Smokers say bigger, clearer health warnings on cigarette packs are more likely to encourage them to quit – according to international research part-funded by Cancer Research UK published today (Tuesday).
The study of smokers’ reactions to the text and pictorial health warnings used in different countries shows that large, prominent written messages are more likely to be read and encourage a change in behaviour, but that graphic images are more effective still.
The findings provide strong support for the UK Government’s proposal to add pictorial warnings to cigarette packs and offer important insights on how the impact of the images can be maximised.
Cancer Research UK’s Professor Gerard Hastings, of the Institute of Social Marketing at the University of Stirling, said: “We know that health warnings work and can save lives as a result. But this study shows that the design and freshness of the message affects how well it does its job.
“More prominent messages are more effective, but graphic pictures have an even greater impact. Importantly, changes in health warnings are also associated with increased effectiveness, which means that regular revamps are key.”
The team compared the impact of the health messages on cigarette packets in four countries – Canada where pictorial images are used, and the USA, Australia and UK where, at the time of study, only text messages were mandatory*.
The most prominent warnings – the graphic images on Canadian cigarette packets – had the most impact. Whereas the least prominent – found on the sides of packs sold in the USA – had comparatively little impact on smokers’ awareness of health risks and their motivation to quit.
Recent enhancement of UK warnings led to higher levels of awareness. However, the impact of these text-only warnings was lower for more important measures, such as thinking about the health risks of smoking and whether the messages made smokers actually forego a cigarette they were about to smoke. For these key indicators, the pictorial warnings had greater impact.
Almost 15,000 smokers in total were surveyed over a period of four years on their awareness of the health messages, any changes in understanding of the risk of smoking, their intention or motivation to quit and any changes in behaviour they had noticed in themselves.
Jean King, director of tobacco control at Cancer Research UK, said: “This research is particularly timely. The UK Government has already pledged to introduce pictorial warnings on cigarette packs and we hope the findings from this study will inform these plans to maximise their effect.
“We urge the Government to bring in graphic warnings – using the hardest hitting images available – at the earliest opportunity. We would also like to see the Government lobby the EU Commission to enable warnings to be placed on the front as well as the back of packs, and to ensure that the bank of pictures is regularly updated to prevent ‘image fatigue’.”
For media enquiries, please contact Sophy Fitzpatrick in the Cancer Research UK press office on 020 7 061 8318 or, out-of-hours, the duty press officer on 07050 264 059.
High-resolution images of the Canadian graphic health warnings are available to download here.
Hammond D et al. Text and graphic warnings on cigarette packages. American Journal of Preventive Medicine 2007; 32(3):202-209
This study is part of the International Tobacco Control Policy Evaluation Project, a research collaboration that is conducting studies on the impact of tobacco policies in 13 countries.
*Australia introduced pictorial health warnings in 2006.