For part of this summer, I escaped the sweltering heat of central Texas and took refuge in Leamington, Ontario, Canada. It's a lovely place in southern Ontario on the banks of Lake Erie. From my sister's cottage, I could see Pelee Island on the horizon.
On a morning walk, the nose of my golden retriever Laredo drew me to a small, smashed cardboard package. It was an empty pack of DK's Full Flavor Premium Canadian Blend cigarettes. But the product and brand on the label were dwarfed by the graphic warnings on four of the six sides of the box.
On the front and back side of the package (one side in French, the other in English) was this message:
"Just breathing is torture. Smoking caused my lungs to collapse four times before I was diagnosed with emphysema when I was 42. Without my oxygen tank, I feel like I'm breathing through a straw." --Lena
Another side of the box has this warning:
"Tobacco smoke contains hydrogen cyanide, a poisonous gas. (Health Canada)"
The pack also contains a package insert with information about Health Canada's toll-free quitline. The insert lists topics about which the quitline specialist can help a smoker, such as coping with cravings, developing a quit plan, and finding resources in her/his community.
Health Canada's graphic warning labels on cigarette packs have been in place since 2000. In 2011, the US Food and Drug Administration attempted to require tobacco companies to include similar warnings on their cigarette packs. That regulation was struck down in 2012 by the US Court of Appeals. Some of the judges said it violated freedom of speech and others said FDA failed to demonstrate that the warning labels would "directly cause" a decrease in smoking rates.
After Laredo gave the Canadian cigarette pack a good whiff, I picked it up and check out the image and warnings. I wondered: Are they effective in getting Canadian smokers to quit or attempt to quit?
At least two analyses indicate that they do. Huang and colleagues estimated that such labels reduced smoking prevalence in Canada by 12 to 19 percent. Azagba and Sharaf reported that the labels decreased the odds of being a smoker by about 12 percent and increased the odds of making a quit attempt by about 30 percent.
I've not found any information that the FDA will take another shot at requiring tobacco companies to place alternative, but less graphic, warning labels on their cigarette packs. What FDA says is it will:
"...move forward to implement the Tobacco Control Act and is committed to reducing death and disease from tobacco use by bringing science-based regulation to the manufacturing, marketing and distribution of tobacco products.
Are you a reader that can provide an update on FDA's efforts?