Warnings on Cigarette Packs May Keep Ex-Smokers From Relapse

WEDNESDAY, April 25 (HealthDay News) — Warnings on cigarette
packages about the health hazards of smoking can help deter many
ex-smokers from lighting up again, a new international study finds.

The findings may be especially timely for policymakers in the United
States, since the U.S. Food and Drug Administration is poised to mandate
graphic anti-smoking images on cigarette packaging in September.

One expert said he believes smokers and ex-smokers need more reminders
of the ravages of smoking.

“I keep an empty package of cigarettes at hand when talking to smokers,
and ask them if they look at the warnings,” said Dr. Len Horovitz,
pulmonary specialist at Lenox Hill Hospital in New York City. “While most
say that they do, they cannot repeat more than two health risks — usually
lung cancer and emphysema are the responses.”

Horovitz believes that more prominent warnings — especially about
non-lung-cancer conditions such as heart disease, bladder cancer and
erectile dysfunction — would help more ex-smokers stay that way.

The new findings, published April 25 in the journal Tobacco
Control
, are based on a poll involving about 2,000 former smokers in
Canada, Australia, Britain and the United States.

The content and graphic nature of cigarette-package warnings varies
widely between these countries, the authors noted. Regardless of
nationality, however, the survey found a common trend: ex-smokers who said
they found anti-smoking messaging on packaging helpful were more apt to
avoid relapse.

“This study provides the first evidence that health warnings can help
ex-smokers stay quit,” researchers led by Dr. Ron Borland of the VicHealth
Centre for Tobacco Control at the Cancer Council Victoria in Carlton,
Australia, said in a journal news release.

The team believes the anti-smoking messages “help generate reasons for
resisting temptations to relapse.”

In the United States, public health messaging on cigarette packaging is
now the subject of considerable debate and potentially dramatic change.
The FDA has already approved plans to overhaul the packaging of all
cigarettes sold in the United States by replacing text-only warnings (in
place since 1984) with extremely graphic cautionary images, some of which
depict smoking-related disease.

Although a court battle over the FDA’s plan is now underway, nine such
images already have been composed, illustrating things such as a smoker
exhaling through a tracheotomy hole in his neck and a mother and child
enveloped in a cloud of cigarette smoke. Images would cover the top
section of all cigarette packs.

One expert believes these images and warnings will help cut U.S.
smoking rates.

“Although U.S. citizens are not routinely exposed to warning labels on
cigarette packs, many have seen graphic commercials and advertisements
related to the health effects of tobacco use,” said Patricia Folan,
director of the Center for Tobacco Control at the North Shore-LIJ Health
System in Great Neck, N.Y. “When these types of commercials are aired,
calls to state smokers’ quit-lines have increased dramatically. This
increase in calls indicates that the ads appear to be motivating smokers
to quit.”

In Canada, similar graphic warnings have been in place since 2000,
covering half of each pack’s surface on both sides. Since 2006, graphic
warnings have covered 30 percent and 90 percent of the cover and back,
respectively, of all cigarette packs sold in Australia. In the United
Kingdom, text-only warnings have taken up 30 percent and 40 percent of the
respective fronts and backs of all packaging.

The survey was conducted between 2002 and 2009. Smokers were tracked
for a year, at which point they indicated their thoughts on package
messaging exposure, as well as their current smoking status.

In all, nearly 58 percent of smokers who had quit remained free of
cigarettes by year’s end. Those who said they viewed such messages as very
helpful had a relapse rate of 41 percent, compared with a rate of 50
percent among those who said the messages were not particularly
helpful.

Meanwhile, another international study also published in the same issue
of Tobacco Control suggests that during the next two decades the
global rate of smoking will barely drop unless governments improve their
anti-smoking policies.

In the study, a team led by Dr. David Mendez, of the department of
health management and policy at the University of Michigan’s School of
Public Health in Ann Arbor, looked at the situation in the 60 nations that
account for 90 percent of all smokers (and 85 percent of the world’s
population). They speculate that unless these countries’ governments
change course and push for effective anti-smoking initiatives by 2030, the
global rate of smoking will fall by only 1.7 percent.

If these nations were to adopt the World Health Organization’s 2008
package of anti-smoking measures, however, global smoking prevalence would
drop from roughly 24 percent today to about 13 percent by 2030.

Such measures include the implementation of tobacco monitoring,
second-hand smoke exposure protection, cessation assistance, publicity
about health dangers, bans on cigarette advertising, and cigarette
taxation.

The study authors noted that the nations with the largest smoking
populations include China (28 percent of the world’s smoking population),
India (11 percent), Indonesia (5 percent), the United States (5 percent)
and Russia (4 percent).

More information

For more on the proposed U.S. cigarette-package warning labels, head to
the U.S. Food and Drug Administration.

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