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Study: Do graphic warnings on cigarette packaging actually work?

Participants who received cigarettes in a standard US packet or in a blank packet with no marketing did not change their hiding behavior.

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Smoking kills sign on the pack of cigarettes. Dangerous habit. Harmful for health. Man holds lighter in hands.
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By Danny Halpin via SWNS

Graphic warnings on cigarette packaging leads smokers to hide their packets - but does not make them stub out the habit, according to a new study.

American researchers found that smokers who were given packets with graphic warnings hid them 38 percent more often than those without.

They also stopped hiding their tobacco when they returned to using regular packets.

Despite having been mandated by Congress in 2009 and commonplace in more than 120 countries, including the UK where they were introduced in 2008, graphic warnings have still not been rolled out in the US due to legal challenges from the tobacco industry.

Study lead author Professor John Pierce, of University of California, San Diego, said: “In a randomized clinical trial, we demonstrated that smokers in the US who received cigarettes in packs with graphic warning labels were less willing to display the packs in public.

“It has been hypothesized that this behavior could reduce perceptions by teens that it is socially acceptable to smoke, perhaps explaining why mandated graphic warning label packs are associated with reductions in teen smoking.”

In the UK in 2019 there were 6.9 million smokers, or 14.1 percent of the population. That had decreased from 14.7 percent the year before, according to the Office for National Statistics.

In the paper, published online by JAMA Network Open, Prof Pierce and his colleagues describe how they licensed images from Australia showing a diseased foot, a newborn with a breathing tube, and throat cancer and put them on cigarette packets.

They then signed up 357 smokers in San Diego who agreed to buy their preferred brand of tobacco from the study website.

Participants were randomized to receive their cigarettes in one of three packet designs: one with a graphic warning label, one blank and one in a standard, commercially available US packet.

About 19,000 packets were delivered to participants.

Senior author Professor David Strong, of the Herbert Wertheim School of Public Health, said: “Prior to the study, we found that many smokers in the US were discrete and reported hiding their usual pack in public settings.

“The packs with graphic warning labels had their main effect on those who were least likely to hide their packs prior to the study.

“We found no evidence that graphic warning-labelled packs changed smoking behavior over the year-long study.”

People continued to smoke as often as they did before and after the study.

During the study participants were asked by text message if, over the previous four hours, they had placed their packets out of sight of others.

Changes in consumption and smoking status were also assessed at the end of the three-month intervention and at the end of the 12-month study.

Participants who received cigarettes in a standard US packet or in a blank packet with no marketing did not change their hiding behavior.

Smokers who had been given the packets with graphic warnings reported that they had increased hiding over the first month of the intervention and continued at that new level until the end of the intervention.

After they stopped receiving the graphic warnings they quickly reverted to their old habits.

When social interactions were queried at the end of the study, the group with graphic warning packets reported that others reacted negatively to their packets while those with a blank packet reported others were expressing a positive interest in the study.

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