journal Tobacco Induced Diseases.

A significant percentage of respondents — 35 to 36 per cent in Canada and the U.K., 51 per cent in Australia and 72 per cent in the U.S. — considered current cigarette package warnings either “not at all” or “minimally” effective in prompting smokers to quit. One Australian survey respondent said candidly, “Smokers are immune to pictures and words. I couldn’t even tell you what is on the packet I’m smoking now.”

“If someone is willing to smoke, they will smoke no matter what the message or image on the packet is,” said a survey participant from Canada.

Regular adult smokers can be exposed to health warnings up to thousands of times per year, and this repetitive exposure has led to desensitization and a loss of “shock value,” Aaron Drovandi, the study’s lead author, told the National Post in an email.

Drovandi said while adolescents and young adults tend to hold health warnings in higher regard, there is also research that suggests younger people feel such warnings are irrelevant. Lung cancer can be difficult for a young person to internalize if they feel more “bulletproof,” he said.

A cigarette pack sold in the U.K. Handout/Canadian Cancer Society

The study concluded that warning messages could benefit from less emphasis on diseases and other health risks and greater emphasis on other negative outcomes, such as the financial costs associated with smoking.

“People play fast and loose with health issues, but a reminder about the drain on the wallet will probably be a lot more effective with many people in our current times,” an American survey respondent said.

At least one country – Jamaica — utilizes such messaging on its cigarette packages. “QUIT NOW,” says one health label. “You work too hard to burn your money.”

Survey participants also seemed to think that more messaging that highlighted the effects of smoking on others — such as family members and pets — could be effective.

Health Canada says it is exploring the idea of placing warning messages directly on cigarettes that could look like this. Handout/Health Canada

Researchers say it’s not just the content of the messaging that needs to expand but the format. Half of survey respondents said they “agreed” or “strongly agreed” with the idea of placing warning messages directly on individual cigarette sticks.

“I believe that cigarette stick warnings would be effective in reducing tobacco use through working in tandem with packaging warnings, and would serve as a logical, novel and effective medium for warnings,” Drovandi said.

Cunningham agrees. Warning messages on individual sticks would “de-normalize” the product, he said.

“It prompts discussion…. It grabs people’s imaginations.”

If someone is willing to smoke, they will smoke no matter what the message or image on the packet is

In 2001, Canada was the first country in the world to introduce picture warnings on cigarette packages. Now more than 100 countries require them, covering 58 per cent of the world’s population.

But while Canada may have started the global trend, it has not kept up with other countries in some respects, Cunningham said.

Whereas Canada has been using the same set of 16 health-warning messages on cigarette packages since 2012, the European Union has three sets of 14 warnings that are rotated every 12 months.

And whereas Canada requires that health warnings cover 75 per cent of the front and back of cigarette packages, other countries are more stringent. East Timor, for instance, leads the way, requiring warnings to cover 85 per cent of the front and 100 per cent of the back.

In an email Thursdsay, a Health Canada spokesman said health-warning messages on tobacco packages remain “an important tool” in reducing smoking rates and that the government is working to update the content and style of those health labels.

Last fall, it circulated a public-consultation document aimed at exploring ways to make health messages more “notice, memorable and engaging.” According to the document, ideas include adopting rotating sets of health warnings and placing warning messages directly on cigarettes.

This spring, the government also rolled out new regulations requiring all tobacco products to be sold using plain “drab brown” packaging to enhance the warning labels.

Asked, however, if the government is considering messaging that goes beyond health risks, the spokesman said not at this time.

“Pursuant to the Tobacco and Vaping Products Act, the information required to be displayed on tobacco products and tobacco product packages must relate to the health hazards and health effects from using these products and from their emissions,” he said.

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A cigarette pack sold in Jamaica. Handout/Canadian Cancer Society

Health – National Post