Here at George Washington University this morning, Department of Health and Human Services officials unveiled a new strategy aimed at preventing new smoking habits and helping current smokers quit. One major component is the Food and Drug Administration’s proposed rule requiring that all cigarette packages and advertising include one of nine health warnings (which will be larger and more noticeable than the current text on cigarette packs) and color graphic images that depict the negative health consequences of smoking.

The Tobacco Control Act that passed last year specified the nine text warnings, which cover cigarettes’ addictive nature; the fact that they cause fatal lung disease, cancer, stroke, and heart disease; their effects on children and others; and the blunt “smoking can kill you.” FDA has now unveiled 36 proposed graphic images to accompany the messages, and is soliciting public comments on them. They’ll select the final nine graphic and textual warnings by June 22, 2011, and the final rule will be implemented September 22, 2012. (Many other countries already require such warnings; this University of Sydney website has a nice compilation of links and graphics.)

My personal impression is that the mouth cancer image (#3) is the most disgusting – and might have the most impact on teens more concerned with their appearance than eventual mortality – and the ones featuring children potentially most effective on parents. I’m neither a smoker nor a likely new smoker, though. FDA has established an 18,000-person study on this topic, and will use those results, along with a literature review and the public comments, to make its image selection.

As FDA Commissioner Peggy Hamburg stressed in her remarks, the graphic warnings are designed to discourage new smokers and strengthen current smokers’ resolve to quit. Assistant Secretary for Health Howard Koh explained that the warnings are just one piece of a four-part strategic plan for reducing smoking’s toll on our country’s health:

  • Improve the public’s health: Strengthen the implementation of evidence-based tobacco control interventions and policies in states and communities. This includes helping states enhance smoking-cessation services (like the 800-QUIT-NOW quitline) and enforce tobacco regulations. The American Recovery and Reinvestment Act (the stimulus) provided $225 million to support local, state, and national efforts to promote tobacco control and expand quitlines.
  • Engage the public: Change social norms around tobacco use. Koh noted that the tobacco industry spends more than $34 million on marketing every day, and it takes a lot of effort to counter that. HHS proposes to conduct a mass-media campaign and develop a communication and education campaign that will have all HHS agencies promoting a unified message.
  • Lead by example: Leverage HHS systems and resources to create a society free of tobacco-related disease and death. HHS plans to make all of its agency campuses tobacco-free and require HHS conferences to be held in jurisdiction with smoke-free laws. HHS also plans to work to expand Medicaid and Medicare coverage to include comprehensive, evidence-based cessation treatment.
  • Advance knowledge: Accelerate research to expand the science base and monitor progress. HHS will expand its research, with an emphasis on research and surveillance related to high-risk populations, including minority racial/ethnic groups, those of low socioeconomic status, and individuals with mental disorders. Koh noted that stimulus funding is supporting 57 community projects to help determine best practices.

HHS Secretary Kathleen Sebelius opened today’s event by noting that the drop in the US smoking rate has leveled off; her blunt assessment of current conditions was “We lose lives, we lose money, and we’re not making any progress.” Tobacco is extremely addictive, and even smokers who want to quit and have help will find it to be a struggle. But with Koh and Hamburg’s explanations of the proposed and in-progress federal efforts, it became possible to think we might start making progress again. Hamburg reminded us of the ultimate goal: “Make the suffering and disease caused by tobacco part of America’s past, not its future.”

Comments

  1. #1 Jay
    November 11, 2010

    Well, the blogosphere is definitely engaged on the proposed rule. I’m not sure if the labels will be worth the budgetary buck after first amendment challenges by the tobacco industry. It is a serious subject however since the number of smokers in the US hasn’t been decreasing over the years. I made a graphic depicting the levels on my blog.

  2. #2 Joe
    November 11, 2010

    My personal opinion is that this is a wasted effort – lots of money and time but it won’t give us the desired effect. My “evidence” is from the occupational and public safet realm – we’ve been showing LOTS of images of dead and mangled bodies in cars, and still have issues with seatbelt use. I suspect if those images really had the power to change behavior, ambulance drivers would all wear seat belts, yet I routinely see them without them. I just don’t think graphic images are what impacts our behavior.

  3. #3 Joe
    November 11, 2010

    Okay – I take it back. I should have looked at the pictures before I posted that comment. All of the pictures except the grotesque rotted teeth picture are more what I consider educational, and not graphic “scare tactic” images. Not sure how to explain that, but these do look like the kind of thing targeted more at our rational thoughts rather than the emotional side.

  4. #4 Liz Borkowski
    November 11, 2010

    I’ll be interested to see what comes out of the FDA survey and lit review, but this study suggests that the important factor is whether a smoker *noticed* a warning – that was predictive of a quit attempt. I wonder how much of noticing is due to the visibility of the warning (size, use of eye-catching color) vs. its content.

    I also wonder whether the same message can be equally effective for nonsmokers (who we want to discourage from starting) vs. current smokers (who we want to encourage to quit).

  5. #5 AZ
    November 11, 2010

    I think that there should be an increase in warning for cigarettes because they are so dangerous to use. I think that there should be commercials, magazine ads… etc. about the dangerous nature of cigarettes and the consequences that using them causes. People who smoke put themselves in serious risk for man things and the more they see that maybe it will get them to stop smoking. If people see what the risks are then maybe that will help them to see what they are doing to themselves. I think that the guilt trip method should have some beneficial results. I think that if the drop in the smoking rate has leveled off then we have to think of a new method of preventing people from smoking. I really believe that targeting people who don’t smoke is a good idea. It’s hard to get people who already smoke to quit but preventing people from smoking is a good way to decrease the numbers too.

  6. #6 darwinsdog
    November 12, 2010

    Why should the government care if people smoke cigarettes or not? It’s their own business, not the government’s. I don’t smoke and I think smoking is stupid, however, I don’t feel like it’s any of my business whether other people smoke or not. I’m certainly not interested in going around telling others that they shouldn’t smoke and I don’t appreciate having my tax dollars contribute to such an effort.

  7. #7 Liz Borkowski
    November 12, 2010

    Darwinsdog, if what you’re interested in the expenditure of your tax dollars, Medicare and Medicaid pay for a lot of smoking-related illnesses – and I’m sure those costs would be far higher if it weren’t for smoking cessation and prevention efforts.

  8. #8 darwinsdog
    November 13, 2010

    Medicare and Medicaid pay for a lot of smoking-related illnesses -

    They should not. Smoking related illness is self-inflicted. If it can be shown beyond a reasonable doubt that illness is due to lifestyle decisions within the control of the person suffering from them, then Medicare and Medicaid should not pay for their treatment. If a person decides to smoke then they should take responsibility for that decision. The same is true of illness consequent to alcoholism or obesity.

  9. #9 Grep Agni
    November 16, 2010

    I’m really curious about the graphic design decisions. Each image has a version with white text and one with black text, and in almost all cases the pictures change subtly. If you compare images 11 and 12, for example the child’s head changes slightly — you can see his ears wiggle if you flip back and forth.

  10. #10 Electronic Cigarette
    November 22, 2010

    Our customers tell us that the new packaging is ridiculous – a wasted effort. At this point, people KNOW smoking is bad…this is just a dog and pony show.
    They smoke for other reasons, each his/her own. Most of our customers buy the electronic cigarette, not to quit, but so they can ‘smoke’ in places that smoking is banned: currently in many places including city parks and beaches.
    Government control is overstepping.