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.”