TOPICS > Health

Cigarette Warnings Get Graphic, but Will Smokers Be Deterred?

June 21, 2011 at 12:00 AM EDT
The biggest change to cigarette pack health warnings in 25 years came Tuesday when the FDA released nine graphic color images that will cover the entire top half of cigarette packs beginning next year. Margaret Warner discusses the new warnings with FDA Commissioner Dr. Margaret Hamburg.

JEFFREY BROWN: Next, new government restrictions on how cigarettes can be marketed and sold.

Margaret Warner has the story.

MARGARET WARNER: It’s the biggest change to cigarette pack health warnings in 25 years. The Food and Drug Administration today released nine color images that will cover the entire top half of cigarette packs, front and back, beginning in September 2012.

The images show gruesome health consequences of smoking, including a smoker’s corpse, a man’s chest with smoke exiting a tracheotomy hole, and a diseased lung next to a healthy one.

At the White House today, Health and Human Services Secretary Kathleen Sebelius said the new labels will discourage smoking among those who do and those considering it.

SECRETARY OF HEALTH AND HUMAN SERVICES KATHLEEN SEBELIUS: With these warnings, every person who picks up a pack of cigarettes is going to know exactly what risks they’re taking.

Over the last two years, we have made giant strides in our fight against tobacco. And our efforts are paying off. So, I’m here today with a renewed sense of hope and momentum that we can make tobacco death and disease a part of our past, and not a continuous part of our future.

MARGARET WARNER: The first warning label, “Cigarettes may be hazardous to your health,” was mandated in 1965. In the mid-1980s, the text warnings were made more explicit.

A 2009 law required the stronger warnings being introduced now. Some 42 percent of Americans smoked in 1965. Now only about 20 percent do. But the decline leveled off in 2004. Tobacco is still the leading cause of preventable death, the CDC says, with more than 440,000 a year.

Cigarette-makers didn’t respond today and declined an invitation to appear on our program. But a lawsuit many of the firms filed against the 2009 law is making its way through the federal courts. And, in it, the companies contend that the huge negative images and other new marketing restrictions interfere with their commercial free speech rights.

Dr. Margaret Hamburg is the FDA commissioner. And she joins me now.

And, Commissioner Hamburg, thank you.

MARGARET HAMBURG, Food and Drug Administration: Thank you.

MARGARET WARNER: So, these are some pretty horrifying images. What’s the theory behind them, behind using them?

MARGARET HAMBURG: Well, as you note, smoking is our leading cause of preventable death in this country. It’s a pretty horrifying medical and public health problem. And we need to address it aggressively.

These graphic smoking health warnings really are designed to help make sure that people are aware of the risks of smoking, that they are encouraged to stop smoking if they do smoke, and, importantly, to discourage people who are just trying a cigarette or two for the first time from ever taking up this deadly habit.

MARGARET WARNER: Is there solid research data showing that a graphic photo image like these is more effective in deterring behavior than, say, a very bold text warning like “Smoking kills” or “Smoking causes cancer”?

MARGARET HAMBURG: Well, there is information from the experience of other countries that have already implemented graphic health warning labels that it does increase awareness of risks and it does increase the intent of smokers to stop. And it appears to discourage new smokers from taking up the habit. That’s very, very important.

And as we were launching this new component of the 2009 law, we conducted a lot of research. We did the largest study, in fact, ever done on consumer response to health warning labels, with 18,000 participants, and learned a lot about what people respond to and what messages they take away from seeing the warning labels. And we think this will make a difference.

MARGARET WARNER: So, I understand you started with something like three dozen images, and you chose these nine. Why these nine?

MARGARET HAMBURG: Well, we chose these nine based on the research that we did really looking at consumer response to the different warning labels.

We looked at different age groups, because we want to target different types of people, different targeted audiences.

MARGARET WARNER: So, everything from young parents to older people.

MARGARET HAMBURG: Right, and young people, 13- to 18-year-olds as well. And we — and we included smokers and non-smokers, because we wanted to really understand people’s response to these health warning labels.

And then we looked at the experience of other countries. We looked at the other existing research and scientific literature. And we took public comment and comment from key stakeholders and experts. And with all that information, we selected these nine graphic warning labels that we’re putting forward today.

MARGARET WARNER: Did you have a kind of a taste threshold? Were there some images so grotesque, you just decided you couldn’t use them?

MARGARET HAMBURG: Well, it’s interesting. There were some that were in fact more gruesome amongst the 36 that we were choosing from.

But we made our choices based on what we found in our research. Many other countries in fact use images that are considered, I think, a lot more striking, but a lot more gross.

MARGARET WARNER: Now, one thing I want to be sure we emphasize here is, this will be the entire half — I don’t have a cigarette pack — the…


MARGARET WARNER: … entire top half of a pack. So…

MARGARET HAMBURG: That’s right, front and back.

MARGARET WARNER: Front and back.

So, the typical convenience store, when they’re in a rack behind the counter — I think we have a photo here that actually your agency put out — you can see that it’s very — will it be very hard to actually read the brand name of the cigarettes? Is that part of the intention?

MARGARET HAMBURG: Well, I think different companies may deal with where to put their brand name differently. And I suspect they’re thinking about it now.

MARGARET WARNER: But they have to put it at the bottom.

MARGARET HAMBURG: But it will have to be at the bottom of the pack. It will not be as visible. And I think the reason for having the warning label at the top is that you can’t cover it up by putting it in some kind of container because you have got to open that pack.

So, every time a smoker opens the pack of cigarettes, they will see this graphic image of the serious health consequences of smoking and they will see that warning. And they will also see the 1-800-QUIT number, which I think is very important, to help support smokers who want to quit.

MARGARET WARNER: Now, the companies say that you are — that that is interfering with their right of commercial speech, that it’s actually too difficult to communicate with potential buyers.

Do they have a point?

MARGARET HAMBURG: Well, as you pointed out, they did bring a lawsuit at the beginning when this law was first enacted. The courts, in the initial round, held up FDA’s authority to implement this law overall, and including this component, this provision of the law.

This is such an important public health issue for the nation. It is taking lives and destroying families. It is costing our health care system and our economy so much money.

So, we think that we have an important role to play in providing accurate information, so that people understand the health risks. And if they choose to smoke, they can, but they should understand the health risks.

MARGARET WARNER: Finally, just the fact that — explain the fact — or what’s your theory about the fact that, for 20 years really, smoking in America went down, as we said earlier. But it’s level off at about 20 percent, despite all these new restrictions on where you can smoke, higher tobacco taxes. Why?

MARGARET HAMBURG: Well, it’s interesting. And I wish I could fully understand it.

But I think it is another reason why these warning labels are so important, and the need to really reactivate the national conversation about smoking and its harms to health.

MARGARET WARNER: But has there been research into that stubborn 20 percent and who they are and why it persists?

MARGARET HAMBURG: Well, there — there is a lot of research of that. People are very, very interested in understanding that better.

And what we’re doing today with these graphic health warning labels is just one component of the kind of integrated, comprehensive strategy that’s necessary to really bring those numbers down. But, you know, part of what we’re trying to achieve and part of what the 2009 tobacco prevention control law was all about was helping to try to stop young people from starting to smoke.

We know that most people that are smoking today started smoking before the age of 18. So, things that we can do to help people not take up this deadly habit are very, very important, and where we can make a real and enduring difference.

MARGARET WARNER: Commissioner Margaret Hamburg, thank you so much.