Cigarette pack warnings could get regular makeovers

All European cigarette packs could soon carry regularly updated graphic images of cancer-ravaged organs and health messages, according to Cancer Research UK experts.

Researchers from the Cancer Research UK Centre for Tobacco Control Research will reveal the results of their study into the effectiveness of tobacco warnings at the 12th World Conference on Tobacco or Health in Finland.

The results show that warnings can become ‘worn out’ and ignored by smokers. To beat this ‘warning fatigue’ the next wave of warnings will have to be regularly ‘refreshed’ to engage smokers.

The study’s aim was to understand the extent to which the new messages were appropriate for smokers in Europe and how to provide targeted and relevant health messages for them. It was commissioned by the European Commission as evidence to support the European Union¹s Directive On Tobacco Product Regulation.

Experts based at the Cancer Research UK Centre for Tobacco Control Research at the University of Strathclyde led a consortium of six other European cancer research groups based in Finland, France, Germany, Greece, Spain and Sweden. 56 focus groups, involving smokers aged 16-64, were conducted across the seven countries.

The groups looked at the old pre-2001 small warnings, the current large ‘black on white’ warnings, a wide range of health and supportive messages and pictorial warnings.

The results showed that it was vital for the warnings to be continually ‘refreshed¹ to avoid smokers becoming immune to them.

Professor Gerard Hastings, Director of the Cancer Research UK Centre for Tobacco Control Research at the University of Strathclyde, says: “Basically the old small warnings had ‘worn out’, and were no longer effective.”

Professor Hastings adds: “Future warnings will have to be reviewed and refreshed, maybe annually or every few years. Otherwise we will fail to communicate the dangers of tobacco to smokers because of this ‘warning fatigue.'”

Throughout Europe there was also an opinion that the old, small warnings were simply paying lip service to the idea of cautioning smokers on the dangers of smoking.

“Many smokers believed the old warnings were just a ‘get out’ clause for the government or tobacco industry. Smokers believed the government was tied to tobacco tax revenue, but felt a duty to murmur a health warning. They were not seen as genuine attempts to help the smoker,” says Hastings.

However the current ‘black on white’ warnings stirred interest and provoked discussion among smokers. The most popular ones in the UK among those considering quitting were the ‘support appeals’ like helpline numbers. The other message types tested were ‘health appeals¹ (eg ‘smoking kills’) and ‘social appeals’ (eg ‘protect children from passive smoke’). These were generally quite effective.

These large prominent warnings were considered more credible and they also made more people consider the ill effects of smoking.

However there are concerns that these warnings will also become ‘worn out’. The study suggests that one of the best methods of refreshing them will be to add graphic images.

The focus groups were shown a selection of graphic images used on Canadian cigarette packs. These were very effective at attracting attention, but were less popular with smokers and made many feel defensive. However the researchers suggest that the images could be balanced with ‘support appeal’ messages.

Elinor Devlin, Research Officer at the Cancer Research UK Centre for Tobacco Control Research, says: “This is a careful balancing act: there is a need to grab attention, but we want smokers to then interact with the warnings, not feel victimized. Warnings should offer information to smokers so they know all the risks. A smoker then has facts to inform their decision on whether they should consider giving up.”

Devlin adds that the impact of the images is largely in their novelty. She adds: “To maintain the attention-grabbing quality they will need to be updated regularly otherwise smokers will even tune an image out in due course.”

Attempts to draw smokers into a dialogue about their habit via the health warnings were generally welcomed by smokers in the study.

Many smokers were interested in how to improve the warnings. Suggestions from smokers included web addresses of support organisations or statistical evidence of the number of people that die from smoking related diseases as opposed to other causes, such as traffic deaths. Smokers also wanted extra information available inside the pack from respected health organisations.

Jean King, Cancer Research UK¹s Director of Tobacco Control, says: “Cigarette packaging is an important area for the tobacco industry. They spend large amounts of money to ensure that smokers are effectively lured to the product.

“The package builds brand through design, colour and wording. The health messages have the potential to disrupt this branding and combat the tobacco industry with accurate information.”

ENDS