Cigarette warnings losing impact: study

Graphic health warnings on cigarette packages, such as those that depict rotting teeth, diseased mouths and throat cancer, are losing their impact as smokers become increasingly desensitized to them, according to an international study.

Experts say the findings highlight a need for governments to introduce more “variety” and “novelty” in their messaging if they want to encourage smokers to break the habit.

Canada, for instance, has been using the same set of 16 health warnings on cigarette packages since 2012, said Ron Cunningham, policy analyst with the Canadian Cancer Society. “That’s too long,” Cunningham said. “Package health warnings are effective, but the messages have to be refreshed. If they’re not, they become stale.”

A research team at James Cook University in Australia carried out the online survey of nearly 700 adult smokers in four countries — Australia, Canada, the United Kingdom and the United States. The results were published recently in the journal Tobacco Induced Diseases.

A significant percentage of respondents — 35 to 36 per cent in Canada and the U.K., 51 per cent in Australia and 72 per cent in the U.S. — considered cigarette package warnings either “not at all” or “minimally” effective in prompting smokers to quit.

“If someone is willing to smoke, they will smoke no matter what the message or image on the packet is,” a survey participant from Canada said.

Regular adult smokers can be exposed to health warnings up to thousands of times per year, and this exposure has led to desensitization and a loss of “shock value,” Aaron Drovandi, the study’s lead author, told the National Post in an email.

Drovandi said while adolescents and young adults tend to hold health warnings in higher regard, there also is research that suggests younger people feel such warnings are irrelevant. Lung cancer can be difficult for a young person to internalize if they feel more “bulletproof,” he said.

The study found that messages could benefit from less emphasis on diseases and other health risks and greater emphasis on other negative outcomes, such as the financial costs of smoking.

At least one country — Jamaica — uses such messaging on its cigarette packages. “QUIT NOW,” one health label says. “You work too hard to burn your money.”

Survey participants also seemed to think that more messaging that highlighted the effects of smoking on others — such as family members and pets — could be effective.

Researchers say it’s not just the content of the messaging that needs to expand but the format. Half of survey respondents said they “agreed” or “strongly agreed” with the idea of placing warning messages directly on individual cigarette sticks.

Cunningham said warning messages on individual sticks would “de-normalize” the product.

“It prompts discussion ... It grabs people’s imaginations.”

In 2001, Canada was the first in the world to introduce photo warnings on cigarette packs. Now more than 100 countries require them.

While Canada may have started the global trend, it has not kept up with other countries in some respects, Cunningham said. Whereas Canada has been using the same set of 16 health-warning messages on cigarette packs since 2012, the European Union has three sets of 14 warnings rotated every 12 months.

And whereas Canada requires health warnings to cover 75 per cent of the front and back of packs, other countries are more stringent. East Timor, for instance, leads the way, requiring warnings to cover 85 per cent of the front and 100 per cent of the back.

In an email Thursday, a Health Canada spokesman said health-warning messages on tobacco packages remain “an important tool” in reducing smoking rates and that the government is working to update the content and style of those health labels.

Last fall, it circulated a public-consultation document aimed at exploring ways to make health messages more noticeable and engaging. According to the document, ideas include adopting rotating sets of health warnings and placing warning messages directly on cigarettes. This spring, the government also rolled out new regulations requiring all tobacco products to be sold using plain “drab brown” packaging.

Asked if the government is considering messaging that goes beyond health risks, the spokesman said not at this time. “Pursuant to the Tobacco and Vaping Products Act, the information required to be displayed on tobacco products and tobacco product packages must relate to the health hazards and health effects from using these products and from their emissions,” he said.

THEY WILL SMOKE NO MATTER WHAT THE MESSAGE ... IS

SUPPLIED BY THE CANADIAN CANCER SOCIETY Graphic testimonial warnings — such as these on packs of Canadian Classic and Pall Mall Red — tend to be ignored by users who see them too frequently.