The health warning labels (HWLs) containing pictures that graphically show the results of smoking on cigarette packages have proven to be effective in causing awareness in adult smokers, suggests a new study in the American Journal of Preventive Medicine.

Previous research has established that HWLs using pictures are much more effective than HWLs with only text in raising education about the dangers of smoking and encouraging the advantages of quitting.

This particular study identifies which pictures tend to function best among adult smokers in the U.S., including smokers from weaker groups where smoking rates are greatest.

Lead investigator James F. Thrasher, PhD, of the Department of Health Promotion, Education, and Behavior, Arnold School of Public Health at the University of South Carolina in Columbia, SC, comments:

“More than 40 countries have implemented pictorial health warning labels. The U.S. was scheduled for implementation in 2012, but tobacco industry litigation has delayed implementation by claiming that the pictorial warnings the FDA proposed violate the industry’s right to free speech. To inform future warning label policy development and implementation, more data are needed on U.S. consumer responses to various kinds of warning label content.”

The current study focuses on this subject, while looking at responses from low income groups where smoking maintains a high incidence rate, because tobacco control interventions are much less effective in reaching these groups.

Dr. Thrasher and his research team coordinated field experiments with around 1,000 adult smokers from July 2011 to January 2012. To participate in the study, the smokers had to have smoked at least 100 cigarettes during their lifetimes and also be a current daily smoker.

Volunteers were found in public places, such as supermarkets, sporting events, and flea markets in a low-income area of South Carolina. Participants were divided randomly at a 1:4 ratio into two groups: an experimental condition group and a control group.

The control group consisted of 207 smokers who gaged four different HWLs that are presently on cigarette packs. The text labels warn of carbon monoxide inhalation, pregnancy complications, emphysema, heart disease, and lung cancer.

The experimental group examined nine separate picture labels that showed lung disease caused by second-hand smoke, heart disease, and cancer. Each label contained a graphic image of either diseased organs, an abstract symbol, or human suffering, as well warning text. The labels had pictures that the FDA recommended for warning labels in the U.S., as well as images used on labels in different countries.

Using a 10-point scale, all participants analyzed the messaged for perceived effectiveness, credibility, and personal relevance.

Dr. Thrasher explains:

“The present study provided the first direct test of the hypothesis that pictorial health warning labels work better than text-only labels among people with low health literacy. Ratings of the personal relevance and effectiveness of pictorial labels compared to textual labels were no different for smokers in high- compared to low-health literacy groups. However, smokers with low-health literacy rated pictorial labels as more credible than text-only warnings, whereas no difference was found among smokers with high health literacy.”

Responses to the type of photos used in the pictorial HWLs differed by study volunteers’ health, literacy, and race. Abstract photos resulted in the greatest differences between these two groups, however, these types of HWL photos caused the least significant reactions overall.

Smokers from both groups rated the graphic HWLs as the most effective and most likely to have an impact on them.

Dr. Thrasher concludes, “These results suggest that the FDA should consider implementing warning labels with more graphic imagery in order to maximize the impact of warnings across different populations of adult smokers, including more disadvantaged smokers.”

An earlier study has also told us that graphic warning labels will decrease the demand for cigarettes. It also found that graphic imagery is most effective than text labeling.

Pictorial labels, particularly graphic photos, are inexpensive and have the possibility of greatly encouraging adult smokers to become aware about the range and depth of smoking-related risks and simultaneously persuading them to quit.

Written by Kelly Fitzgerald