Research shows graphic images get smokers' attention

(Medical Xpress) -- They say a picture is worth a thousand words, but its worth might just be measurable in terms of lives, according to research by a University of South Carolina public health professor.

That’s because visual imagery on cigarette packages deters smoking, and the more graphic they are, the better the results, said Jim Thrasher, assistant professor in the Arnold School of Public Health Department of Health Promotion, Education and Behavior.

“Tobacco use continues to be the leading cause of preventable death in the United States, and graphic health warnings are among the most cost-effective interventions that exist,” Thrasher said.

As a result, the recent decision by a U.S. federal judge to entertain tobacco industry arguments against putting graphic warning labels on cigarette packages next year refuses to recognize the public health benefits of similar measures in other countries , he said.

“This preliminary injunction indicates that the United States places greater value on deadly commercial speech than on public health,” said Thrasher, who leads a variety of international research projects to assess the impact of cigarette warning labels around the world.

His research consistently shows that warnings with imagery that illustrates the consequences of smoking are more effective than warnings with only text in increasing teens’ and adults’ understanding of smoking risks.

The two most effective strategies show physical damage to the body and integrate personal testimonials.

“Compared to abstract imagery or information, evocative imagery is better able to communicate the range and magnitude of harms from smoking,” Thrasher said. “Pictures of bodily harm and pictures that depict human suffering work well across cultural groups,” he said.

Thrasher and his team work with governmental and research institutions in China, India, Bangladesh, South Korea, Guatemala, Honduras, Germany, and the United States. This work involves assessing adult smokers’ and adolescents’ responses to different kinds of warning label content, sizes and designs.

As a result of his work with colleagues from Mexico’s National Institute of Public Health, Mexico’s Minister of Health adopted their recommendations for which pictorial warnings to put on cigarette packages, which began circulating in September. T
hrasher, who has a joint research and faculty appointment with Mexico’s National Institute of Public Health, is also assessing what labels are the most convincing for low socioeconomic status groups. “There is an increasing concentration of smoking among populations with lower education. Our research suggests that people with lower education respond most strongly to the warnings that are the most graphic, perhaps because of issues related to health literacy” Thrasher said.

Thrasher and his colleagues are also testing the impact of “plain” packaging that removes attractive design and brand elements, such as colors and logos, from cigarette packaging.

“Plain packaging reduces consumer misunderstanding of tobacco-related health risks, it enhances the effects of warning labels, and it makes tobacco products less appealing to consumers, especially youth,” Thrasher said.

In June, Kathleen Sebelius, the U.S. Health and Human Services secretary, announced that pictorial warning labels on cigarette packages would be introduced in 2012.

“Nine new pictorial warnings were scheduled to go into effect in September 2012, but their introduction may be delayed if tobacco industry litigation is allowed to advance,” Thrasher said. The proposed U.S. warning labels would be the first change to cigarette package warnings in 25 years.

“We know that the use of tobacco products won’t go away completely. But the warning labels increase consumer understanding of smoking-related risks, and this understanding is critical to addressing the tobacco epidemic,” he said. “Our research is influencing policy changes that will have an impact around the world.”