Graphic labels on cigarettes shown effective

Cigarette warning labels that include a graphic image depicting the long-term consequences of smoking are more likely to make smokers remember the dangers and prompt them to consider quitting, according to a new Ohio State study.

The study's findings are in line with previous studies that have found warning labels with powerful images provoke visceral reactions, prevent children and other nonsmokers from starting to smoke and motivate smokers to quit.

A federal judge on Sept. 5 ordered the Food and Drug Administration to accelerate plans to require tobacco companies to cover cigarette packs with graphic warnings, a process mired in years of legal challenges.

Advocacy groups have long pushed for sterner warnings on tobacco products, even as the tobacco industry pushes back, claiming label requirements violate their First Amendment rights.

OSU researchers showed two groups of smokers health warnings accompanied with pictures. One group was shown “low emotion” images such as a gravestone with the letters “RIP” written on it. A second group was shown "high-emotion" pictures such as a smoker puffing from a cigarette through a stoma lodged in his throat.

The groups were quizzed on text warnings placed beside the images shortly after they saw them, and then again six weeks later.

Thirty two percent of the group who viewed the low-emotion images recalled the anti-smoking messages when asked immediately following the study but their recall dropped by nearly half six weeks later, the study found. Of the group who saw the more vivid images, 26 percent remembered the anti-smoking messages in the short term, but 21 percent recalled the messages weeks later, and were more likely to say they intended to quit.

“Greater emotion focuses our attention,” said Ellen Peters, an Ohio State psychology professor who led the study. “It activates brain systems that ultimately mean you store (the messages) better."

Such studies heighten the sense of urgency for organizations seeking explicit warning labels, advocates said.

"It shows it does help educate people about the consequences of tobacco use,” said Mark Greenwold, senior consultant at the Campaign for Tobacco Free Kids. “There is complete agreement that the current (text-only) warnings are grossly inadequate.”

The fight over labeling began with a 2009 law that required graphic warnings to cover 50 percent of cigarette packs. The tobacco industry challenged the law, claiming it violated their free-speech rights and hindered their ability to promote brand loyalty. Because tobacco companies are barred from most traditional forms of advertising, the message on packaging is especially critical, they said.

“The resistance of the tobacco industry shows you the value of the real estate on the packaging,” said Gregg Haifley, director of federal relations for the American Cancer Society’s Cancer Action Network.

The tobacco companies lost the first round when courts upheld the law in 2010, but fought back again when the FDA unveiled proposed warnings in 2011, contending that the images went beyond public health information and were designed to provoke an emotional response.

A judge sided with the industry in 2012, ordering the federal agency to change their labels. Six years later, the FDA has yet to release new labels; court filings indicate the agency plans to do so in 2021.

Public-health advocates accused the FDA of dragging its feet and filed their own suit, culminating in last week's ruling.

"We’re continuing to move forward ... and the agency will comply with any court order," FDA spokesman Michael Felberbaum said in an email.

While studies consistently show that smokers shown graphic warnings are more likely to say they intend to quit smoking, they largely fall short in proving that intent is followed by action, prompting calls for more research.

A 2016 study published in the JAMA Internal Medicine journal was the first to show that graphic images convince smokers to quit in the short term.

However, “a lot of smokers make multiple attempts to quit over varying lengths of time,” said Bill Shadel, a senior behavioral scientist for the Rand Corporation. He called the results of the 2016 study "encouraging," but added, "as with everything in science, we need repetition."

Advocates argue that anything that prompts smokers to even consider quitting is a good start.

“In the U.S., polls show 70 percent of smokers want to quit,” Haifley said. “Graphic warnings, we believe, reinforces that desire.”

pcooley@dispatch.com

@PatrickACooley