Cigarettes with health warnings could nudge smokers to butt out: researchers

VANCOUVER — Cigarettes with health warnings printed directly on them are being sold in some parts of Canada, making it the first country to adopt the regulation aimed at encouraging people to kick the habit or keep them from taking it up in the first place. 

Manufacturers are required, by Tuesday, to ensure that warnings about harms such as cancer, impotence, leukemia and damage to organs are printed directly on individual cigarettes. Retailers must sell only packages with those cigarettes by July 31.

Six different warnings, in English and French, are printed in rotation on the paper around the filter of each cigarette. The wording ranges from “Tobacco smoke harms children” to “Poison in every puff.”

“It’s an innovation that’s unprecedented, and it’s going to reduce smoking,” Canadian Cancer Society senior policy analyst Rob Cunningham said in an interview. Manufacturers print their brand names on cigarettes sold in most countries, he added.

Canadian Regulations dating back to 1989 required text warnings to be printed on packages. Canada stepped up efforts even further and became a world leader in 2001 when 16 rotated graphic pictorial warnings started covering half of the front and back of packages. As of 2012, the photo warnings have covered 75 per cent of a pack and eight messages have been printed on the inside flap.

Now, 138 countries sell cigarettes in packages that show graphic images of health consequences, Cunningham said, noting Australia has proposed a law that would emulate Canada’s new approach and print warnings on each cigarettes.

The messages on individual smokes repeat some of the warnings that have previously appeared on packages. But some cigarettes will feature a new caution about the link between smoking and leukemia.

Cunningham said he recently bought some of the new packages at stores in Ottawa, Toronto and Gatineau, Que., and he provided samples to The Canadian Press.

He said it will now be impossible to ignore the health harms of smoking when someone holds a cigarette, even if they have become desensitized to the graphic warnings. One shows a brain damaged by stroke and another has a photo of a hospitalized baby hooked up to a breathing apparatus due to harms from smoking during pregnancy.

More than one million people in Canada have died from tobacco-related illness including cancer, heart disease and emphysema since 2000, according to the Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction.

Sathio Zed of Vancouver said peer pressure pushed him to start smoking four years ago at age 20 and he tried unsuccessfully to quit six months ago by using nicotine gum.

“I want to quit but I have to be mentally strong, no distractions. The job I’m doing is stressful so I smoke during breaks,” Zed said as he finished a cigarette on a downtown street.

He shrugged when he looked at the words “Poison in every puff” printed on a cigarette shown to him.

“I know it’s harmful,” said Zed, adding he worries about his health if he remains addicted to nicotine.

“Nicotine is dopamine,” he said of the buzz he gets from smoking. 

Tracy Brunskill said she smoked between the ages of 14 and 29 before starting to vape eight years ago, though she is concerned about the unknown long-term impact of that choice.

Brunskill was surprised to see the warnings printed on individual cigarettes and said she’s “1,000 per cent” sure that she would not have started smoking if she’d seen them as a teen.

Dr. Peter Selby, head of the Nicotine Dependence Clinic at Toronto’s Centre for Addiction and Mental Health, said the warnings on each cigarette could start more conversations about the harms of a “public health nuisance” that is particularly dangerous for young smokers, adding their brains are not fully developed until at least age 25.

“My hope is that it will nudge some people to rethink their smoking addiction,” he said. “Health-care costs are the most immediate societal cost but there are productivity costs and losses due to the No. 1 cause of fires in homes in Canada — that’s cigarettes.

Nicotine is so addictive that smokers typically have their first cigarette within 30 minutes of waking up, and many who have become ill wish they had never taken up the habit, he said.

“These are people who’ve tried 10, 20, 30 times to quit. They’ve got cancer, they’ve got heart disease, lung disease.”

An estimated 10 per cent of people in Canada smoke, and the goal is to cut that figure to less than five per cent by 2035.

Geoffrey Fong, a psychology and public health sciences professor at the University of Waterloo in Ontario, said warnings get people’s attention.

A 2019 study he co-authored in the journal Tobacco Control showed the 2012 graphic warnings on cigarette packages were effective in increasing people’s knowledge about health risks.

He said about 2,000 smokers were surveyed in 2010 about whether they knew that bladder cancer and blindness were associated with smoking. They were surveyed again 17 months after the pictorial warnings appeared on packages showing links to those harms.

Researchers found that 27 per cent of respondents knew smoking could cause bladder cancer before seeing the warnings, and that number rose to 43 per cent in the second phase of the survey, he said.

Thirteen per cent of people knew blindness was linked to smoking before the warnings were printed on packages. That number nearly tripled to 36 per cent after the warnings appeared, said Fong, founder and chief principle investigator of the International Tobacco Control Policy Evaluation Project, which has done research in 31 countries to assess various policies listed in the World Health Organization’s tobacco control treaty.

“Warnings are fantastic in informing people about the specific harms of smoking,” he said. “Everyone kind of knows that smoking is bad for you but they don’t know how bad, or the extraordinary array of diseases that smoking causes.”

This report by The Canadian Press was first published April 29, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Camille Bains, The Canadian Press