In a dramatic bid to get more Americans to quit smoking, the U.S. Food and Drug Administration on Tuesday released nine graphic warning labels that will appear on all packs of cigarettes by no later than September 2012.
One image shows a man’s face and a lighted cigarette in his hand, with smoke escaping from a hole in his neck — the result of a tracheotomy. The caption reads “Cigarettes are addictive.” Another image shows a mother holding a baby as smoke swirls about them, with the warning: “Tobacco smoke can harm your children.”
A third images depicts a distraught woman with the caption: “Warning: Smoking causes fatal lung disease in nonsmokers.”
A fourth picture shows a mouth with smoked-stained teeth and an open sore on the lower lip. “Cigarettes cause cancer,” the caption reads.
In addition to the images, the label on packs of cigarettes will include a phone number — 1-800-QUIT-NOW — so smokers will know where to go for help quitting.
By law, the labels must appear on every pack of cigarettes sold in the United States and on all cartons and in all cigarette advertising. The campaign marks the first major change to cigarette packaging in the last 25 years, the FDA said.
“President Obama is committed to protecting our nation’s children and the American people from the dangers of tobacco use. These labels are frank, honest and powerful depictions of the health risks of smoking and they will help,” U.S. Health and Human Services Secretary Kathleen Sebelius said in a news release. “These labels will encourage smokers to quit, and prevent children from smoking. President Obama wants to make tobacco-related death and disease part of the nation’s past, and not our future.”
Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, called the new warnings the “most dramatic change in cigarette warnings in the history of the United States. For the first time the warnings are large enough to be seen and graphic enough to catch the attention of consumers.”
The labels will fill the top half of all cigarette packs.
Myers said the images on the labels are exactly the kind of measure that has been shown to be effective in encouraging children not to smoke and getting adults to quit. But, to keep the message vibrant, the images need to be changed regularly because as people get used to them, the impact of the warning weakens, he added.
“For the first time we have labels that not only tell people that smoking is dangerous, but provide them the kind of information they need to now how dangerous it is,” he said. “The warning labels have the potential to dramatically reduce the number of our kids who start, but they will be most effective if they are complemented by comprehensive tobacco-control programs in every state.”
Many such programs have been curtailed in recent years as cash-strapped states have diverted funding from tobacco-control efforts to pay for constituent services or to hold down tax increases. In states that have maintained funding, the number of smokers continues to drop, Myers said.
The new labels are a part of the requirements of the new Family Smoking Prevention and Tobacco Control Act, signed into law in 2009 by President Barack Obama, who has struggled for many years to quit smoking. For the first time, the law gave the FDA significant control over tobacco products.
The FDA hopes these new warnings will have a “significant public health impact by decreasing the number of smokers, resulting in lives saved, increased life expectancy, and improved health status.”
The agency said it chose the nine images from 36 originally proposed. The agency also said it reviewed the relevant scientific literature, analyzed the results from an 18,000-person study and reviewed more than 1,700 comments from a variety of groups, including the tobacco industry, retailers, health professionals, public health and other advocacy groups, state and local public health agencies, medical organizations and consumers.
Dr. Jonathan Whiteson, director of the Cardiac and Pulmonary Wellness and Rehabilitation Program at NYU Langone Medical Center in New York City, is concerned that the images may be too graphic.
“The ‘fear factor’ of the negative message can lose its potency — we become immune to the negative warnings over time, and if too graphic, we often hide behind the denial wall stating, ‘This just can’t possibly happen to me.’ The more graphic the image, the more likely the message will become marginalized and thrown out as too wild and extreme a possibility for the smoker,” he said in a statement.”
Whiteson thinks that to get kids not to take up smoking, messages have to convey the idea that smoking isn’t cool.
Smoking is the leading cause of early and preventable death in the United States, resulting in some 443,000 fatalities each year, according to the U.S. Centers for Disease Control and Prevention, and costs almost $200 billion every year in medical costs and lost productivity.
Over the last decade, countries as varied as Canada, Australia, Chile, Brazil, Iran and Singapore, among others, have adopted graphic warnings on tobacco products. Some are downright disturbing: in Brazil, cigarette packages come with pictures of dead babies and a gangrened foot with blackened toes.
Currently, the United States has some of the weakest requirements for cigarette package warnings in the world, David Hammond, an assistant professor in the department of health studies at the University of Waterloo in Ontario, Canada, told . The text-only warnings on packages have changed little since 1984.
Elsewhere, graphic warnings seem to be helping to drive down smoking rates. In Canada, about 13% of the population smokes daily, a 5% drop since graphic warnings were adopted in 2000, according to Hammond.
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