Warning: Cigarettes Are Scary
Why can’t we have an adult conversation about smoking? Why resort to scare tactics and simplistic messaging on cigarette cartons when it’s unclear whether they’ll do any good?
November 19, 2010
Did you know that cigarettes are addictive, tobacco smoke can harm your children, and that smoking can kill you?
If yes, congratulations, you are just as intelligent as members of the Food and Drug Administration and probably passed your middle school health class. If not, these messages could be all up in your face – with pictures – by around 2012 after new tobacco labeling requirements go into effect.
Last week, the FDA introduced a series of proposed new graphic warning labels for cigarettes  in order to continue to lower the American smoking rate. As the Associated Press reports:
The number of Americans who smoke has fallen dramatically over the past 40 years, but those declines have stalled in recently. About 46 million adults in the U.S., or 20.6 percent, smoke cigarettes, along with 19.5 percent of high school students.
These new labels are part of a prevention plan passed in June 2009, the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). According to the FDA, this act “requires that cigarette packages and advertisements have larger and more visible graphic health warnings.” In response to that directive, the FDA has issued a proposed 140 page rule, Required Warnings for Cigarette Packages and Advertisements, that modifies the existing warnings.
Under the Tobacco Control Act, nine graphic health warnings must appear on the upper front and back of each cigarette package, and be at least 50 percent of the panels. In advertising, warnings need to occupy at least 20 percent of the ad.
The FDA’s new proposed graphics each feature one of nine terrifying messages:
- WARNING: Cigarettes are addictive. 
- WARNING: Tobacco smoke can harm your children. 
- WARNING: Cigarettes cause fatal lung disease. 
- WARNING: Cigarettes cause cancer. 
- WARNING: Cigarettes cause strokes and heart disease. 
- WARNING: Smoking during pregnancy can harm your baby. 
- WARNING: Smoking can kill you. 
- WARNING: Tobacco smoke causes fatal lung disease in nonsmokers. 
- WARNING: Quitting smoking now greatly reduces serious risks to your health. 
The images are open to public comment through January 9, 2011, with final regulations issued by June 2011, then required to be on packages 15 months later.
Before we go any further, you must check out the graphics. Some, like this one of dying cancer patient are unsettling, but familiar. Others, like this one of a cartoon mother purposely exhaling smoke into the face of her baby, strike me as hilarious. I doubt that’s what the FDA was going for.
But do graphic warning labels work? From what I could discover, responses are mixed.
In 2004, a group of researchers concluded that graphic cigarette warning labels in Canada were effective at cutting smoking  in an article in the American Journal of Public Health.
They suggested that, in particular, people who reported negative responses to the ads were more likely to have quit, tried to quit, or reduced smoking months later.
Months later, after the European Union advised its members to start using graphic warnings, scientists wrote to the European Journal of Public Health contesting those claims . They argued that when self-reporting, smokers are more likely to say they’d quit anyway, and the prior study could not prove the warning labels were the cause.
Most of the news reports I read after the initial FDA announcement last week quoted experts suggesting that labels do decrease smoking, but I didn’t find much hard evidence either way. My Googling may just be inadequate, though.
Let me toss out the requisite caveats: Smoking is a bad thing. It’d be better if people didn’t do it. And the fact that cigarette companies market a purposely addictive product to youth is underhanded. Duh.
But why can’t we have an adult conversation about smoking? Why resort to scare tactics and simplistic messaging on cigarette cartons when it’s unclear whether they’ll do any good?
Kids who take any type of health class in middle school or high school are going to be subjected to pictures of blackened lungs and throats with holes from emphysema. It’s practically required in any student health textbook. Adults who already smoke are not likely to be deterred by more obtrusive packages if smoking is already part of their routine.
These images, however graphic, lose impact every time we use them, especially as part of a campaign in partnership with cartoons and other melodrama.
If the FDA were really serious about cutting back smoking, it seems to me it would be more effective to increase health education funding in schools and invest more money into programs that help smokers quit – not just fancy new package labels.
Smoking is an activity that is slowly becoming more socially unacceptable, but it is also addictive and hard to stop. These new packages may add to the unacceptability by making smokers hide their packs a little better, lest they not be grossed out by a smokers lung, but on the whole the labels strike me as more laughable than laudable.
Have any bad warnings or poor packages you’d like to complain about? Will more graphic warning labels persuade you or your patients to quit smoking? E-mail comments to firstname.lastname@example.org .