Health warnings on individual cigarettes could lower smoking rates

A new study from the University of Stirling’s Institute of Social Marketing has found that simply adding the warning “Smoking kills” on each cigarette rather than just on the outer package has the potential to reduce the number of people who smoke significantly. The study was published in the journal Addiction Research & Theory on August 29, 2019.

Smokers were asked to describe how they felt about the individual warning on each cigarette, and overall there was a strong agreement that it could well deter young people who don’t smoke or are just beginning to smoke.

The Framework Convention on Tobacco Control states the principle of informing consumers about tobacco-related risks. This has mostly been achieved using statutory warnings on cigarette packages.
These warnings have become bigger and bolder over the years, and are often required to cover at least half of the display package area. However, individual cigarettes can be used to warn smokers of the dangers.

This approach is part of the Scottish government’s anti-tobacco campaign called “Raising Scotland’s Tobacco-free Generation”, which began in June 2018. Other action points include changing the color and composition of cigarettes.

The government of Canada has also published the results of their discussions on the proposal to label tobacco products, including individual cigarette-based warnings, in the first part of this month.
However, tobacco companies opposed the move, partly because there is no evidence that these warnings influence smokers to start, maintain or stop the smoking habit.

Studying the effect of changes to individual cigarettes

The present study looks at this aspect, exploring the way smokers respond to the warning on the cigarettes. Three older British studies have already looked at this area, among 11-16-year-olds, 16-24-year-olds, and 16-34 year-olds. The second group included both smokers and nonsmokers, while the third was composed only of smokers.

The participants were asked to compare regular cigarettes to those which were colored an ugly color (green) or had the warning on each stick. The consistent trend was lack of appeal, perception of harm, and a lower desire to smoke with the ugly or warning-mounted cigarettes. This has been confirmed by other studies of the same kind.

In total, the research included 120 smokers aged at least 16 years, in Glasgow and Edinburgh, in 20 small groups based on age, gender, and social stratum, how they felt about seeing the warning on every cigarette.

All the groups felt that this kind of warning had the potential to create some effect on themselves or on others. The primary gain from this technique is that the message is now visible to all the new and young smokers as well as those who don’t smoke yet.

How was the study helpful?

Both smoking and second-hand smoking are predicted to decline in countries which have adopted plain packaging. Similarly, the researchers in the current study have previously predicted that this would occur if cigarettes themselves display clear warnings.

With this approach, smokers say that seeing the warning on every cigarette prolongs the message for much longer since it is seen with every fresh cigarette taken from the pack, on half-smoked cigarettes in the ashtray, and on the cigarette in one’s hand while it is being smoked.

Another aspect of putting warnings on individual cigarettes is the negative image of smoking that it creates. Especially among females, smokers associated this display with depression, worry and fear, reducing the enjoyment of the experience of smoking. Many smokers, mainly those who were younger, said they smoked less of each cigarette, cut down on the number of cigarettes, or even quit.

This study suggests that the introduction of such warnings could impact the decision-making of these groups. It shows that this approach is a viable policy option and one which would - for the first time - extend health messaging to the consumption experience.”

Crawford Moodie, First Author

The warning may work in several ways: it forces smokers to confront the results of their choice upfront, reduces the appeal of smoking for those who haven’t yet begun, provides a much longer duration of warning, keeps reminding smokers of their risks with each cigarette, and precludes the possibility of avoiding the message. However, constant exposure may also wear down the intensity of the warning over a relatively short time.

Real-life responses

The qualitative nature of the study meant it explored individual responses as well as the mean trend. Several salient comments include:

On how smoking such a cigarette would look: “Someone who had been smoking for a long time and couldn’t give up. Didn’t have the willpower - older.”

On how others perceive the smoker in this case: “The main problem for me would be people being able to see. They’d question you more on it, like, ‘Why are you doing that?”

On the emotional response: “It’s not so bad between people who smoke cause you are in the same position, but if you were with friends who don’t smoke, it would be a bit embarrassing.” “Maybe gives you a wee (small) bit of a guilt trip as well cause you’re standing there with that in your hand and you’ve got kids to think about.”

On the stimulus to quit smoking: “A lot of people wouldn’t even smoke it, and you wouldn’t even get a couple of draws.” “I actually have reasons to quit and I’m just being reminded every single time that I smoke.”

And conversely, the truly addicted say: “Warnings are nae (not) going to make any difference to an ardent smoker.” This group, interestingly, was mostly male, mostly from lower social scales, and said that if they quit it would be to save money or for health reasons.

On the deterrent effect: “I think for new smokers looking at it, they’d be like ‘oh I don’t want to do that.” “It was cool, you know, to be doing it, but if there was a blatant message on the cigarettes, I think I was intelligent enough to go no way… I didn’t know it was as bad.”

Cancer Research UK responded to the research with a statement:

Government anti-smoking campaigns and tax rises on cigarettes remain the most effective methods to stop young people starting smoking, but we need to continue to explore innovative ways to deter them from using cigarettes to ensure that youth smoking rates continue to drop. This study shows that tactics like making the cigarettes themselves unappealing could be an effective way of doing this.”

Journal reference:

Extending health messaging to the consumption experience: a focus group study exploring smokers’ perceptions of health warnings on cigarettes. Crawford Moodie,  Rachel O’Donnell, Joy Fleming, Richard Purves, Jennifer McKell & Fiona Dobbie. Addiction Research & Theory. https://doi.org/10.1080/16066359.2019.1653861.