Graphic Pictorial Warnings Reduce Smoking in Canada, Researchers Say US Should Follow Suit

In the year 2000, Canada introduced a set of new cigarette warning labels that included graphic images of rotting teeth and other scenes that portray the negative health effects of cigarette smoking. Now, a study of Canadian smoking habits before and after the event reveals that since the introduction of the labels, the smoking rate in Canada fell between 12 percent and 20 percent by 2009.

The researchers behind the study say that it could have some real-world impacts on smoking in the United States and that US policymakers have markedly underestimated the effectiveness of the graphic warning label system.

As the majority of Canada's major cities are close to the US border and the country shares more cultural similarities with the US than any other, the researchers contend that Americans would likely smoke less if cigarette packages had graphic warning labels.

By using a statistical model to compare smoking in Canada nine years before and nine years after the introduction of graphic warning labels, Jidong Huang and Frank J. Chaloupka of the

University of Illinois at Chicago and Geoffrey T. Fong of the University of Waterloo and the Ontario Institute for Cancer Research in Canada, report that smoking rates in Canada decreased sharply after the introduction of the graphic warnings, and that in the nine years before and after 2000, smoking rates in the US, where there were no such warning labels or any changes in labeling practices, did not decline as significantly as Canada's.

The researchers estimate that a Canadian-style warning system offers a potential reduction in smoking rates up to 53 times larger than what the US Food and Drug Administration (FDA) predicts would occur if a similar system were adopted.

"These findings are important for the ongoing initiative to introduce graphic warnings in the United States. The original proposal by the FDA was successfully challenged by the tobacco industry, and the court cited the very low estimated impact on smoking rates as a factor in its judgment," Huang said. "Our analyses corrected for errors in the FDA's analysis, concluding that the effect of graphic warnings on smoking rates would be much stronger than the FDA found. Our results provide much stronger support for the FDA's revised proposal for graphic warnings, which we hope will be forthcoming in the near future."

According to Canada's Tobacco Labeling Resource Center, there are 39 countries which require pictorial warning labels on cigarette packaging, including Australia, Thailand, Egypt, India and Brazil.

"Canada was the first country to introduce pictorial warnings, and many other countries have since been inspired to use this powerful method of communicating the harms of cigarettes and other tobacco products," said Melodie Tilson, Policy Director of the Non-Smokers' Rights Association. "Evidence shows that plain packaging both reduces the appeal of tobacco products and increases the effectiveness of health warnings."