From Sexy to Gross

New smoking warnings designed to help people quit or never start

/ Author:  / Reviewed by: Joseph V. Madia, MD

Every day, some 4,000 teenagers smoke their first cigarette. About 1,000 of them will become addicted daily smokers.

Their new tobacco addiction will add to the $200 billion burden that smoking costs the United States every year.

And with their first puff, these youngsters start the clock ticking toward an unhealthy - and likely fatal future.

To combat this disturbing public health menace, the U.S. Food and Drug Administration (FDA) is requiring all cigarette packaging to be wrapped in graphic and sometimes disturbing images starting next year.

Nothing pretty about new labeling

By September 2012, all cigarette packs, cartons and advertising will prominently display one of nine attention-grabbing images that depict the dangers of smoking. These labels will make up 50 percent of the packaging or advertisement. Even retail stores will display the images, instead of tobacco brand logos.

Smokers will see images of a dead body, a gaping mouth ulcer, smoke coming out of a person's windpipe, a man unconscious wearing an oxygen mask, and a crying woman whose the victim of second-hand smoke among others.

Explicit written warnings will accompany each image, along with a toll-free phone number - 1-800-QUIT-NOW - to encourage and support people wanting to quit.

This initiative is part of an aggressive new strategy to take tobacco out of America's future. In a Twitter Q&A session, an FDA spokesman wrote, "Larger, graphic warnings are proven to communicate more effectively by getting consumer’s attention & impacting awareness. There are serious health consequences of smoking and these frank, honest images will encourage smokers to quit."

These warnings mark the first change in cigarette warnings in more than 25 years and are a significant improvement in communicating the dangers of smoking.

More than 30 countries/jurisdictions have similar packaging warnings.

The warnings

“The Tobacco Control Act requires the FDA to provide current and potential smokers with clear and truthful information about the risks of smoking – these warnings do that,” said FDA Commissioner Margaret A. Hamburg, M.D. She added in a White House press briefing that pack-a-day smokers will see these warnings about 7,000 times a year.

Cigarette manufacturers will be required to rotate these warnings on their products throughout the year. So every time a person buys a pack of cigarettes, they will see one of the following:

  • WARNING: Cigarettes are addictive
  • WARNING: Tobacco smoke can harm your children
  • WARNING: Cigarettes cause fatal lung disease
  • WARNING: Cigarettes cause cancer
  • WARNING: Cigarettes cause strokes and heart disease
  • WARNING: Smoking during pregnancy can harm your baby
  • WARNING: Smoking can kill you
  • WARNING: Tobacco smoke causes fatal lung disease in nonsmokers
  • WARNING: Quitting smoking now greatly reduces serious risks to your health

The human statistics

While smoking has become far less popular than it was in say the 1960s, millions of Americans remain hooked.

  • Some 46.6 million U.S. adults (20.6 percent of the adult population) are smokers
  • Nearly half of kids in grades 9 through 12 have tried cigarette smoking
  • Smoking among adults has decreased over the past decade
  • Rates have been stalled since 2004 Youth smoking rates did not decrease from 2006 to 2009
  • Each year millions of U.S. adults and children become new smokers
  • An estimated 365,000 youngsters under the age of 18 start smoking every year
  • Approximately 8,600,000 people in the United States have chronic illnesses related to smoking
  • 443,000 Americans die a tobacco-related death every year

Young people particularly vulnerable

Statistics show that the age at which a person starts smoking influences how much they smoke and how long they smoke. These facts then increase the risks of tobacco-related disease and death. So the consequences for young smokers can be particularly dire.

"It starts as a tool to fit in (if their friends smoke), then becomes a habit," said Zab Mosenifar, MD, Director of the Women's Guild Lung Institute at Cedars-Sinai Medical Center. "Early on, smell and odor is a problem. Then, as they continue it affects their lung, their heart, skin and blood vessels." Eventual health consequences from smoking include stroke, lung cancer, emphysema, bronchitis and heart attacks, Dr. Mosenifar adds.

The economic impact

In addition to being the number one cause of premature and preventable death in the United States, smoking costs the economy nearly $200 billion every year $96 billion+ in medical costs & $97 billion in lost productivity, according to the FDA.

And to remain a viable industry, tobacco companies spend billions to attract new users, increase use and generate favorable attitudes toward the habit. In 2006, the major U.S. cigarette manufacturers spent approximately $12.5 billion in marketing dollars. That's more than $34 million every day.

A large share of this money is aimed at young people. These efforts have included everything from fruit- flavored cigarettes, which have been banned, and sponsoring concerts to creating ads and logos to convey that smoking is cool, sexy or the in thing to do. And it has worked, but not for much longer.

The change process

“Our work to protect our children and improve the public’s health is not complete. Today, tobacco is the leading preventable cause of death not just in America, but also in the world.” That's what President Barack Obama said in June, 2009. 

This statement began a legislative effort that has resulted in sweeping packaging changes. These newly unveiled warnings, which were proposed in November 2010, are required under the Family Smoking Prevention and Tobacco Control Act which Congress passed and President Obama signed into law in 2009.

The FDA selected nine images from the originally proposed 36 after reviewing the relevant scientific literature, analyzing the results from an 18,000 person study and considering more than 1,700 comments from a variety of groups.

Secretary of Health and Human Services, Kathleen Sebelius said in a White House Press Briefing that the detailed study to test the effectiveness of the graphics and messages was the largest of its kind. The response to individual messages were measured within specific demographics, such as pregnant women, she noted.

Expected results

When asked if he thought the new labelling would be effective, Dr. Mosenifar said, "Yes, it will scare people."

The FDA expects the new warnings to decrease the number of smokers almost from the start with the U.S. having 213,000 by 2013. Additional smaller reductions are exected through 2031.

Sebelius says the law contemplates that people will become desensitized to the messages, so ongoing testing will be conducted to make sure the graphics continue to make a difference.

Part of a broader initiative

This FDA action is part of a broad Federal strategy called “Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan” being led by Assistant Secretary for Health, Howard K. Koh, M.D., M.P.H. .

Dr. Koh said in a White House briefing, "We're entering a new era in public health as we all work together for a tobacco-free future."

Reviewed by: 
Review Date: 
June 22, 2011