Ewwww ... Gross! But Pics on Cigarette Packs Are Effective

By Lila Abassi — Jun 07, 2016
When it comes to helping people quit smoking, there is no such thing as an aggressive method. It's time for the United States to use pictorial warning labels, even if they are disturbing, to aid smokers to kick an awful and deadly habit.
Pictorial warning labels courtesy of JAMA Pictorial warning labels courtesy of JAMA

During my medical training, it seemed like a guarantee that  the patients who were the sickest or fared the worst were smokers. Despite diagnoses of chronic obstructive pulmonary disease or limb amputation, these folks continued to smoke.  One would think that inability to breathe or losing a foot would be an "aha moment," but sadly, that's not always the case.

Quitting smoking is not easy and the longer one has been smoking the tougher it becomes to kick the habit.  Smoking is the foremost modifiable lifestyle risk factor contributing to preventable death and disability globally, accounting for six million deaths worldwide and 1,300 deaths in the United States every day. In the pediatric population, smoking is considered a pediatric disease – which makes the battle to prevent smoking and assist people in quitting a critical public health challenge.

No single method has proven very successful when it comes to quitting. Available cessation methods include nicotine replacement, pharmacotherapy, behavioral approaches (i.e. counseling), and also most recently, electronic cigarettes. Unless tobacco farms are completely eliminated, the methods used to help smokers quit will only be moderately successful. Therefore, we can’t rely on any one method – this has got to be a multi-pronged approach.

A recent study, published in JAMA Internal Medicine, reveals that providing smokers with pictorial warnings versus plain text warnings effect greater attempts at quitting smoking.

The study included 2,150 adult smokers randomized into two treatment arms, one group received cigarette packs with text warnings that including the Surgeon General’s statements, such as “Smoking causes lung cancer, heart disease, emphysema and may complicate pregnancy.”  The other group received cigarette packs with pictures that elicit strong emotional responses, such as smoke billowing out of a person’s tracheostomy site.  What researchers found was that pictorial warnings had an absolute increase of 6 percent over text only warnings (40 percent vs. 34 percent, respectively) in quit attempts.

Although data gathered from surveys are not always reliable, as participants may not always answer questions truthfully, or they may not have adequate recall. The one aspect of this study that may have diluted recall bias to some extent is the volume of participants: Each arm of the study had over 1,000 participants.

The authors argue that though the effects with pictorial warnings were modest, they could have substantial effects across the U.S. population. None more so, in my opinion, than in younger smokers as they may be more easily swayed than a "hardened" smoker. And when it comes to fighting tobacco addiction, the best place to start is by preventing it from ever becoming a problem.

Directing as many resources and efforts at targeting the youth population will always be our greatest hope, with regard to intervention. Words, especially boring phrases from the Surgeon General, is simply an insufficient strategy in ameliorating smoking. Visual cues, as has been shown repeatedly, have a far greater impact on effecting better outcomes and it is something on which, as a country, we have lagged behind.

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