New global study suggests making graphic warning images top priority for tobacco control

A new study has firmed up the evidence that pictorial warning is an inexpensive way of controlling tobacco use and raising awareness against it.

The authors, after reviewing 32 studies from 20 countries involving over 800,000 participants, concluded that strengthening pack warning policies should be a “priority” for tobacco control globally.

Anti-tobacco campaigners say Bangladesh is loosely enforcing the pictorial pack warning since Mar 19 this year.

The study, published recently in ‘Social Science and Medicine’ journal, was one of the largest of its kind.

The researchers, from Chapel Hill USA’s School of Media and Journalism at the University of North Carolina, Lineberger Comprehensive Cancer Centre, and Department of Health Behaviour of the Gillings School of Global Public Health, assessed the impact of strengthening warnings on knowledge, beliefs, attitudes, intentions and behaviour.

They included any study about strengthening pack warnings (including, for example, increasing text size), although the bulk of the studies assessed the transition from text warnings to graphic warning images.

The key findings were that strengthening pack warnings increases knowledge about the risks of smoking, increases quitline calls, reduces smoking consumption, increases quit attempts, increases short-term smoking cessation and reduces smoking prevalence.

Larger changes in smoking behaviour were observed when the warning label changes were implemented alongside other major tobacco control policies than when implemented alone.

Tobacco use is the leading cause of preventable death and disease in the world, causing nearly six million people to die each year, according to the World Health Organisation.

Tobacco product packaging is a key part of marketing efforts to make tobacco use appealing. A pack-a-day smoker potentially sees a cigarette pack an estimated 7300 times per year, that’s 20 views per day, according to the study paper.

Messages on these packs generate exposure that far outweighs exposure from other anti-tobacco communications such as mass media campaigns and at essentially no cost.

Pictorial warning is considered the best way to draw attention rather than using simple texts. At least 80 countries in the world including Bangladesh have so far implemented such pictorial warnings.

But Bangladesh that introduced this warning from Mar 19 this year has not fully implemented it.

Dr Mahfuzur Rahman Bhuiyan, Bangladesh grants manager of the Washington-based Campaign for Tobacco Free Kids’ (CTFK), told bdnews24.com that anti-tobacco groups had analyses the implementation of the pictorial warning.

They found that the provision was being flouted widely with almost all low-brand cigarettes not caring to print the graphic warning.

Bidis, or locally hand-rolled cigarettes, and smokeless tobacco products are also coming to the market without graphic warnings, according to the analysis which was carried out a month after the Mar 19 deadline.

“We saw a little change with one or two bidi products printing pictorial warning after we carried out the study,” Dr Bhuiyan said.

“But this pictorial warning is highly effective, particularly in raising awareness among those who cannot read.

“Even adolescents who have not got into the habit yet get aware of the consequences much earlier with the pictorial warnings. Some pictures are so frightening to them that they can also create pressure on the adults to quit smoking,” he added.

An old estimate suggests 57,000 people die of tobacco-related illnesses every year, and nearly 300,000 suffer from related illnesses in Bangladesh - a country where nearly 45 percent of the population aged 15 and above consume tobacco in some form.