Graphic Labels Reduce Smoking More Than First Thought

(National Institute of Mental Health)

Public health researchers at University of Illinois in Chicago and University of Waterloo in Ontario, Canada found graphic warnings on cigarette packs can reduce smoking to a greater extent than the U.S. Food and Drug Administration estimated two years ago. The team led by Chicago’s Jidong Huang published its findings online earlier this month in the journal Tobacco Control.

In 2009, the FDA received authority to regulate the marketing of tobacco products under the Family Smoking Prevention and Tobacco Control Act, which led to regulations in 2011 calling for new warning labels on cigarette packages and in cigarette advertisements with color graphics depicting the negative health consequences of smoking. The FDA’s regulatory impact analysis, however, showed that in Canada after graphic warning labels were mandated, the rate of smoking decreased only by only 0.09 percent. The small reduction in smoking rate provided ammunition for a successful tobacco industry court challenge, which led to FDA withdrawing the regulations.

Huang and colleagues found problems in the FDA’s method for estimating the impact of warning labels on smoking rates. FDA compared smoking rates in the U.S. and Canada, using Canada’s experience with warning labels as a guide. Among the problems, say the researchers was FDA’s relying on respective cigarette excise taxes to calculate their economic effects on smoking rates. A more accurate economic indicator, say the researchers, is the full price paid by smokers for cigarettes, not just the taxes.

The Chicago-Waterloo team used a quasi-experimental method to compare smoking rates in Canada and the U.S. for nine-year periods before and after graphic warning labels were introduced in Canada. Unlike FDA’s approach, however, the researchers factored in the full price of cigarettes, not just taxes.

The results show graphic warning labels make much more of a difference in smoking rates in Canada than FDA originally estimated. In Canada, say the researchers, introducing the labels led to a 2.9 to 4.7 percentage point reduction in smoking, far greater than the 0.09 percent found by FDA. Translating those percentages to the U.S. would mean from 5.3 to 8.6 million fewer smokers if graphic warning labels were used as originally proposed.

Co-author Geoffrey Fong, a health psychologist at Waterloo, is principal investigator of the International Tobacco Control Policy Evaluation Project, indicating that tobacco control is a worldwide concern. The World Health Organization’s Framework Convention on Tobacco Control requires parties to the convention to display large, rotating pictorial warnings on cigarette packages, which are running in 40 countries, but not the U.S.

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