Nine graphic health warnings will appear on the top half of every pack of cigarettes sold in the United States and in every advertisement starting September 2012 in an effort to deter smoking.
Images include a smoker with a hole in his throat, chest staples on a corpse and mouth cancer. Others include infants in smoky environments. The warnings will appear on the top half of both the front and rear panels of each cigarette package, and in the upper portion of each cigarette advertisement, occupying at least 20% of it. Each warning is accompanied by a smoking cessation phone number, 1-800-QUIT-NOW.
The Food and Drug Administration selected the nine images from 36 submissions after reviewing the scientific literature, analyzing the results from an 18,000 person study and considering more than 1,700 comments from the tobacco industry, retailers, health professionals, public health agencies, medical organizations and consumers.
The FDA estimates this regulation will reduce the number of smokers by 213,000 in 2013 and more each year through 2031. The agency also estimates there will be 16,544 to 19,687 smoking preventions annually, and 1,749 to 5,802 quality-adjusted life-years saved annually.
Global research among 14 countries indicates that graphic images encourage smoking cessation. The FDA's new graphic warnings bring the U.S. in compliance with the methodology from that report. (Other countries include pictures of miscarried fetuses and representations of impotence in their warnings. For a slide show of what the world's cigarette pack labels look like today, click here.)
To measure the impact of the graphic labels, the FDA sampled 18,000 people. The agency released the study results online.
The agency sampled current smokers 25 or older, ages 18 to 24, and ages 13 to 17 who are current smokers or who may be susceptible to start smoking.
The study tested two to seven warning images per warning statement with a control group for each warning. The control group viewed a hypothetical pack of cigarettes with no warning image but just the warning statement presented in the style or format of the current standard warning. The treatment groups viewed a hypothetical pack of cigarettes that included the graphic warning label.
Respondents answered questions about their reactions to the cigarette package, related attitudes and beliefs, and intentions to quit (young adults and adults) or start smoking (youth). At the end of the survey, subjects were asked to recall which warning statement and image they saw earlier in the survey. One week after completing this survey, subjects were re-contacted and asked to recall the warning statement and image to which they were exposed.
The most graphic or emotional labels elicited the strongest reactions and were ranked as difficult to look at compared to the control groups. But, the study concluded, those are the labels that are likely to be most effective in warning smokers of the health risks involved.