Graphic health warnings on cigarettes packs caused one-quarter of smokers to consider quitting in 13 of the 14 foreign countries surveyed for a report published by the CDC.
Adding graphic warnings to cigarettes as part of a comprehensive quit-smoking push could save lives by reducing global smoking rates, according to the researchers from various global health organizations and nonprofit organizations who published their findings in the May 26 issue of the CDC's Morbidity and Mortality Weekly Report.
"Tobacco kills more than five million people a year -- more than HIV, tuberculosis, and malaria combined -- and will kill more than one billion people in this century unless urgent action is taken," said CDC director Thomas Frieden, MD, MPH, in a press release. "Warning labels motivate smokers to quit and discourage nonsmokers from starting, are well accepted by the public, and can be effectively implemented at virtually no cost to governments."
A total of 172 countries have adopted the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC), which requires tobacco products to carry large, clear warnings describing harmful effects of tobacco use -- preferably incorporating pictures -- that cover at least one-third of the packaging.
To assess what effect the health warnings have on individual interest in quitting smoking, CDC researchers reviewed data from the 2008-2010 Global Adult Tobacco Survey from 14 FCTC countries: Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine, Uruguay, and Vietnam.
The Global Adult Tobacco Survey is a nationally representative household survey conducted among people 15 years of age or older that uses a questionnaire asking such questions as whether current smokers noticed health warnings on cigarette packages within the previous month, and whether that label made them consider kicking their habit.
Smoking prevalence varied widely in the countries surveyed, but in all countries, men were more likely to be smokers than women. Among men, prevalence ranged from about 10% in India to about 60% in Russia. Among women, prevalence was highest in Poland at 23%, while less than 2% of women in Bangladesh, China, Egypt, India, Thailand, and Vietnam said they were smokers.
The majority of men and women smokers in all surveyed countries said they noticed the warnings on the cigarette packages in the previous 30 days. But did that affect behavior?
Yes, according to the findings of the survey: More than 25% of men and women in all countries (excluding Poland) were thinking about quitting because of the warnings.
In some countries, the percentage of people considering quitting because of the warnings was much higher -- it was more than 50% in Bangladesh, Brazil, India, Thailand, Ukraine, and Vietnam.
"Implementing effective warning labels as a component of a comprehensive approach can help decrease tobacco use and its many health consequences," the researchers concluded.
They added that prominent, pictorial warnings are most effective in communicating the harms of smoking.
Four of the 14 countries had warnings that contain graphic images since 2008, and one country, India, added pictorial warnings in 2009.
Starting in 2012, cigarettes sold in the U.S. will have to carry . The Department of Health and Human Services is still deciding which images and warnings to use, but contenders include a photo of young girl with an oxygen mask and words saying "Tobacco smoke can harm your children" and a body in a coffin above the words "Smoking can kill you."
The 2009 law that gave the FDA control of tobacco products mandated that cigarette packs have health warnings.
Primary Source
Morbidity and Mortality Weekly Report
Caixeta R, et al "Cigarette package health warnings and interest in quitting smoking -- 14 countries, 2008–2010" MMWR 2011; 60: 645-651.