New Severe Warning Graphics on Cigarette Packages Will Save More Than Half Million Lives, Researchers Predict
/Graphic photos showing an array of severe consequences of smoking, which will be printed on all cigarette packages in the U.S. beginning in October 2022, will save an estimated 539,000 lives over the remainder of this century, according to new research by the Yale School of Public Health and a group of public health researchers at institutions in the U.S. and Canada.
But if a new rule requiring this vivid imagery had been implemented in 2012 as originally planned — only to be delayed by lawsuits and other intervening circumstances — an additional 179,000 deaths would have been averted from smoking-related diseases, according to the researchers.
“There was a lost opportunity here and people suffered as a result,” said Jamie Tam, assistant professor in the Department of Health Policy and Management at the Yale School of Public Health and the study’s lead author. “When tobacco industry litigation and delays with the [U.S. Food and Drug Administration] keep evidence-based policies from being implemented, public health pays a heavy price.”
“These much-needed warnings could not come soon enough,” Tam added. “Many countries around the world already have graphic health warnings on their cigarette packs, and they’ve saved many lives by doing so. It is past time for the U.S. to catch up.”
The current warnings on cigarette packages have not changed since 1984, according to the FDA. In a 2020 news release, the FDA indicated that the agency “undertook a science-based approach to develop and evaluate the new cigarette health warnings. These warnings focus on serious health risks that are less known by the public as being negative health consequences of smoking.” (Federal Register, March 18, 2020)
The FDA’s cigarette health warnings each consist of one of the following textual warning statements paired with an accompanying photo-realistic image depicting the negative health consequences of smoking:
WARNING: Tobacco smoke can harm your children.
WARNING: Tobacco smoke causes fatal lung disease in nonsmokers.
WARNING: Smoking causes head and neck cancer.
WARNING: Smoking causes bladder cancer, which can lead to bloody urine.
WARNING: Smoking during pregnancy stunts fetal growth.
WARNING: Smoking can cause heart disease and strokes by clogging arteries.
WARNING: Smoking causes COPD, a lung disease that can be fatal.
WARNING: Smoking reduces blood flow, which can cause erectile dysfunction.
WARNING: Smoking reduces blood flow to the limbs, which can require amputation.
WARNING: Smoking causes type 2 diabetes, which raises blood sugar.
WARNING: Smoking causes cataracts, which can lead to blindness.
Beginning next October, following numerous delays due to tobacco industry lawsuits, extensions related to COVID-19, and other challenges, the new U.S. Food and Drug Administration (FDA) rule will require that warnings be posted on all cigarette packages and advertisements.
The study’s findings are published in the journal JAMA Health Forum. The researchers stated “implementing graphic health warnings in 2012, as originally planned based on the FDA’s 2011 rule, may have been associated with 33.2% more smoking-attributable deaths averted and 42.7% more life-years gained, suggesting potential health consequences associated with delayed implementation and tobacco industry litigation.”
According to the rule, warnings must be printed on the front and back of each package and cover 50% of the packaging. These warnings will include a variety of 13 disturbing images that depict the consequences of tobacco use. According to the Campaign for Tobacco-Free Kids, 120 countries around the world already have graphic health warnings on cigarette packs. In Canada, which became the first nation to do so in 2001, these graphic images cover 75% of packaging.
“These warnings are designed to grab attention and make people think twice about lighting up,” said Rafael Meza, a professor at the University of Michigan and the study's senior author. “The consequences of smoking are dire. Fortunately, they can be prevented if people quit smoking.”
Theodore Holford, the Susan Dwight Bliss Professor Emeritus of Biostatistics and a senior research scientist in biostatistics at the Yale School of Public health, co-authored the paper. The research team also included scientists from the University of Michigan, the University of South Carolina, University of Waterloo in Canada, and the Georgetown University Medical Center. Holford is a member of the Connecticut Academy of Science and Engineering.
The researchers noted, in addition to the warnings set to appear next year, “the need for progressive policy action that goes beyond graphic health warnings.”
Portions of this article first appeared in Yale News.
