FDA Unveils Graphic Cigarette Packaging Intended to Deter Smoking

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Just Stop Smoking

I give the FDA a

“B” on this action, but I don’t think it’s enough. Congress could have decided on

much stronger pictures. It could have made them larger, not just 20% of the

pack and located on the back . In other countries that use such warnings, the

pictures cover almost 80% of the packaging.

Plainly put, the United States is a Third

World country when it comes to warning about cigarettes. Similar

pictorial warnings have been used in Canada

for almost a decade; Australia,

almost all of the European Union countries, and even Uruguay have similar warnings.

Having said that, we do know

that pictures speak louder than words and may help motivate smokers to quit.

But here is the hard reality: Even though nearly everyone wants to quit smoking

and many are trying to do so every day, the ability to sustain that motivation

is not always present.

Two factors are highly

predictive of a successful quit: the clinical predictor of personal biology and

the financial predictor of cigarette engineering.

Biologically, some people

are more prone to developing addictions than others. If you have a patient who

reaches for a cigarette before their feet even hit the floor in the morning,

that patient is going to need more medical assistance to be successful.

The second factor is

cigarette engineering. Cigarettes are designed to get people hooked and keep

them hooked. This is what makes quitting so hard despite strong personal motivation.

If we look back in

history, around 1900 there were only a few hundred cases of lung cancer

diagnosed in the U.S.

each year. This year it will be around 160,000. What has happened since then?

People were indeed smoking

then – pipes, cigars, and roll-your-own cigarettes. But this was not a daily-use

situation, mostly because the pH of the smoke made it very hard to inhale.

Right around 1920, commercially available cigarette brands reformulated their

tobacco to make the smoke milder. This allowed people to smoke more, loading

their brains up with lots more nicotine, lots faster.

Around 1950, manufacturers

began adding chemicals to moderate the pH, facilitating deep inhalation. the

lungs. These ingredients – diammonium phosphate, urea, and hydrochloride among

them – are still on the packs’ ingredient list, although manufacturers call

them “flavorings.”

Filters were the next step

in developing an addictive product. Manufacturers presented filters as making

cigarettes safer. Their real purpose was both to break down the tar into

smaller particles and to force people to suck on the cigarette harder to get

the smoke. Filters actually make things worse by forcing rapid inhalation and

rapid absorption – delivering the nicotine to the brain within seconds.

These things were done

secretly and purposefully to promote tobacco addiction and maintain profits. Tobacco

companies deliberately suppressed this information until 2006, when a

racketeering lawsuit forced the disclosure of dozens of documents showing the

intention behind these decisions. U.S District Court Judge Gladys Kessler determined

that tobacco companies conspired to lie about the dangers of smoking and, in

her 1,600-page ruling, called the conspiracy “decades long.”

“In short, the defendants

have marketed and sold their lethal product with zeal, with deception, with a

single-minded focus on their financial success, and without regard for the

human tragedy or social costs that success exacted,” according to her ruling.

Despite lawsuits, public

information campaigns, and the current warnings on cigarette packs, Americans

continue to smoke and I continue to see the effects.

About a third of the

patients I see at the Roswell Park Cancer Institute have smoking-related

cancers. Imagine a vaccine that would prevent a third of cancers. The inventor would

be a Nobel Laureate, globally praised.

We already have this – but

it’s not a vaccine. It’s much simpler.

Just stop smoking.

K. Michael Cummings,

Ph.D, is the director of the New York State Smokers’ Quitline and a senior research

scientist at the Roswell Park cancer Institute, Buffalo.


The Food and Drug Administration unveiled on June 21 the final nine warning images that will appear on every package of cigarettes by 2012 – graphic photos and drawings intended to educate and even deter consumers from buying cigarettes.

The images, set to debut in stores this September, are required by the 2009 Tobacco Control Act, according to FDA spokesman Jeffrey Ventura, who added that these are the first changes to cigarette pack warnings in 25 years. By Oct. 22, 2012, cigarette manufacturers will no longer be able to distribute cigarettes for sale in the United States unless they display these warnings.

Courtesy of Food and Drug Administration

The law required the warnings to cover the top half of the front and back of cigarette packs and 20% of cigarette advertisements, and they must contain color graphics depicting the negative health consequences of smoking.

"This is something Congress wanted to happen and mandated that the FDA carry out," Mr. Ventura said in an interview. Based on a study of 18,000 smokers conducted for the FDA by RTI International, federal officials said they firmly believe that visually communicating smoking’s harm will deter cigarette consumption over the long run.

The images include photos of tobacco-diseased lungs beside healthy lungs, a corpse in casket, a man exhaling smoke though a tracheostomy, and lip cancer. There are also several cartoons and photos of mothers blowing smoke into infants’ faces. One positive image shows a burly man exposing a T-shirt saying, "I Quit."

Blunt statements accompany each image, intended to drive home the messages that cigarette smoke not only directly harms the smoker, but the smokers’ children and people in close proximity.

"The introduction of these warnings is expected to have a significant public health impact by decreasing the number of smokers, resulting in lives saved, increased life expectancy, and improved health status," FDA officials said in a press statement.

Mr. Ventura said the images were selected after the consumer study involving smokers aged 15-50 years. After viewing each of the images, subjects rated their emotional and cognitive responses, their ability to recall the images, and their opinions on whether the pictures could alter their beliefs about the danger of smoking and the desire to buy tobacco products and quitting tobacco.

Young people responded most strongly to a cartoon image depicting tobacco addiction – a cigarette being injected into an arm vein as well as a puppet controlled by strings.

Adults, on the other hand, responded most strongly to photos showing the direct effects of cancer on their bodies – the man with the tracheostomy and a woman smoking in the pouring rain, trying to shield her cigarette with a folded newspaper. Adults also reacted more strongly than did young people to images depicting harm to young children.

The study did conclude, however, that none of the images were significantly related to an increased likelihood of quitting smoking within the next 30 days, or the likelihood of smoking a year after viewing the images. Thus, the report noted, the campaign is more likely to exert a long-term behavioral impact than any immediate effects.

Courtesy of Food and Drug Administration

"Eliciting strong emotional and cognitive reactions to the graphic cigarette warning label enhances recall and processing of the health warning, which helps ensure that the warning is better processed, understood, and remembered," the study said. "As attitudes and beliefs change, they eventually lead to changes in intentions to quit or start smoking and then later to lower smoking initiation and successful cessation. The time scale on which this behavior change process occurs is largely unknown in the context of the impact of exposure to graphic warning labels on smoking behaviors, but the effects on behavior change are unlikely to be immediate or short-term.

Nevertheless, groups promoting antitobacco messages – including the American Heart Association – strongly believe that the warnings will enhance consumer education and change behavior.

"Undoubtedly, the new graphic health warnings will heighten awareness about the dangers of smoking and, more importantly, encourage smokers to quit and discourage smoking initiation," an AHA press statement read. "We’re confident that the new labels will move us closer to our goal of making the nation 100% smoke free."

Tobacco-Free Kids, a group dedicated to educating children and teens about the dangers of smoking, also issued a statement of support, but with a moderated view on the campaign’s possible impact. The group also called on political leaders to financially commit to "waging war" against tobacco.

"The warnings and other FDA regulations are powerful tools, but they are a complement – not a replacement – to other federal and state strategies to reduce tobacco use," Matthew L. Meyers, the group’s president, said in the statement. "To win the fight against tobacco, elected leaders must also fund and implement public education campaigns, expand health care coverage for therapies to help smokers quit, increase tobacco taxes, and enact strong smoke-free laws in every state."

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