Affixing pictures on cigarette packs to illustrate the dangers of smoking increased attempts by smokers to quit, according to the findings of a University of North Carolina study published online June 6 by JAMA Internal Medicine.
Reducing smoking is a top public health priority because it is a leading cause of preventable death. While the 2009 Family Smoking Prevention and Tobacco Control Act requires pictorial warnings on cigarette packaging, implementation was stalled by a 2012 lawsuit filed by the tobacco industry.
[Photo: These images represent four of the pictorial warnings used in the study.]
The United States Court of Appeals for the District of Columbia Circuit ruled against nine pictorial warnings proposed by the U.S. Food and Drug Administration (FDA), saying the FDA had “not provided a shred of evidence” that the pictorial warnings reduce smoking.
Dr. Noel T. Brewer, professor of health behavior at the UNC Gillings School of Global Public Health, worked with co-authors to address gaps in the research with a large randomized clinical trial. The investigators examined the effects on smoking behavior caused by adding pictorial warnings to the fronts and backs of cigarette packs.
“Courts have demanded evidence that pictorial warnings change smoking behavior,” said Dr. Brewer, who also is a member of the UNC Lineberger comprehensive Cancer Center. “The findings from our trial can help the FDA implement required pictorial warnings on cigarette packs in the U.S.”
The authors used four pictorial warnings that contained text required by the Tobacco Control Act and pictures illustrating the harms of smoking, which were selected from the FDA’s originally proposed set of images. In addition, they used four text-only warnings that contained U.S. Surgeon General warning statements that have been required on the side of cigarette packs since 1985.
The four-week trial included adult smokers in North Carolina and California. Of the 2,149 smokers enrolled in the study, 1,901 individuals completed it. Participants were randomly assigned to receive either text-only or pictorial warnings on their cigarette packs for four weeks, and research staff placed the warnings on cigarette packs that smokers brought with them when they attended weekly visits. Surveys were administered at the start of the study and at each visit.