Warnings on cigarette packs getting bigger, more graphic

Smoking causes gangrene.

It says so right on the front — and back — of cigarette packages sold in New Zealand, right beside a revolting photograph of a severely gangrenous foot.

Some consider the connection between tobacco and gangrene to be vital information that smokers in New Zealand and elsewhere need to know. Maybe the knowledge will help persuade them to quit.

“It’s very important to educate and raise awareness about all the health risks associated with smoking,” says Garfield Mahood, honorary executive director of the Non-Smokers’ Rights Association, a Canadian lobby group.

Others wonder.

“My mother got gangrene and she never smoked in her life,” says Yvonne Bertin, an accounts manager at Canada Trust, who’s taking an outdoor cigarette break on a cold, drizzly autumn day, shivering amid the glass-and-steel jungle of downtown Toronto. “If you’re gonna smoke, you’re gonna smoke.”

Up to a point, Bertin is probably right.

At least for diehard smokers, even the spectre of body tissue necrosis (a.k.a. gangrene) seems unlikely to accomplish what the fear of lung cancer, heart disease, miscarriage and myriad other medical malfunctions caused by smoking has so far failed to achieve.

In other words, gangrene alone won’t cause hard-core smokers to quit.

Not that the dangers of gangrene play any part in a series of sometimes-lurid warning labels scheduled to be affixed to Canadian cigarette packages early next year, the first new issue of such labels in more than a decade.

But other, equally horrible fates do, including stroke, oral cancer and chronic obstructive pulmonary disease.

The question is: do grotesque depictions of disability, disfigurement and even death produce changes in behaviour? Do they make some smokers quit?

“Frankly, I don’t know,” concedes Mahood. “There are so many other factors. I don’t know how you separate the different factors.”

Smokers themselves are not necessarily in the best position to judge — being addicts, after all — but many say they regard the warning labels as ineffective.

“It’s not like I don’t know the health risks,” says Rahul, a research analyst at a Bay St. investment dealer, who withheld his last name because his wife doesn’t know he smokes. “I don’t think the warnings, as such, help.”

First introduced in Canada in 1989, mandatory warning labels on packages of cigarettes and other tobacco products have grown steadily more prominent and sensational.

The 16 exterior labels now in use were rolled out in 2000, and they cover 50 per cent of the front and back surfaces of cigarette packages sold legally in Canada.

The replacement labels will occupy 75 per cent of the front and back surfaces and will include some extremely gory images (for example, oral cancer) as well as others that are less gruesome but possibly more disturbing (for example, a photo of a gaunt and wasted Barb Tarbox, who died of smoking-related lung cancer at age 42 in 2003).

Manuel Arango, director of health policy for the Heart and Stroke Foundation, is convinced such warnings work, even if it’s difficult to prove statistically.

“An average smoker sees the package approximately 30 times a day,” he says. “It’s right in your face. If the warning is emotionally powerful, it can have an impact.”

But Amir Amir, who sells magazines and cigarettes at a downtown news agency, isn’t so sure.

“Most people — they don’t look at them,” he says.

Statistics Canada reported last year that the introduction of the current warning labels 11 years ago coincided with a significant decline in the proportion of Canadians who smoke, which fell from 25 per cent of those aged 15 years or older in 1999 to 19 per cent in 2005. But smoking rates have levelled off since then.

Besides, it’s difficult to attribute such fluctuations to any single factor. Other variables that may influence tobacco use include price increases, restrictions on the advertising and open display of cigarettes, bans on smoking in public places and the availability of contraband tobacco products.

Still, there is an intuitive case to be made that the warnings have some effect.

After all, who wouldn’t be shaken by the sight of a dead human fetus crumpled amid a litter of cigarette butts (a warning label in Brazil) or a man with a hole in his throat (various countries, soon to include Canada)?

“A lot of this is just common sense,” says Mahood. “Can anyone believe these images would not have an effect on attitude?”

Well, yes. Eric Gagnon, for one.

A spokesman for Imperial Tobacco of Canada — the country’s largest purveyor of cigarettes — Gagnon denies the warning labels act as deterrents to smoking.

“It’s poor policy for political gain,” he says. “Everybody knows the health risks associated with smoking.”

But knowing is one thing. Repulsive pictures of diseased hearts, lungs or gums are another.

Shortly after such images were first slapped on cigarette packages in Canada, at least some smokers reacted defensively, hurriedly slipping their newly purchased smokes into pretty sleeve devices that hid the pictures of blood and gore.

That practice seems less common now, but at least some smokers remain keenly sensitive to the warning labels, tolerating some but eschewing others.

“They don’t want pictures of humans or human parts,” says Amir. “They don’t like the humans.”

Amir reports that men seem pickier than women in this regard. But women have their weak spots, too.

Bertin, who admits to smoking about five cigarettes a day, says she tries to avoid labels that highlight the second-hand effects of smoking on infants and children.

“More than anything, it’s the babies,” she says. “If I were pregnant, I would quit.”

Unpleasant as they are, the new Canadian labels don’t satisfy all health advocates, at least some of whom believe the revised warnings should be even more jarring.

Their precise impact may be in doubt, but the trend toward ever more graphic warning labels on cigarette packages appears to be relentless. Even the United States, which has favoured mild warnings , is joining the anti-smoking horror show, with the first update of U.S. cigarette warning labels in 25 years.

“The aggregate of these messages has to send a multitude of implications,” says Mahood at the Non-Smokers’ Rights Association. “If the risk of gangrene doesn’t deter someone, maybe a picture of someone who has had a part of their jaw removed might. These people — most of them want to quit.”

By Oakland Ross

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