A new study from the National Centre for Social Research (London) and the Institute for Social Marketing, University of Sterling shows no effect of England's graphic warning labels on cigarette smoking. The study consisted of two waves of surveys, one conducted before the implementation of the graphic warning labels and one conducted afterwards. The graphic warning labels were introduced in October 2008. The second wave of interviews was conducted in the summer of 2010. Thus, the warning labels had been in effect for nearly 2 years at the time of the second wave survey.
The following were the major findings of the study regarding the effects of the graphic warning labels on smoking behavior:
1. There was no observed effect of the graphic warning labels on cigarette smoking prevalence.
2. There was no observed effect of the warning labels on cigarette consumption.
3. There was no observed effect of the warning labels on smoking reduction (measured as forgoing cigarettes due to the warning labels).
Thus, there was no observed effect of the new warning labels on any aspect of smoking behavior.
The report concludes: "Smokers were more likely to report that the warnings messages made them think about their smoking behaviour and thought about quitting smoking after the pictures warnings were introduced. However, as yet, these ‘emotional’ responses have not been translated into behavioural change. It remains to be seen whether such transitions are observed once the picture health warnings have been in circulation for a longer period of time."
The report also concludes: "Forgoing a cigarette when about to smoke one; stubbing out a cigarette or using a variety of techniques to avoid viewing the health warnings messages are important behavioural responses to the health warnings. Among both adults and young people, the prevalence of forgoing a cigarette or stubbing a cigarette out did not change post implementation of the pictures. However, using techniques to avoid viewing the health warnings messages (such as covering up the messages or using a case or container) increased significantly post 1st October 2008."
The report summarizes its findings as follows: "The only significant change in behaviour was that more adult smokers reported using a technique to avoid seeing the messages. It therefore remains to be seen whether these emotional responses are translated into behavioural change in the future. Among young people, the impact of picture health warnings was negligible."
The Rest of the Story
Although there was high recall for the graphic cigarette warning labels, these report finds no evidence that these labels had any impact on smoking behavior of either youths or adults. In fact, the only change in smoking behavior observed in this study was that smokers were more likely to cover up the warning labels to avoid having to see them.
This study provides significant evidence that graphic warning labels did not have any profound effect on cigarette smoking behavior after their introduction in England. While the authors of the report suggest that with time, the warnings could have an effect, I believe the opposite is the case. The impact of the warning labels is likely to be greatest when initially introduced because of the shock value of the images. This immediate effect is likely to wane over time. In fact, I think it is likely that the warning labels could have had a small, but immediate effect on smoking behavior that was missed by the study because the follow-up survey was conducted so long after the warning labels were introduced. Nevertheless, any such immediate effect does not appear to have had any substantial sustained effect on smoking behavior.
While this is just one country's experience, the results of the study do support my prediction that the graphic warning labels soon to be introduced in the United States will have no substantial effect on cigarette consumption. The only piece of the Family Smoking Prevention and Tobacco Control Act which I believe had any chance of having a significant positive effect on the public's health looks like even it will not produce any tangible results. Thus, I continue to believe that the Tobacco Act was an unmitigated disaster for the public's health, and a great victory for the tobacco companies, especially for Philip Morris.
I contend that you are not going to out-negotiate the tobacco companies at the bargaining table. The Campaign for Tobacco-Free Kids thought they could, but they failed miserably. They should have learned their lesson from the failed 1997 global tobacco bailout and the successful (from the point of the tobacco companies) 1998 global tobacco settlement: you cannot outsmart the tobacco companies in the negotiating room. They will take public health groups to the cleaner any day.