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U.S. Study Says Graphic Images Make the Case to Quit Cigarette Smoking

By Erik Pineda

Graphic images carry more punch in convincing smokers to kick the habit, a new U.S. study said, which also showed that mere text warnings were no match to powerful representations of the numerous ill-effects of cigarette smoking.

Researchers led by Dr James Thrasher of the University of Carolina in Columbia confirmed on their study of 1,000 individuals that “that pictures work better than text,” in terms of driving home the message that smoking leads to serious health conditions and even death.

Mr Thrasher added that such findings are applicable not only in the United States but also in other countries including Australia, which this year is set to implement one of the strictest regulatory measures that the global tobacco industry will face.

By December 2012, cigarette products being sold locally are legally required to come in drab packages, with the plain look to be complemented by imposing health warnings that occupy much of each pack’s total makeup.

Rolling out this kind of policy is powerful enough to reduce any country’s incidence of smoking but more traction for such campaign will be gained if compelling images of people suffering from tobacco-related diseases are used, Mr Thrasher said.

“Our research supports this finding while also showing what tobacco researchers have assumed for a while – that warnings with pictures work particularly well among smokers with low levels of literacy,” the lead author of the new report was quoted by USNews as saying.

The report is set to be published by the American Journal of Preventive Medicine on December 2012, USNews said.

According to Mr Thrasher, the findings that he and his co-researchers arrived at are especially true for smokers with low health literacy.

This bracket of the respondents “rated the warning labels with pictures as more credible than text-only messages,” the report said while “the warnings with very graphic imagery were rated as the most effective by smokers with both high and low health literacy.”

The strongest indication that the study has reflected is that governments “should put prominent, graphic warnings on cigarette packages . . . (because) smoking is highest among people with the least education,” such as the case in the United States, Mr Thrasher stressed.

Dr Aditi Satti of the Temple University Health System in Philadelphia and is not part of the study offered that “a picture is probably worth a thousand words . . . (for) lower-income, less educated (patients).”

Putting strong images along with specific health warnings “get people at least thinking about what the consequences of smoking cigarettes are. It gets them in the contemplation state,” Mr Satti told USNews.

Europe soon to adopt graphic cigarette package warnings

Posted Dec 13, 2012 by Marcus Hondro

The German daily newspaper ‘Bild’ reported on Thursday that the European Commission has, after a lengthy time debating it, finally agreed to more graphic warnings on the labels of cigarette packages.


One of nine new warning labels required by the FDA on all packs of cigarettes sold beginning in the fall of 2012.

The labels that will become law in European Union countries will feature photos of damaged lungs and other parts of the human body that are affected by cigarette smoking; text surronding the photos will warn of the dangers of smoking in a stark manner.

Other aspects of the changes being made in how countries will be dealing with cigarettes, Bild reported, include a banning of the word ‘light’ to describe any tobacco product and the end to allowing cigarette companies to use taste-enhancers in their cigarettes.

The laws will also address the amount of packet space companies must devote to the images and text: fully 75 percent of the packets, on the front and back, must be given over to the graphic photos and text.

Germany, which already has graphic warnings on cigarettes, will be one of the first countries to experience the new packets, Bild said. In the U.K. similar labelling already exists. Bild did not have an exact date for the new changes.

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Wednesday, 12 December 2012 EMAIL | PRINT | FEEDBACK

Graphic cigarette pack labelling packs a punch

Lionel Wijesiri

Health Minister
Maithripala Sirisena

The National Cancer Institute recently paid a glowing tribute to Health Minister Maithripala Sirisena for obtaining government approval to cover 80 percent of tobacco packaging with Pictorial Health Warnings (PHW). NIC Consultant and President Cancer Association, Dr. Samadhi Rajapaksa said 22 percent of the country’s annual health budget is spent on people who fall sick due to tobacco smoking. This figure is many times bigger than the amount the tobacco industry pays as annual tax to the government, he said. He further warned that 18,000 cancer patients are treated in the NCI every year for smoking complications.

This is a good move by the government since internationally pictorial health warnings on tobacco product packaging are now been recognized as an effective and valid tool to inform smokers about the consequences of tobacco use. The International Tobacco Control Evaluation Project has studied tobacco-control policies around the world and it confirms the effectiveness of graphic images which incorporate vivid colour images. Vivid images, in particular, tend to elicit emotional reactions, which have been shown to be powerful motivators.


World Health Organization Framework Convention on Tobacco Control (WHO /FCTC), is an international treaty that provides a global policy framework for Parties to implement strong measures against the death and disease caused by smoking. Article 11 of the FCTC contains provisions relevant to ‘Packaging and labelling of tobacco products’. Requirements include that countries ensure that each package of tobacco products carries pictorial health warnings that cover 50 percent or more of the principal display area but no less than 30 percent and are rotating; large, clear, visible and legible.

As with the rest of the world, tobacco use is one of Sri Lanka’s leading causes of preventable death and disease. According to Dr. Samadhi Rajapaksa 18,000 cancer patients are treated in the NCI every year for smoking complications.

Global trend

Smoking is highly addictive and in a majority of cases, smokers become addicted during adolescence. Cigarettes and other tobacco products are harmful due to the presence of carcinogens (cancer-causing agents), nicotine (an addictive agent) and hundreds of other toxic substances.

Tobacco smoke contains 69 known human carcinogens and numerous other chemical compounds that are highly likely to be classified as carcinogenic to humans. There is no risk-free level of exposure to tobacco smoke. Half of all lifetime smokers die early from smoking related diseases. Smokers have an increased risk of death or illness from numerous conditions, including heart and respiratory diseases and a number of cancers.

Over the last decade there has also been a global trend towards bigger health warnings on tobacco packaging that includes graphic images. By now over 50 countries had finalised requirements for pictorial health warnings.

For example, in 2005 Thailand switched to graphic labels, and the percentage of smokers who reported thinking about health risks because of the warnings increased from about 35 percent to 55 percent. The percentage of smokers who said that the warnings made them more likely to quit rose from 31 percent to 46 percent. During the same period, Malaysia had retained small text-box labels and there was no change in the effect of warnings on attitudes about health risks. The likelihood that warning labels might induce people to quit there actually went down slightly from 14 percent to nine percent. When Mauritius, introduced graphic warning labels the percentage of smokers who said they frequently noticed warnings on packages rose from 56 to 83 percent.

Some pictorial health warnings in cigarette packs in Brazil

Research also has revealed that with regard to pictorial warnings, more than half (55 percent) of EU citizens believe that adding a large colour picture to a text-only health warning strengthens the effectiveness of the text-only warning. This percentage is higher in United Kingdom (56 percent) where pictorials were introduced in 2008.

Australian experience

Australia is another classic example demonstrating the effectiveness of pictorial health warnings. The country introduced the pictorial warnings in 2006. Two years later, the Australian government established a Preventative Health Taskforce, an expert group to examine the evidence on tobacco, alcohol and obesity, acknowledged extensive new evidence about the health effects of smoking that consumers have not yet been warned about, and also indicated that consumers need to be warned about all the risks posed by smoking in a clearer, more systemic and timelier manner.

The report demonstrated that the graphic health warnings had achieved their intended purpose by increasing consumer knowledge of the health effects related to smoking, encouraging cessation of smoking and discouraging smoking uptake or relapse. The 2008 Evaluation indicated that the health warnings received strong support among consumers and public health experts, had achieved a high level of noticeability and gained widespread acceptance as believable. The significance and dominance of including graphic images was also reflected in the findings.

However, smokers commented that the health warning on the front of packs was ‘too small’ and ‘too difficult to read’. Branding and use of colour on the packaging was thought to overpower the warning on the front of packs and the report indicated that some consumers were surprised that a greater amount of space was allotted to tobacco industry branding rather than the health warning.

Consumers and public health experts made other suggestions for improvements including revising existing warnings with new images, updated text, more simplified and personalised messages, and changing layout and design. There were requests for increased variety in the types of messages with a range of suggestions for new topics.


According to WHO Report on the global tobacco epidemic, although tobacco deaths rarely make headlines, tobacco kills one person every six seconds. Tobacco kills a third to half of all people who use it, on average l5 years prematurely. Today, tobacco use causes 1 in l0 deaths among adults worldwide – more than five million people a year. By 2030, unless urgent action is taken, tobacco’s annual death toll will rise to more than eight million.

In Sri Lanka, this epidemic is getting serious and the people have suggested that an effective solution is needed in order to reduce the numbers of smokers and deaths. Presently, we have some approaches from campaign on awareness in television, billboard, newspapers, and magazines and to the uses of regulation or penalty to the smokers. The question here is, whether these approaches are effective enough to motivate the smokers to reduce or stop from smoking.

The latest approach will be a good idea since health warnings are an extremely cost effective intervention and have immediate reach of smokers. Pack-a-day smokers will be exposed to the warnings over seven thousand times per year. This will exhibit to them to the risks involved in smoking each time they pull out a cigarette out of the pack.

Policymakers should not rely solely upon large pictorial health warnings, which are designed primarily to inform consumers about smoking harms, to also reduce brand appeal. Other strategies are likely to be required. For example, Pictorial warnings in Canada and elsewhere also include supportive messages and concrete information on quitting.

Research from health communication and ‘fear appeals’ indicate that the most effective messages are those that both warn and provide supportive ‘efficacy’ information. Indeed, large warnings that also include a toll-free telephone ‘helpline’ have dramatically increased the use of cessation services in places such as Australia, the United Kingdom, Brazil and the Netherland.

As common citizens, we need to understand that smoking is not only an individual’s problem, but also a societal problem – “a social carcinogen,” as one prominent researcher characterized it. Also, it is a problem that cannot be left solely to government to solve.

It will require the combined efforts of all of us to achieve a tobacco-free society.

Produced by Lake House Copyright © 2006 – 2012 The Associated Newspapers of Ceylon Ltd.

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