Study: Graphic Warnings on Cigarette Packs Would Be Effective

Legislation that would require photo warning labels on cigarettes is bogged down in the legal system.

Tobacco warning labels that include graphic pictures of the health consequences of smoking are more effective than text-only warnings, a study found.

Tobacco warning labels that include graphic pictures of the health consequences of smoking are more effective than text-only warnings, a study found.

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As the battle over graphic picture warning labels on cigarette packs makes its way through the court system, a new study suggests what many other countries already know: A picture is worth a thousand words.

The Family Smoking Prevention and Tobacco Act of 2009 required color photos and text warnings that cover half of the front and back of each pack of cigarettes sold in the United States. The law was set to take effect in 2012, but tobacco companies successfully argued to an appeals court that the law violates their First Amendment rights and won a temporary injunction to stop new FDA warning labels from appearing on cigarette packs. The case will likely eventually make its way to the Supreme Court.

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But a new study from researchers at the University of South Carolina has found that if graphic images ever make their way to American cigarette packs, they will be much more effective at dissuading potential smokers than text warnings.

The study, conducted by James Thrasher, a professor in the school's Department of Health Promotion, Education, and Behavior, found that the more graphic or gruesome an image, the more effective it was at dissuading people from smoking, especially among lower-income smokers.

"We found the more graphic the image, the more credible, relevant, and effective smokers saw the warning," Thrasher says. "Our study suggests that more graphic warnings would have a bigger impact on smoking than text warnings."

That's a lesson dozens of other countries already know—countries such as Canada, Mexico, Brazil, and Uruguay have had success in decreasing smoking rates with graphic warnings. But Thrasher's was one of the first study that used hypothetical warnings on actual American smokers. Between July 2011 and January 2012, Thrasher tested hypothetical warning images on nearly 1,000 smokers in low- and middle-income areas in South Carolina and found that the warnings similar to the proposed FDA graphics were more effective than text ones.

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People with lower incomes smoke at a higher rate than people who make more money, and are most likely to be unaware of the health risks of smoking, Thrasher says.

"Smoking is highly concentrated among people with low levels of education and low income, and those groups are the ones that have the weakest response to text warnings," he says. "With pictures, you can increase their understanding of the risks of smoking in a way you can't with text."

Thrasher hopes that eventually smoking companies will drop their complaint and the new warnings will make their way onto tobacco products.

"I think we're ultimately going to have to include them. This has happened with a lot of other tobacco control policies—the industry tries to delay as long as they can," Thrasher says. "But the more we delay doing this, the longer we're delaying informing people about the consequences of smoking."

Jason Koebler is a science and technology reporter for U.S. News & World Report. You can follow him on Twitter or reach him at