Smokers to Face Graphic Warnings

Smokers buying a pack of cigarettes will be confronted by a photo of diseased lungs, a man on oxygen, a dead body or another grim image starting in September 2012. Those are among nine tobacco use warning images FDA officials unveiled during a June 21 news conference; cigarette manufacturers will be required to place one or another of the images on every cigarette package beginning next year.

The nine images were selected from an original group of 36 that were proposed in November 2010. Manufacturers will be required to devote half of the front and back panels of every cigarette package to the warnings. The images, which also will appear on cartons and in advertisements, will be accompanied by harsh written messages about the dangers of tobacco use.

The move by the FDA marks the first significant change to cigarette warnings in more than 25 years.

The AAFP is strongly opposed both to the use of tobacco and all forms of advertisement of tobacco products, said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, in a June 21 statement on the FDA's action.

"The AAFP therefore adamantly supports the required use of color graphic warnings and new textual warning statements on cigarette packages and advertisements as an important step toward reducing the existing and future use of tobacco products. While we advised FDA to make these warnings obligatory sooner than September 2012, we commend the agency for the commitment to making these warnings as compelling as possible."

More than two dozen countries already require similar packaging for cigarettes. Lawrence Deyton, M.D., M.S.P.H., director of the FDA's Center for Tobacco Products said during a June 21 briefing that, based on data from those countries, the FDA expects the number of smokers in the United States to decline by more than 200,000 people in 2013 alone because of the warnings.

There are an estimated 47 million adult smokers in the United States, and an estimated 20 percent of U.S. high school students smoke, assistant Secretary for Health Howard Koh, M.D., M.P.H., said during the briefing. About 3,500 children try their first cigarette every day. The new warnings will help counter the $12.5 billion cigarette manufacturers spend marketing their products each year, he added.

Surgeon General Regina Benjamin, M.D., M.B.A., said during the briefing that the new warnings will help smokers stop and prevent others from starting in the first place.

"It's simple," said Benjamin, a family physician from Bayou La Batre, Ala. "Smoking kills. Sending this message to smokers, or those who are thinking about smoking or thinking about starting to smoke, just got a lot easier. These nine graphic health warnings, which will appear on everything from cigarette packs to in-store tobacco displays, show stark images in bold messaging that will now graphically illustrate on every ad and every pack of cigarettes the painful and deadly reality of tobacco use."

The warnings, which were required under the Family Smoking Prevention and Tobacco Control Act, also will be accompanied by quitline information.

Benjamin encouraged smokers to talk to their physicians about quitting.

"That's important because patients who are advised by their doctors to quit smoking have a 66 percent higher success rate," she said.

The AAFP offers members tobacco cessation resources through its Ask and Act program, which encourages family physicians to ask all patients about tobacco use, then act to help them quit.

The Academy also is working to reduce tobacco use through Tar Wars, the only youth tobacco education program offered by a U.S. medical specialty organization. The prevention program reaches about 400,000 fourth- and fifth-graders each year.