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Cigarette warnings getting graphic

FDA reveals new labels required on packages, ads

The FDA hopes gruesome warning labels will encourage smokers to quit and deter others. The FDA hopes gruesome warning labels will encourage smokers to quit and deter others. (Kayana Szymczak for The Boston Globe)
By Deborah Kotz and Neena Satija
Globe Staff And Globe Correspondent / June 22, 2011

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Cigarette packages will soon be splashed with horror-movie-style warning labels showing corpses, diseased lungs, and rotted teeth, which were among nine new images unveiled yesterday by the Food and Drug Administration. By September 2012, cigarette manufacturers will be required to place these images across the top half of every pack, with large-type warnings such as “smoking can kill you’’ and “cigarettes are addictive.’’

The new images will replace the small white warning boxes that have adorned cigarette packages unchanged for more than two decades; they are required under a federal law passed in 2009 that gave the FDA regulatory authority over cigarettes. The same new warnings will appear on print ads and must take up at least 20 percent of the ad space.

“The new graphic warnings will make a powerful difference,’’ FDA Commissioner Dr. Margaret A. Hamburg said in an interview. “Research demonstrates that they encourage smokers to quit and nonsmokers to not start.’’

Packages will also contain the 1-800-QUIT-NOW toll-free telephone number, she added, to provide smokers with a resource to help them quit.

Greg Connolly, a professor at Harvard’s School of Public Health and former director of Massachusetts’ tobacco control program, called the new labels “a marvelous improvement over what we’ve had for over 25 years.’’ But he cautioned that they won’t work unless they’re accompanied by a mass media campaign, similar to ads that Massachusetts and some other states have aired featuring “real people telling real stories.’’

While graphic warning labels appear to galvanize people to quit in the short term, there is no evidence that those smokers quit for good, he added.

Some 43 countries, including Canada, Great Britain, and Brazil, already require large graphic warnings on cigarette packages, and a European Union directive gives its 27 member countries the option of adding pictures to warnings as a way to educate smokers about risks.

A 2006 study found that two-thirds of smokers in four countries that have graphic warning labels reported that the package was an important source of health information and strongly associated with an intention to quit smoking.

David Pham, a Boston financial analyst, remembers his reaction when a friend offered him a cigarette from a Canadian box featuring the warnings. “I didn’t even want to smoke anymore . . . I told him I’ll pass,’’ said the 28-year-old. But while he’s been trying to quit ever since, he still smokes up to a pack a day. “When you need a fix, you’re still going to buy it,’’ he said as he puffed on a cigarette outside his office near South Station.

Matthew Myers, president of the nonprofit advocacy group Campaign for Tobacco-Free Kids, said the current warning labels have lost their effectiveness and the new, more graphic warnings “counter images that the tobacco industry is seeking to project — that smoking makes a person strong, cool, and independent.’’

Indeed, one can clearly see the consequences of a smoking-induced heart attack in the face of a man, lying with his tie askew, whose nose and mouth are covered with an oxygen mask. While warning labels will no longer mention lung cancer and emphysema, they will show tobacco’s devastating effects through images of smoke seeping out of a tracheotomy hole in a smoker’s neck.

Connolly was concerned that some of the labels could be seen as demeaning to smokers. “People just turn off,’’ he said. And he also noted that the industry has a track record of countering federal regulations.

Last year, the FDA banned the sale of tobacco products with descriptors such as “light,” “low,” or “mild,” saying they misled consumers to believe that such products were less damaging to their health than other cigarettes. But manufacturers replaced the words with colors that critics say convey the same message. And a recent Harvard School of Public Health survey found that an overwhelming majority of smokers of brands formerly labeled light, medium, or ultra-light said they could easily identify their usual brand of cigarettes by color, even without the descriptors. “That’s not a good success story,’’ said Connolly.

The results of the survey will be released today at a conference examining FDA regulation of tobacco.

Cigarette manufacturers are challenging the legality of the new labels in a federal lawsuit and say the size of the warnings make the company brands “difficult, if not impossible, to see.’’ They claim the 2009 law violates their right to free speech. A spokesperson for Altria, which owns Philip Morris, said in an e-mail that the company is reviewing the new images but made no further comment.

Before selecting the nine images, the FDA conducted studies involving 18,000 participants — including children, pregnant women, and seniors — to determine which graphics had the most powerful effects.

An estimated 47 million people smoke in the United States, and nearly half a million die every year of smoking-related causes. In Massachusetts, more than 8,000 residents die each year from the effects of smoking, and 1,000 or more die from the effects of secondhand smoke, according to the state Department of Public Health.

On the streets of Boston, the new warnings received a mixed reaction from smokers. “This is gross,’’ said 24-year-old makeup artist Stephanie Johnson as she flipped through printouts of the nine images with a Camel between her fingers. “I don’t think it’s really that necessary.’’

Johnson’s first memory of cigarettes is her aunt’s box of Newports, always resting on a coffee table or countertop during family functions. Had those boxes included a picture of a corpse, Johnson acknowledged, she might have thought twice before she began smoking in college.

“I would have thought, ‘That’s the gross stuff that makes your lungs icky,’ ’’ she said.

But Christopher Comeau, who started smoking when he was 12, doesn’t think the labels would have had any impact on him. “I already know it’s bad for me. But I do it anyway,’’ he said and reached for his pack of cigarettes. “Now I want another one.’’

Deborah Kotz can be reached at dkotz@globe.com.

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