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Tobacco Pack Information …
Tags: australia, borland, costa e silva, glance, health warnings, incomes, netherlands, population, premature death, proportion, smokers, strong health, stud, surveys, tobacco, usdhhs, vague notion, warning labels, world health organization, world today,Pages: 4
Language: english
Created: Wed Jun 11 11:13:16 2003
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Tobacco Pack
Information at a glance
Smokers benefit from information want to quit. The impact was espcially strong among
people with low incomes and education (Costa e Silva
about tobacco risks and quitting 2002). In Australia, stronger warning labels resulted in
a 29% increase in the percentage of people reporting
that they always noticed the warnings, and a 7%
There are an estimated 1.2 billion regular smokers in increase in people reporting forgoing smoking at least
the world today, approximately one third of the global once due to the warnings (Borland 1997). Other stud-
population over the age of 15, and the numbers are ies report similar findings. A survey of 8,836 people
rising (World Health Organization 2002). Studies 15 and older in the Netherlands in 2002 found that
show that many smokers still do not know that tobacco 16% of the 2,812 smokers surveyed said that new,
causes disease and premature death. Many others larger health warnings made them more motivated to
know little beyond a vague notion that "smoking is bad quit, (this was 26% among smokers who intend to quit
for you"-- even in the US, where a great deal of at some point); 8.7% said they were already smoking
information is easily available from multiple sources less as a result of the new warnings. Surveys find that
(USDHHS 1989). There is a clear need for effective a high proportion of smokers (for example, 70% in
ways to inform and alert smokers and provide Canada) want to quit. Strong health warnings and
information on how to reduce their tobacco-related information about where to turn for help in quitting
health risks. Strongly worded, specific, large label help reinforce this attitude (Mahood 1995).
information on tobacco product packages provides
important public health messages, targeting smokers.
Package warnings efficiently
Mandated labels on tobacco products are an effective target smokers
way to inform smokers of the hazards of smoking,
encourage smokers to quit, and discourage non- Smokers (and poten-
smokers from starting to smoke. Many countries require tial smokers) see the
health warnings on tobacco products. Evaluations of warnings at points of
these warnings conclude that they are effective only if purchase and every
they contain multiple strong and direct messages that time they take a ciga-
are prominently displayed (WHO 1997). Evidence rette, or handle or see
from Canada and Brazil shows that the large warnings a cigarette pack.
with photos introduced recently are effective in discour- Targeting smokers is
aging smoking and increasing public awareness of the especially important in developing countries where few
health effects of smoking (Environics 2002, Costa e people have access to information about the hazards
Silva 2002). Of 633 Canadian smokers surveyed nine of smoking. Large health warnings detract from the
months after new, large pictorial warnings were intro- glamour and appeal of tobacco packages, making
duced, 58% said the pictures had made them think them less likely to be seen as stylish accessories. Strong
more about the health effects of smoking; 44% said the warnings also help to create a social milieu in which
new warnings increased their motivation to quit smok- non-smoking is the norm. They can inform smokers who
ing; and 38% of smokers who tried to quit in 2001 want to quit about where to find help.
said the new warnings were a factor in motivating their
attempt. In a survey of 2,216 Brazilians 18 years or Legal and ethical considerations
older in 126 municipalities, in April 2002, 3 months
after the introduction of new picture warnings, 73% of "Informed consent" or consumer protection laws in
smokers approved of them, 54% had changed their some countries require that information is provided to
opinion on the health consequences of smoking and smokers about the health effects of tobacco use. In
67% said that the new health warnings made them Canadian law, "informed consent is held to exist when
June 2003
adult buyers are informed about: the nature of the the perceived credibility of warning messages, as
risks (for example, that smoking causes lung cancer well as the perceived risks from tobacco use,
and a host of other potentially fatal diseases); the increase proportionately with increases in the size
magnitude of the dangers including the prognosis of warnings (Études de marché Créatec 1999).
should illness develop (for instance, that lung cancer
o Content:
has a very high fatality rate); and the probability of
such diseases occurring". Common law requires that · To be effective, warnings have to contain a
"once a duty to warn is recognized, ...the warning clear and unequivocal message about the
should be communicated clearly and understandably, dangers of tobacco use, in simple and stark
...and in terms commensurate with the gravity of the terms. Messages should be worded simply and
potential hazard"(Mahood 1995). be in the principal language(s) of the country.
· They should explain the nature and extent of
risk, and what to do to avoid or reduce the
Country experiences
risks. They should speak directly to the reader
using the word "you." Technical language
Canada and Brazil have become global leaders,
should be avoided.
and now require large tobacco package warning
labels, with pictures and strong text. In Canada the · The use of marker words, such as
top half of the front and back of cigarette packages "WARNING" is desirable. The message should
must show one of 16 picture-based warnings. One not be diluted by attribution to government
of 16 additional detailed messages is required inside agencies or officials. (However, in Canada, the
the package, either on an insert or on the inner court ruled that warnings must be attributed to
"sliding" part of the package. Brazil introduced the government, lest they be seen as statements
similar warnings in 2002, and has banned the use by the cigarette companies themselves, who
of misleading terms such as "Lights", "Ultralight", have a constitutional right to free speech,
"Slim", and "Superslim" on cigarette packages. interpreted to include the right to not say
Picture-based warnings are being considered in something.)
Australia and Thailand, and an European · It is important to include information about
Community directive gives member states the where to find cessation help: for example, a
option of using them. toll-free quit line number (as in Australia, Brazil,
the EC, Canada and South Africa), an Internet
But warnings are weak, small or non-existent in and/or physical address where more informa-
many other parts of the world, especially in
developing countries. More than 40 developing
countries do not require any warnings at all. A
review of regulations on the content, size, and Examples of
location of tobacco health warnings in 45 countries good warning messages
found that people in developing countries receive
inferior information about the hazards of smoking i Cigarettes are highly addictive.
(Aftab et al 1999). This is unacceptable, especially i Quitting now reduces your risk of serious dis-
since about 80% of the world's smokers live in ease.
developing countries (World Bank 1999). i Tobacco smoke hurts babies.
i The smoke from your cigarette harms people
around you.
Effective tobacco pack labels i Smoking causes lung cancer.
i Tobacco can make you impotent.
Detailed specifications on all aspects should be
i Children who see adults smoking are more likely
included in legislation or regulations governing the
to start smoking.
information required on tobacco packs, to prevent
i Smoking when pregnant harms your baby.
companies making them difficult to read or weak.
i Smoking causes bad breath, tooth loss, and
o Size: the warning/information label should ideally mouth cancer.
cover 50% of the front and back areas of the i Smoking can cause a slow and painful death.
package. Warnings must be large enough to be i Smoking clogs your arteries and causes heart
easily noticed and read. Evidence suggests that attacks and strokes.
tion is available, quitting tips, and/or advice to o Package inserts: additional health information can
ask a health care provider for help in quitting. be provided through inserts similar to those used
· Packages should be free of erroneous or with prescription drugs, or on the inner "sliding"
misleading terms, such as "light", "low tar", or part of packages that have them. Besides textual
"mild", which give the wrong impression that information on tobacco addiction and tips for
tobacco is safer at lower tar and/or nicotine quitting, inserts should contain pictures that
concentrations. These misleading terms have illustrate the hazards of tobacco.
been banned in Brazil and the European o Timing: The time given to companies to implement
Union, and several other countries are new warnings should be just enough to use up
considering banning them. existing stocks and print new packages. In
o Format and font: the warning message should be Canada, the regulations took effect after six
printed in easy-to-read black type on a white months. Tobacco companies will typically ask for
background (or vice versa). Large upper case let- a longer time,
ters should be used. Glossy surface coatings and but 3 to 6 months is sufficient.
metallic inks should be avoided, flat or matte
finish will make the warnings legible under a The tobacco industry usually tries to delay or block
wider range of lighting conditions. The text should more effective warnings. Countries should be pre-
be indelible and irremovably fixed. A black pared to face these challenges. Legal challenges are
border should surround the message in a way that often based on constitutional rights such as free
does not interfere with the text of the warning or speech, or trade practices. Some constitutions guar-
the information given. antee the right to life, and inducements to smoke or
failure to warn of the health consequences, could be
o Location: the warnings should be on the top of the argued to infringe this right. The case for tobacco
front and back of the package. The warning control measures, including stronger health warnings,
should not be hidden or obscured by other written is compelling, especially from a human rights and
or pictorial matter, or when the packet is open. consumer rights perspective. Cigarette companies
o Pictures: warning messages with pictures are should have at least the same obligations as drug
accessible to illiterate people, and provide signifi- companies to inform users fully of the risks of using
cantly more encouragement to quit and not to their products. Moreover, health-warning regulations
start smoking than messages without pictures should specify that displaying health warnings on
(Liefield et al 1999). Nearly a third of adult men tobacco products does not relieve tobacco compa-
and half of all adult women in low-income coun- nies of their liability for damages caused by the use
tries are illiterate. Pictures will help ensure that of their tobacco products.
they too receive important information empower-
ing them to better protect their health. In addition Political will to initiate or implement tobacco control
to delivering new information, pictures elicit a vis- reforms may be lacking for a variety of reasons.
ceral response in viewers, Some politicians fear that tobacco control would
so their impact is both cognitive (intellectual) and harm the economy and worsen unemployment. But
affective (emotional). To improve visual sound economic evidence shows that tobacco control
effectiveness, the pictures should be colorful efforts typically have no net negative impact on
and the largest size possible. employment and can even increase employment.
Nevertheless, given the industry influence and
power, political challenge remains significant.
Examples of good pictures Effective cooperation among health agencies, health
professionals and the media can counter the
i human heart with damaged muscles as a result of influence of tobacco companies. Intensive media
myocardial infarction campaigns, and grassroots lobbying are needed as
i healthy lung and a lung with cancer well. The issue can be framed as a moral and legal
i children and pregnant women obligation on the part of tobacco companies to
i human brain showing effects of a stroke properly inform consumers after decades of mislead-
ing consumers.
i diseased mouth
Resources PAHO. Developing Legislation for Tobacco Control.
May, 2002 provides basic information and legal tem-
Examples of Canadian and Brazilian health messages plates for tobacco control measures including warnings
and pictures: http://www.hc-sc.gc.ca/english/media/ http://www.paho.org/English/HPP/HPM/TOH/
photos/tobacco_labelling/index.htm tobacco_legislation.pdf
Agencia nacional de vigilancia sanitaria (for Brazilian
health warnings--in Portuguese) References
http://www.anvisa.gov.br/divulga/noticias/ Aftab, M, D Kolben, P Lurie. International cigarette
040601_1.htm labelling practices. Tobacco Control 1999;
8:368372.
Evaluations and advice
Borland R. Tobacco health warnings and smoking-
o http://www.cancer.ca Canadian Cancer Society related cognitions and behaviours, Addiction 1997
(search "warnings") Nov.; 92(11):1427-35.
o http://www.hc-sc.gc.ca/hecs-sesc/tobacco/
Costa e Silva, VL. Presentation to EU Commission on
research/archive Health Canada--includes
enforcement of health warnings in Brazil. Brussels
research and surveys to evaluate tobacco health
2002.
warning effects and best practices
o http://www.nsra-adnf.ca Non-Smokers' Rights Environics Research Group Limited. Evaluation of New
Association (NRSA) Canada, especially "Health Warnings On Cigarette Packages, January 2002.
warnings on tobacco packages in Canada" in Truth http://www.cancer.ca/ccs/internet/standard/
and Labeling section. 0,3182,3172_334419_436437_langId-en,00.html
o http://www.uicc.org/programmes/tobacco/ Environics Research Group Limited. Health Warning
International Union Against Cancer (UICC) Testing, Final Report. June 1999.
http://www.hc-sc.gc.ca/hecs-sesc/tobacco/pdf/
Documents health_warning_testing_final.pdf
Canadian Cancer Society. Controlling the Tobacco Mahood G. Canadian tobacco package warning
Epidemic: Selected Evidence in Support of Banning All system, Tobacco Control 1995; 4:10-14.
Tobacco Advertising and Promotion, and Requiring US Department of Health and Human Services.
Large, Picture-Based Health Warnings on Tobacco Reducing the health consequences of smoking: 25
Packages. Ottawa: Canadian Cancer Society, years of progress. A report of the surgeon general,
International Union Against Cancer, April 2001 1989.
www.globalink.org/tobacco/docs/packaging/evi-
Willemsen MC. The altered view of tobacco products:
dence.doc
The effects of the new health warmings on smokers.
Corrao MA, Guindon GE, Sharma N, Shokoohi DF DEFACTO, The Hague, Netherlands 2002.
(eds). Tobacco Control Country Profiles, American World Bank. Curbing the Epidemic: governments and
Cancer Society, Atlanta, GA, 2000 the economics of tobacco control, World Bank 1999,
http://www5.who.int/tobacco/page.cfm?sid=57 see also: Jha P. and F. Chaloupka (editors). Tobacco
International Union Against Cancer, International Union Control in Developing Countries, published by OUP for
Against Tuberculosis and Lung Disease, World Heart the World Bank and World Health Organization,
Federation, International Non Governmental Coalition 2000. both on line at www.worldbank.org/tobacco
Against Tobacco. Memorandum re `Package Zatonski, W, K Przewozniak, M Porebski. "The positive
Warnings' health impact of enlarged cigarette pack warning
http://www.ontario.cancer.ca/Siteboth/files/TOBUIC labels in Poland," Paper presented at the 2nd
Cwarninglabels.pdf European Conference on Tobacco or Health, Las
Palmas de Gran Canaria, Spain, 23-27 February
1999.
Expanded versions of the "at a glance" series, with e-linkages to resources and more information, are
available on the World Bank Health-Nutrition-Population web site: www.worldbank.org/hnp