Putting more gruesome labels on tobacco packages raised health concerns but led to smoking cessation

Putting more gruesome labels on tobacco packages raised health concerns but led to smoking cessation

In some countries, such as Spain, tobacco packages are adorned with highly graphic warning labels describing the dangers of tobacco use, including images of gangrene of the foot, a newborn with a breathing tube, and throat cancer.

Graphic warning labels are used in more than 120 countries to counter marketing that promotes cigarette use. Their efficacy, however, is questionable, as suggested by this new study that tested these labels with the US population .

Worry is not enough

The case of the United States is an exception . Despite being the first country to introduce health warnings on cigarette packages in 1965, it now belongs to the small group of nations that never ratified the WHO Framework Convention on Tobacco Control and does not require tobacco companies to include prominently package warnings. In the same group are South Sudan, Haiti and Malawi.

The graphic warning labels were ordered by the United States Congress in 2009, but implementation was halted pending the outcome of legal challenges to the law by the tobacco industry.


The cited study, conducted by researchers at UC San Diego’s Moores Cancer Center, California State University San Marcos, San Diego County Public Health Services, and San Diego State University, produced specialty cigarette packs. which incorporated the graphic warning labels used on cigarette packages in Australia (under license from the Australian government).

The study participants were 357 smokers living in San Diego who agreed to purchase their preferred brand of cigarettes on a study website. Participants were randomly assigned to receive their cigarettes in one of three package designs: in a package with a graphic warning label, in a blank package, or in a standard package commercially available in the United States .

During the study, participants were questioned via interactive text messages about concerns about health risks and their perceptions of the most recent cigarettes they smoked. Changes in consumption and smoking were assessed at the end of the three-month intervention.

Participants who received cigarettes in the standard pack or in a blank pack had no change in their positive perceptions of their cigarettes, while smokers randomized to the graphic warning label arm perceived their cigarettes less favorably. Health concerns increased in all three groups , probably due to the intervention that made them think about health consequences more often.

But while these labels make smokers more likely to think about quitting, they did not make them more likely to make a serious attempt to quit, nor was it enough to help them quit their nicotine addiction .