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Would a photo of charred lungs or a large neck tumor make you put down a pack of cigarettes? Graphic warning labels on cigarette packaging can help increase awareness of the dangers of tobacco use and possibly reduce cigarette smoking. These types of warnings have been mandated by Congress since 2009. However, the U.S. Food and Drug Administration’s plans to implement them in 2012 and 2020 have been stalled by repeated litigation by the tobacco industry.

Example of cigarette graphic“Smoking remains the leading preventable cause of disease and death in the U.S. Seeing realistic images depicting health consequences on cigarette packages can make an impact on those who smoke. We have substantial evidence these warnings are effective at curbing smoking in many other countries worldwide,” said Dr. Bethany Shorey Fennell, a postdoctoral fellow in Dr. Jenny Vidrine's lab in the Department of Health Outcomes & Behavior at Moffitt Cancer Center

A team of Moffitt researchers, in collaboration with Washington State University Vancouver and the University of California, Merced, conducted a study to quantify the impact the most recent images proposed by the FDA could have on important predictors of tobacco use. They surveyed two groups of smokers: people who smoke daily and nondaily. Each group was shown the 13 FDA proposed graphic warning labels, as well as 13 text-only warning labels. After viewing each warning, participants were asked five questions designed to assess whether the warning label improved understanding of smoking risks, provided new knowledge about the consequences of smoking, induced worry about tobacco use, discouraged them from wanting to smoke and was believable.

photo of Dr. Bethany Shorey Fennell standing in front of her scientific poster

Dr. Bethany Shorey Fennell presents her findings at the Moffitt Scientific Symposium in May 2023.

“Overall, we found that graphic warnings were rated as far more impactful than text-only warnings by both groups. However, the graphic warnings seem to have an even more robust effect on people smoking nondaily,” Fennell said. Adults smoking nondaily rated the graphic warnings as more discouraging than did daily smokers. People smoking nondaily also found graphic warnings, compared to text only, especially believable and effective at conveying new knowledge about smoking consequences.

Globally, more than 120 countries have cigarette packaging featuring graphic warning labels. Evaluating how well the proposed FDA warnings work for Americans builds evidence that could facilitate congressional approval of these warnings being added to cigarette packages in the U.S.