New Cigarette Health Labels: Gross or Effective?

You may think an image of rotting teeth and a mouth lesion are gross. But the U.S. government says it's just what you need to kick the habit.

Cigarette packs in the U.S. will soon feature new warning labels with graphic images of the negative health effects of smoking, including diseased lungs and the sewn-up corpse of a smoker. The U.S. government hopes the new warnings will discourage smoking, but smokers and nonsmokers alike question whether the ads are too gory.

"Somebody said when they first saw the warnings, 'These are really gross.' And they are," FDA Commissioner Margaret Hamburg said at a White House briefing. "We want kids to understand smoking is gross __ not cool __ and there's really nothing pretty about having mouth cancer."

The labels, which were released on Tuesday, are a part of a campaign by the Food and Drug Administration that aims to convey the dangers of tobacco, which is responsible for about 443,000 deaths in the U.S. a year.

The warnings, which must appear on cigarette packs by the fall of 2012, include several images that could be seen as shocking to some __ and disturbing to others. Among the images: A man with a tracheotomy smoking, a mother holding her baby with smoke swirling around them and a man with an oxygen mask. The labels also feature phrases like "Smoking can kill you" and "Cigarettes cause cancer." They will take up the top half — both front and back — of a pack of cigarettes and be featured in advertisements.

Some consumers on Tuesday said that they were concerned that the images on the new labels were too explicit for children and others who might come across them in store aisles.

Zenobia Marder, a nonsmoker and high school student from New York City, was startled when she looked at some of the labels. "Oh my God!" screamed the 15-year-old.

Ashley Johnson, 21, of Cincinnati, had a similar reaction. "They look so bad," says Johnson, who has been smoking for about a year. "I think that when people see these pictures, they might put the cigarettes back and get something else instead."

Warning labels first appeared on U.S. cigarette packs in 1965, and current warning labels that feature a small box with text were put on cigarette packs in the mid-1980s. Changes to more graphic warning labels that feature color images of the negative effects of tobacco use were mandated in a law passed in 2009 that, for the first time, gave the federal government authority to regulate tobacco.

Tobacco companies and others have argued graphic warnings like the nine new labels may cross the line of social acceptability.

In comments to the FDA, some tobacco companies argued the "shock and awe" of the labels have been used in numerous ideological debates like when anti-abortion protesters display photographs of aborted fetuses or animal-rights activists display photographs of mutilated animals.

"Although such images illustrate actual effects of abortions and actual animal treatment, no one would contend that they are 'purely factual and uncontroversial,'" Reynolds American Inc., parent company of America's second-largest cigarette maker, R.J. Reynolds; No. 3 cigarette maker Lorillard Inc.; and No. 4 cigarette company Commonwealth Brands Inc., told the FDA. The companies also are part of a federal lawsuit that in part deals with the legality of the new labels.

Cigarette labels with more graphic images could also concern some retailers; customers who may be offended or disgusted by the packs behind the counter may take their business elsewhere.

"You're going to run into people that will not necessarily like this," said Jeff Lenard, spokesman for the National Association of Convenience Stores, a group representing an industry that gets about 160 million transactions each day. "When somebody's hungry, they get something to eat. When somebody's thirsty, they get something to drink, and we just want to make sure that when they go in, they still want to get that."

Health and Human Services Secretary Kathleen Sebelius acknowledged that the labels are "frank, honest and powerful depictions" aimed at making tobacco-related death and disease part of the nation's past. Marketing and tobacco control experts say that's what's needed.

"It's clear to us that the stronger, the more graphic, the better," said Jeremy Kees, a marketing professor at the Villanova School of Business who has done studies on graphic cigarette warning labels. "Fear really drives the effectiveness of these warning labels ... mild, weak images are, in some cases, no better than a plain text warning."

Marketing experts also say the new labels aren't unique to the U.S. In fact, the new U.S. labels are typical of what's being used in the more than 40 other countries, said Stanton Glantz, a tobacco researcher at the University of California at San Francisco. Canada, for instance, in 2000 rolled out warning labels to include a pregnant woman smoking. Uruguay also shows rotting teeth and gums on its labels, similar to the images on the new warning labels in the U.S.

"These are the images that work," Glantz said. "What the research shows is that images that evoke a strong emotional response are the best ones."

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