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 In a four-week experiment, researchers randomly assigned about 2,150
adult smokers to receive either text-only or photo-enhanced warnings
on their cigarette packs.
With pictures, smokers were 29 percent more likely to try quitting
during the study.
Quitting for at least a week before the end of the study was 53
percent more likely with photos than with text alone.
“Smokers told us that the pictorial warnings didn’t make them feel
any more at risk for harm from smoking. However, the pictorial
warnings made the harms of smoking ever present and vivid, while the
usual text warnings were bland, stale, and easy to ignore,” said
lead study author Noel Brewer, a public health researcher at the
University of North Carolina at Chapel Hill, in email to Reuters
Health.
Once a week for four weeks, participants in the study visited the
researchers’ clinic and brought along an eight-day supply of
cigarettes. Every week, researchers put stickers on participants’
cigarette packages, either with pictures and text, or just with
text.
The researchers removed the cellophane from the outside of the
packages and affixed the stickers directly to the packs, covering
the existing U.S. Surgeon General’s warnings with the messages
designed for the experiment.
At each visit, smokers also filled out surveys indicating whether
they had tried to quit.
To be included in the study, people had to smoke at least seven
cigarettes a week. They were told that the point of the study was to
see how well they understood the labels on their cigarette packs.
Photo warnings included a close-up shot of rotting teeth with the
message “Warning: cigarettes cause cancer,” and an image of a gaunt,
bald, bedridden person juxtaposed with “Warning: smoking can kill
you.”
Text-only warnings followed some Surgeon’s General statements, such
as “Quitting smoking now greatly reduces serious risks to your
health,” and “Smoking causes lung cancer, heart disease, emphysema
and may complicate pregnancy.”
With pictures, 40 percent of smokers said they tried to quit during
the study, compared with 34 percent of participants who received
only text warnings, researchers report in JAMA Internal Medicine.
In addition, 5.7 percent of the people who received photo warnings
quit for at least one week prior to the end of the study, compared
with 3.8 percent for the word-only messages.
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“Pictorial warnings also increased forgoing a cigarette, intentions
to quit smoking, negative emotional reactions, thinking about the
harms of smoking, and conversations about quitting,” the authors
reported.
One limitation of the study is that people who joined the experiment
may have had a greater desire to quit than typical smokers, the
researchers also point out.
It’s hard to say whether photos would have the same impact over a
long period of time, or if the novelty of the warnings encouraged
people to quit, the authors note.
“Current warnings in the United States are small and barely
noticeable, as they are on the side of the cigarette packages and
have had the same messages for over 30 years,” said Jim Thrasher, a
public health researcher at the University of South Carolina who
wasn’t involved in the study.
“The data are very consistent across a range of different studies in
different cultural contexts – graphic warnings on cigarette packages
do a better job than warnings with only text when informing
consumers about the many serious health risks from smoking and in
promoting smoking cessation,” Thrasher added by email.
Roughly 70 countries outside the U.S. already have regulations
requiring pictorial warnings similar to the ones tested in the
current study, noted David Hammond, a public health researcher at
the University of Waterloo in Ontario, Canada, who wasn’t involved
in the study.
“Viewing an image of the effects of lung cancer or heart disease
communicates the severity of smoking-related disease far more
effectively than words alone,” Hammond said by email.
SOURCE: http://bit.ly/1TWBAGn JAMA Internal Medicine, online June 6,
2016.
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