San Diego smokers get graphic warnings on their packs for new study

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An employee in a bookshop adjusts packaged cigarettes which have to be sold in identical olive-brown packets bearing the same typeface and largely covered with graphic health warnings, with the same style of writing so the only identifier of a brand will be the name on the packet, in Sydney on December 1, 2012. (Photo: WILLIAM WEST/AFP via Getty Images)

SAN DIEGO (CNS) – Researchers at several San Diego-area universities and public health agencies found in a report published Wednesday that graphic warning labels on tobacco products are effective reminders of the negative health consequences of smoking.

Smokers in Australia, as one cited example, are accosted with graphic warning labels depicting the dangers of tobacco use — including images of gangrene of the foot, a newborn with a breathing tube and throat cancer.

“Graphic warning labels are used in more than 120 countries to counter marketing that promotes cigarette smoking,” said David Strong, professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego. “We wanted to know what effect such cigarette packaging would have on United States smokers.”

Graphic warning labels were mandated by Congress in 2009 but implementation has been stopped pending the outcome of legal challenges to the law by the tobacco industry.

In a paper published online in JAMA Network Open, Strong and colleagues at UCSD Moores Cancer Center, Cal State San Marcos, San Diego County Public Health Services and San Diego State University, found the warning labels could significantly diminish how study subjects felt about tobacco products.

“Graphic warning labels caused daily smokers in the United States to perceive cigarettes to be less positive and it increased their concerns about the health effects of smoking on both themselves and their loved ones,” said corresponding author John Pierce, professor at the Herbert Wertheim School of Public Health.

The study manufactured special cigarette packs that incorporated the graphic warning labels used on cigarette packs in Australia — under license from the Australian government. Study participants were 357 smokers living in San Diego who agreed to purchase their preferred brand of cigarettes from a study website. Participants were randomized to receive their cigarettes in one of three pack designs: in package with a graphic warning label, with a blank pack or in a standard commercially available U.S. pack.

Participants were queried by interactive text messaging about concerns over health risks and about their perceptions of the most recent cigarettes they smoked. Changes in consumption and smoking status were assessed at the end of the three-month intervention.

Participants who received cigarettes in the standard pack or a blank pack had no change in their positive perceptions of their cigarettes, while smokers randomized to the graphic warning label arm perceived their cigarettes less favorably. Health concerns increased in all three groups, likely due to the intervention that made them think about health consequences more often, the study authors said.

“While these labels make smokers more likely to think about quitting, it did not make them more likely to make a serious quit attempt, nor was it sufficient to help them quit their nicotine addiction,” said senior author Karen Messer, professor of biostatistics at the Herbert Wertheim School of Public Health.

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