Health warnings in the form of pictures or text on the back of cigarette packets are common in many countries, serving to deter smokers from the habit. But according to a new study, they have little impact on teen smokers.

In the US, cigarette packets carry health warnings in the form of text only. In 2011, the US Food and Drug Administration (FDA) published a final rule stating that health warnings in the form of images must be present on all cigarette packets to deter smokers.

However, this ruling was challenged in court by tobacco companies, and the rule was dropped.

But in many countries, such as the UK, this ruling is very much in place, with some pictures covering more than 75% of the main surface area on a cigarette packet, alongside text warnings. Researchers from the UK wanted to find out exactly what effect this had on smokers, particularly teenagers.

They conducted a study involving two waves of a Youth Tobacco Policy survey of adolescents 11 to 16 years of age. One survey was completed in 2008 by 1,401 teens, and the other in 2011 by 1,373 teens.

For each survey, the same text warnings appeared on the front and back of the cigarette packets, while pictorial health warnings were present on packets for the 2011 survey.

All teenagers were required to share their thoughts regarding the visibility and impact of the warnings, and their responses were scored on a sliding scale of 1 to 5. They were asked:

  • How well the health warnings served as visual cues
  • How easy they were to understand and believe, and
  • How persuasive they were.

Teen holding cigarette pack showing warningShare on Pinterest
Teenage smokers are not deterred by health warnings on cigarette packs, the study shows.

The surveys showed that 68-75% of teens had never smoked, 17-22% had experimented with cigarettes, while 1 in 10 were deemed as regular smokers (smoked at least one cigarette a week).

Results from the health warning questions revealed that only 1 in 10 teenagers said they thought about the warnings when the cigarette packet was not in sight.

At the time of both surveys, around 85% of teens said they found the warnings credible. However, from the 2011 survey, those who had never smoked were less likely to find the warnings easy to understand, but experimental smokers were more likely to find them trustful and believable.

Those who had never smoked were more likely to think about the warnings “often” or “very often.”

Additionally, while the proportion of teens who thought the warnings were capable of deterring them from smoking increased between 2008 and 2011, this was only apparent in never and experimental smokers, with no change in regular smokers.

When it came to the teens remembering the health warnings on the cigarettes, the recall of text health warnings stating “smoking kills” fell from 58% in 2008 to 47% in 2011, while the recall of the text “smoking seriously harms you and others around you” fell from 41% in 2008 to 25% in 2011.

However, memory of three images on cigarette packets, including rotten teeth, diseased lungs and neck cancer, all increased.

But the researchers add that when the pictures were only present on the back of the cigarette packet and not the reverse, they had less impact.

The study authors say:

The findings have implications for warning design. Positioning pictorial warnings only on the back of packs may have had a deterrent effect on never and experimental smokers, but for most measures no significant differences were observed.”

They add that the EU ruling endorsed by the European Parliament’s Committee on the Environment, Public Health and Food Safety in July 2013, which said large pictorial warnings should cover 75% of the pack on both sides, is likely to increase the impact warnings have for all adolescents, irrespective of smoking status.

Research in 2012 from the University of South Carolina suggested that health warning labels containing pictures have proven to be effective in causing awareness in adult smokers.

Other research from Susquehanna University in Selinsgrove suggested that graphic cigarette packet warning labels could significantly reduce demand.