To make smokers quit and discourage others from starting, put graphic images of mouth tumours, cancerous lungs and tar-covered teeth and gums on cigarette packets. That鈥檚 the message from countries that have already made these kinds of graphic images compulsory.
鈥淭he most effective are the large, emotionally arousing pictures. The grosser the better,鈥� says of the University of Waterloo in Ontario, Canada, and author of a soon-to-be-published international review of the effect of cigarette-packet warnings on cigarette consumption. 鈥淪ubtle doesn鈥檛 appear to work.鈥�
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Canada introduced graphic images on cigarette packages in 2000 and since then more than 30 countries have followed suit. In his review, Hammond finds growing evidence from around the world that these images are effective in helping people quit. The most dramatic pictures work far better than text warnings because they have an emotional impact on the viewer, he concludes.
鈥淪tudies in France, Belgium, Romania, Ireland, Spain, Italy, Bulgaria and the UK consistently demonstrated that warnings with shocking images, such as rotten teeth, or throat cancer, were rated as most effective,鈥� says the review.
They鈥檙e also the ones that people remember, according to studies in Australia, Canada and Europe. 鈥淭he top four warnings recalled by Australian smokers and nominated as most effective all depicted graphic health effects, including a picture of a lung tumour, a sick baby in a hospital, a picture of mouth cancer and a gangrenous foot,鈥� says Hammond鈥檚 review.
Right to shock
The evidence in the review vindicates the to make graphic warnings on cigarette packets mandatory in two years鈥� time.
Last week the US Department of Health and Human Services (HHS) to comment on 36 proposed images. Pictures must cover at least half the front and back of the packet and will also cover 20 per cent of all cigarette adverts.
The images include photographs of people killed by smoking, mouth cancers and people with throat cancer breathing cigarette smoke out through their tracheotomy hole. By June next year, the HHS and the US Food and Drug Administration hope to have selected the nine most effective.
Hammond supports the US stance. 鈥淚t鈥檚 a big, very high-profile step,鈥� he says. 鈥淲hen governments put these images on packets, they are making a very public commitment, and making a public statement that undermines the marketing appeal of cigarettes.鈥�
Death and taxes
The move is the latest by the US government to combat smoking. Earlier this year, it introduced new rules to prevent sale of cigarettes to teens.
But it鈥檚 hard to work out exactly how effective the images in any particular country are. Hammond points out that because other anti-smoking measures are often introduced at the same time, such as increased taxes and marketing bans, it鈥檚 impossible to tease out the effect of the images alone. But other studies reveal that a third of current smokers say that the warnings motivate them to quit, while the same proportion of former smokers say the images help them continue to abstain.
Overall, Hammond says that probably the most effective ways to stop people smoking are to raise taxes on cigarettes and ban advertising. But making shocking images compulsory is a major, cheap and effective step as well. 鈥淭hey provide a salient reminder of the dangers of smoking at critical points when people buy packs, when they open them and when they鈥檙e viewed by non-smokers,鈥� he says.
