Cigarette Warning Labels Research and Smoker's Behavior

Over 120 nations have required cigarette packages sold within their boundaries to carry graphic warning labels (GWLs) in order to remind smokers of the health risks affiliated with using cigarettes. The United States is not among those nations. 

In 2009, the U.S. Congress had mandated that cigarette packages sold within the U.S. carry GWLs, however, before the U.S. Food and Drug Administration could implement the mandate in 2012 (and again in 2020), the tobacco industry filed suit to put a halt to this action and the issue is still before the courts. 

But even if the mandate went into effect and cigarettes packs sold in the U.S. were required to carry GWLs, would it change the attitudes and/or behaviors surrounding cigarette use among American smokers?  

Claudiu Dimofte: Marketing professor, Claudiu Dimofte, of the Fowler College of Business

 

To find out, marketing professor, Claudiu Dimofte, from the Fowler College of Business at San Diego State University worked with researchers from the University of California at San Diego, California State University San Marcos, and San Diego County Public Health Services to study several hundred San Diego County smokers (who reported not being ready to quit) over three months in order to measure and compare their reactions to various types of cigarette packaging. The research plan was published in the November 2020 edition of Contemporary Clinical Trials. 

The smokers were sold study-designed cigarette packs with one of five different types of packaging: one with the standard packaging designed by the tobacco manufacturers, one in a blank olive drab package devoid of any imagery, and three with GWLs showing images of maladies associated with smoking (foot gangrene, a neonatal infant and throat cancer). These three GWLs are currently licensed and used on cigarette packs sold in Australia. 

The researchers assessed the smokers’ subsequent smoking behavior on a daily, weekly and monthly basis with SMS questions that asked them about the satisfaction they derived from smoking, how they thought smoking impacted their health and the health of others, if they thought about quitting, and how many cigarettes they had smoked. They also submitted saliva samples which were analyzed for cotinine content to determine the smokers’ exposure to nicotine, and to confirm the approximate number of cigarettes smoked. 

When the results were tabulated, the researchers learned of the following results:

• Smokers receiving their cigarettes in the standard packaging maintained positive perceptions about smoking throughout the course of the survey, however, those smokers receiving the packs with GWLs showed a slight, but consistent, decline in positive perceptions. 
• Health concerns increased in all smokers in the study, though more so in the group getting the GWL packs.
• While the groups getting the standard and blank packages had no increased thoughts of quitting smoking, those getting the packs with the GWL images did. 
• There was nearly no change in the number of daily smoked cigarettes among study participants, regardless of condition.  

Cigarette packs available to smokers in the survey included packaging from the tobacco company, a blank pack and a pack with a graphic warning label (GWL).

In conclusion, the researchers determined that while the smokers who received the cigarette packs with GWLs showed significantly increased thoughts about kicking their smoking habit, there was no evidence that they reduced or quit their cigarette consumption. The researchers also noted that there was virtually no difference in the positive perception of smoking between the groups getting their cigarettes in the standard packaging or blank packaging. Only those getting packs with GWLs reported decreased smoking satisfaction. 

“While there was a marginal increase in health concerns and a substantial increase in thoughts of quitting smoking among study participants receiving GWLs, there was no evidence of increased quitting behavior,” said Dimofte. “This is in line with previous research which indicates that intentions to change are rarely sufficient to alter addictive behavior. In summary, GWLs alone do not seem to send a strong enough message to reduce cigarette consumption among smokers who are not ready to quit.” 

This research was supported by a grant from the National Cancer Institute (Grant Number: R01 CA190347 and Grant Number RO1 CA234539) and by the Tobacco-Related Disease Research Program (Grant Number: 28DT-0005).   

The funders had no role in either the design or conduct of this study or in the decision to submit for publication.