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Study nails doubters of pictorial smoke warnings

New Delhi, June 6: Pictures that portray the health hazards of smoking when printed on cigarette packets appear to increase smokers’ attempts to quit, new research has suggested, challenging claims by the tobacco industry that there isn’t evidence to support such warnings.

A clinical trial in the US has demonstrated the impact of pictorial warnings, showing that 40 per cent of smokers whose cigarette packs had pictorial warnings tried to quit compared with 34 per cent whose cigarette packets had text-only alerts.

Public health specialists say the findings are relevant to India where the health ministry earlier this year made mandatory pictorial warnings on 85 per cent of the surface area of tobacco packs, resisting persistent opposition by sections of MPs and the tobacco industry.

The New Delhi-based Tobacco Institute of India, which represents the domestic cigarette industry, has described the 85 per cent pictorial warnings images on tobacco packs as “large and gruesome warnings… directed at creating shock and evoking emotion among consumers”.

Under the old rules, the warnings in India had to cover 40 per cent of the pack’s front portion.

The US has seen similar disagreements between industry and public health professionals about the need for and the effectiveness of pictorial warnings. Sections of the US tobacco industry had used a lawsuit to stall the implementation of the 2009 Family Smoking Prevention and Tobacco Control Act. A US court had ruled against nine pictorial warnings proposed by the Food and Drug Administration, saying the FDA had “not provided evidence” that the pictorial warnings reduced smoking.

“The court said there was inadequate evidence to support the warnings. I and many others disagreed with the court at the time,” Noel Brewer, associate professor of health behaviour at the University of North Carolina, who led the new study, told The Telegraph.

“Our new trial provides strong evidence that we believe the court will find compelling,” Brewer said.

The study’s findings, published today in JAMA Internal Medicine, a journal of the American Medical Association, also show that 5.7 per cent of smokers who had pictorial warnings on their cigarette packs had quit smoking for at least a week, compared to 3.8 per cent of smokers who had packs with text-only warnings.

Public health experts in India have in the past argued that pictorial warnings are all the more necessary in this country, where text-only warnings may have limited impact due to literacy barriers. The new US study found that pictorial warnings also increased forgoing a cigarette, intentions to quit smoking, negative emotional reactions, thinking about the harms of smoking and conversations about quitting.

In their trial, Brewer examined the smoking patterns and behaviour of 2,149 smokers, some of whom were given cigarette packs with pictorial warnings, while the others had packs with text-only warnings. The scientists say the effectiveness of the pictorial warnings was apparent despite the short duration of the trial that lasted only four weeks.

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