NEW YORK—Resorting to shock and awe in its antismoking campaign, US health officials on Tuesday released their final selection of nine graphic warning labels to cover the top half of cigarette packs beginning next year, over the opposition of tobacco manufacturers.
The US warnings—the biggest change to the labels in 25 years—use images such as a diseased lung, a smoker wearing an oxygen mask, cigarette smoke coming out of a tracheotomy hole in a man’s neck, and a sewn-up corpse.
The Department of Health and Human Services selected the nine color images from among 36 proposed to accompany larger text warnings.
The new warning labels will take up the entire top half—both front and back—of a pack of cigarettes. They must also appear in advertisements and constitute 20 percent of each ad.
Cigarette makers, which have to run all nine labels on a rotating basis, were given until the fall of 2012 to comply.
Critical moment
The Food and Drug Administration (FDA) estimates the new labels will cut the number of smokers by 213,000 in 2013, with smaller additional reductions through 2031.
“This is a critical moment for the United States to move forward in this area,” Dr. Margaret A. Hamburg, head of the FDA, said in an interview.
“The trends in smoking really support the need for more action now. For four decades, there was a steady decline in smoking, but five to seven years ago, we leveled off at about the 20-percent level of adult and youth smoking in this country,” Hamburg said.
The rate of smoking in America has been cut roughly in half to 19 percent from 42 percent in 1965. Each day, however, an estimated 4,000 youths try their first cigarette, and 1,000 a day become regular smokers.
Smoking remains the leading cause of preventable death, killing 443,000 Americans a year, according to government data. Tobacco use also costs the US economy nearly $200 billion annually in medical costs and lost productivity.
Praises, protests
The government move drew praise from health advocacy groups but protests from cigarette manufacturers.
“These labels are frank, honest and powerful depictions of the health risks of smoking, and they will help encourage smokers to quit, and prevent children from smoking,” Kathleen Sebelius, the secretary of health and human services, said in a statement.
“We are pleased with the images they picked,” said Nancy Brown, chief executive of the American Heart Association. “They strongly depict the adverse consequences of smoking. They will get people’s attention. And they will certainly be much more memorable than the current warning labels.”
Gregory N. Connolly, a professor and tobacco expert at the Harvard School of Public Health, also praised the strength of the warnings.
But Connolly said the FDA needed to take tougher action against cigarettes. “What’s on the pack is important, but if you really want to cut smoking rates, you’ve got to get inside the pack and deal with ingredients like menthol and nicotine,” he said.
Legal action
The four leading tobacco companies in America, however, threatened legal action, saying the images would unfairly hurt their property and free speech rights by obscuring their brand names in retail displays, demonizing the companies and stigmatizing smokers.
A submission to the FDA by R.J. Reynolds, Lorillard and Commonwealth Brands, the second, third and fourth largest US cigarette makers, said the “nonfactual and controversial images were intended to elicit loathing, disgust and repulsion” about a legal product.
The Altria Group, the largest US tobacco company, said it would not comment. Altria, the parent company of Philip Morris, the only major tobacco company to support the overall FDA legislation, said in a letter this year that the graphic warning provision was an unconstitutional part of the law “added in a last-minute amendment.”
Powerful messages
The government acknowledges that the new warning labels are graphic but much-needed.
“Some of the powerful images certainly are a reminder of the health risks. Some of the images like the one of the mouth with the sort of rotting, dirty teeth and the ulcerating lesion on the lip are also reminders that smoking causes disfigurement,” said FDA Commissioner Hamburg said at a White House briefing.
“And I think that those are very powerful messages,” she added.
The government surveyed 18,000 Americans of all ages to determine which of the 36 proposed labels would be most effective to deter smoking. The FDA can revise the selection of images in the future.
The nine images chosen include some of the less vivid, including a cartoon depiction of a baby rather than a photo in the draft set that showed a mother blowing smoke at a baby.
The images also include one of a man proudly wearing a T-shirt that says: “I QUIT.”
Landmark law
The new labels were required under landmark antismoking legislation giving the FDA power to regulate—but not ban—tobacco products.
The Family Smoking Prevention and Tobacco Control Act required FDA action on the graphic warning labels by Wednesday, two years after President Obama signed it into law.
Under the new law, all cigarette packs must also display a toll-free telephone number for smoking cessation services.
The FDA has already proposed nine text warnings to be paired with the graphic images, including: “Warning: Cigarettes cause cancer” and “Warning: Quitting smoking now greatly reduces serious risks to your health.”
Unswayed
Still, a few smokers surveyed on New York sidewalks were unswayed by the images.
Khariton Popilevsky, 46, a pawnbroker, shrugged and said: “Telling me things we already know. I’ll still be smoking.”
Hayley Sapp, 28, a paralegal, said: “There are lots of other high risks out there, you know. Obesity is huge.”
Saiful Islam, 34, a convenience store clerk, said higher prices would cut sales a lot more than the images on cigarette packs. Reports from AP and New York Times News Service