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Will New Graphic Images Deter Smokers?

Everyone knows that smoking is bad for their health (er, can kill you), but the FDA is banking on a scared straight tactic to get more smokers to quit. As you likely know by now, yesterday the FDA turned a small warning box of text into emotion-evoking images that take up half the package of cigarettes--front and back--images of a tracheotomy, a baby inhaling a parent's smoke, a mouthful of decayed teeth, smoker's lungs, and a man with some sort of oxygen mask, to describe just a few.

The question is, will these grotesque images convince more smokers to quit (or not start in the first place) than the existing warning on the box from the Surgeon General? The New York Times offered one smoker's response to the images, "Telling me things we already know. I'll still be smoking," said the 46 year old. But the research says otherwise (though it's not completely definitive).
Before I get to the research, you should know that the U.S. is not in the avant guard when it comes to cigarette packaging. The UK, Australia, Canada Brazil, Egypt, Thailand, Uruguay and India all have more visible and graphic warnings.

  • Several studies show that images have a greater impact on quitting smoking or on not lighting up in the first place, and on attitudes towards smoking. Graphic warning labels create negative emotional associations with smoking, more so than a few words of warning.
  • One Canadian study offered proof that graphic images deterred smokers. It compared the impact of the small warning box on U.S. cigarette packs to the graphic warning labels in Canada, which cover half the package. Results showed that people looked at the Canadian warnings longer than the U.S. ones and when asked how the labels made them feel, respondents said the Canadian labels made them feel more negative towards smoking and towards people who smoked.
  • Those who quit after the introduction of new graphic labels in Canada were 2.8 times more likely to cite warning labels as having an influence on their quitting than those who quit prior to the introduction of the graphic labels (and would have seen only the old warning labels).
  • In smokers living in countries that have followed the World Health Organization's recommendations for more graphic warnings, the percentage thinking about quitting because of the warnings was more than 50% in six countries and more than 25% in all other countries, according to a report by the Centers for Disease Control and Prevention.
  • Yet, there is still uncertainty about the impacts of images versus text and for how long the impact persists (i.e, do people just get used to the images, so their deterrent effect wears off?.) One Australian study found mixed results with a graphic image attracting more attention, making people stop and think more and causing more avoidance behaviors (like hiding the package or using a case), but did not significantly reduce smoking.
What do you think the impact of the new graphic images will be?
Laurie Tarkan is an award-winning health journalist who writes for the New York Times, national magazines and websites. Follow her on twitter.