Graphic Cigarette Labels Can Influence Smokers Who Know Less About Health

Cigarette labels that display graphic images of the consequences of smoking have a greater impact on smokers who are less educated about health issues, compared with text-only labels, a new study suggests.

The researchers from the University of South Carolina wanted to focus on less educated smokers, because previous studies found people in lower socioeconomic groups with lower education levels are among the heaviest smokers, and have the highest rates of tobacco-related disease.

They recruited almost 1,000 adult smokers, and asked them about their education, smoking habits and salary level. Participants were asked to interpret a nutrition label, in order to assess their health literacy. They were then divided into two groups. One group was shown four text-only cigarette warnings, which are currently used on cigarette packs. The other group was shown nine cigarette packs that displayed text and pictures showing the negative consequences of smoking. These included a graphic picture of a diseased chest of a deceased person, as well as more abstract images that warned of cancer, stroke and heart disease.

Smokers rated the pictures more highly in terms of personal relevance and effectiveness, compared with warnings that simply included words. Smokers with low health literacy found the warning labels and pictures to be more credible than the text-only labels.

“Research on cigarette warnings in the United States and other countries has repeatedly shown that pictures work better than text,” study author Dr. James Thrasher told HealthDay. “Our research supports this finding while also showing what tobacco researchers have assumed for a while — that warnings with pictures work particularly well among smokers with low levels of literacy.”

The study appears in the American Journal of Preventive Medicine.

The Food and Drug Administration wants to require tobacco companies to add graphic warning labels to cigarette packages. The labels include graphic images of the consequences of smoking, including diseased lungs and rotting teeth. The warning label requirement has been tied up in court. Tobacco companies have argued that the labels violate the right to free speech.