Graphic warning labels latest bid to curb smoking habits

As the federal government prepares the public for new cigarette health warning labels, an American Cancer Society official says primary care physicians should be ready for an influx of patients who want help to quit smoking.

The Food and Drug Administration on June 21 released the nine text and graphic image health warnings that must appear on all cigarette packs, cartons and advertisements by September 2012. The new, bolder labels, which include images of a man smoking through a tracheotomy hole and a dead man with a surgery-scarred chest, will update the text warning that has been in place for more than 25 years.

"The more focus there is [on the dangers of cigarettes] the more people are going to come into their primary care doctor" asking for help quitting smoking, said Thomas Glynn, PhD, director of Cancer Science and Trends for the ACS in Washington, D.C. "Primary care physicians are on the front line of tobacco control and prevention, and they can help their patients stop [smoking]."

Glynn recommends that during each office visit, physicians ask patients if they still smoke and need help quitting.

An estimated one in five U.S. adults 18 and older (about 46.6 million people) smokes cigarettes, according to the Centers for Disease Control and Prevention. The habit causes 443,000 deaths each year due to firsthand and secondhand smoke, the CDC said. This makes tobacco use the nation's leading cause of premature and preventable death.

The new health warning labels are the federal government's latest effort to cut the nation's tobacco use by urging smokers to quit and preventing others from starting. The warnings are part of the Family Smoking Prevention and Tobacco Control Act, which was signed by President Obama and became law in June 2009.

The legislation calls for nine new larger text warning statements and color graphic images depicting the negative health consequences of smoking on cigarette packages and in advertisements. They will cover the top 50% of the front and rear panels of all cigarette packages. In cigarette ads, the warning will fill at least 20% of the total space.

The labels include photographs and illustrations, accompanied by text such as "Smoking can kill you." Each warning contains a phone number for a smoking-cessation hot line (800-QUIT-NOW).

"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," said Kathleen Sebelius, secretary of the Dept. of Health and Human Services.

The FDA estimates that the health warnings will reduce the number of U.S. smokers by 213,000 people in 2013. This figure includes smokers who quit and people who choose not to take up the habit.

The projection is based, in part, on the results of similar cigarette health warning labels that have been implemented in other countries, such as Canada.

Taking a step against smoking risks

The ACS is pleased with the health warnings the FDA selected, said Glynn, who described the new labels as "a significant step forward."

Tobacco company Philip Morris USA responded in January to the then-proposed warnings in a letter to the FDA. The company said smokers and those considering the habit should be informed about the health risks.

But it considers the warnings a violation of the First Amendment, which guarantees freedom of speech.

"Any government requirement that compels a private entity to carry a message not of its own choosing raises constitutional concerns," Philip Morris said in the letter.

Glynn expects the health warnings to lead some smokers to quit and prevent others from beginning the habit. But he stressed that more needs to be done on the local level to curb tobacco use.

He recommends that state officials continue increasing taxes on cigarettes and keep promoting the importance of smoke-free environments.

"I don't think anyone is thinking [the health warnings are] a game-changer. They're not. But they're an important piece of the puzzle," Glynn said.