April 5, 2018

The importance of Graphic Warning Labels on cigarette smoking prevalence and consumption

In 2011, the United States Food and Drug Administration (FDA) issued regulations requiring tobacco companies to add Graphic Warning Labels (GWLs) to cigarette packages. However, tobacco companies challenged these regulations, arguing that the FDA had not yet established the effectiveness of GWLs in reducing smoking prevalence. Eventually, the Courts ruled in their favor, denying the FDA’s requirement for GWLs in the U.S.

Though some of the proposed GWLs by the FDA were gruesome, the intent was not to make people queasy. Rather, GWLs have shown to be an effective tobacco control policy by providing health information to the public while increasing the knowledge of the many public health risks of smoking. This is because the visual aspect of a pictorial warning has been shown to attract greater attention and recall of health warning messages than text-based warnings. In fact, by 2016, 94 countries or jurisdictions outside of the United States implemented GWL regulations as recommended by the WHO Framework Convention on Tobacco Control (FCTC).

After the requirement for GWLs on cigarette packages was rejected by the Courts, Tobacconomics researchers, Anh Ngo, Kai-Wen Cheng, Ce Shang, Jidong Huang and Frank Chaloupka, sought to evaluate the effectiveness and association of these labels on reducing adult smoking prevalence and cigarette consumption across multiple countries. Their recent paper published in the International Journal of Environmental Research and Public Health was the first to specifically examine the effects of GWLs on cigarette consumption.

Over the course of the study period, they found the number of countries that had GWLs increased significantly from approximately 15% in 2007 to 55% by 2014. While there was a clear increase in prevalence of GWLs in other countries, the question still remained: do they actually have an effect on smoking prevalence and cigarette consumption? If this association was proven, the implementation of GWLs in the US would be more conceivable.

The answer to the first question—if GWLs had a reduced smoking prevalence—was no. Their research found that GWLs were associated with a 0.9 to3 percentage point decrease in adult smoking prevalence, however, this result was not statistically significant.

Moreover, they did determine that GWLs reduced adult cigarette consumption in the countries that had them. There was a demonstrated reduction in cigarette consumption of 230 to 287 sticks per capita in countries with GWL compared to countries without and this result was statistically significant.

So, do GWLs actually have an effect on reducing smoking prevalence and cigarette consumption? The answer is a partial yes. But, the number of countries which are adopting this policy is steadily increasing. That alone is enough evidence to assume that something is working.