Warn about the dangers of tobacco
Warning labels on tobacco packaging and hard-hitting mass media campaigns provide needed information about the health dangers of smoking
Despite conclusive evidence regarding the dangers of tobacco, relatively few tobacco users worldwide understand the full extent of the risk to their health (138). Smokers tend to underestimate the risks of tobacco use to themselves and others. Article 11 (Packaging and labelling of tobacco products) of the WHO FCTC establishes an obligation for Parties to meet global standards for warning labels that clearly communicate the dangers of tobacco use in the principal national language, comprise not less than 30% of the principal display areas on all tobacco products, and rotate periodically. The Conference of the Parties has developed and adopted guidelines for implementing Article 11 (3).
Comprehensive warnings about the dangers of tobacco are critical to changing tobacco’s image, especially among adolescents and young adults, the ages at which people are most likely to begin tobacco use (139).
Ultimately, the objective of anti-tobacco education and counter-advertising is to change social norms about tobacco use. This will cause many individuals to choose not to use tobacco, and also increases support for other tobacco control measures. Article 12 (Education, communication, training and public awareness) of the WHO FCTC reinforces this by creating a legal obligation for Parties to promote access to information about the dangers of tobacco consumption and the benefits of cessation. To this end, a working group is elaborating guidelines for implementation of Article 12 for adoption by the Conference of the Parties (140).
Prominent warning labels on tobacco product packaging provide the most direct health messages to all smokers, as well as to non-smokers who see the packs (138, 141-143). Warning labels encourage smokers to quit and discourage nonsmokers from starting, are well accepted by the public, and can be implemented at virtually no cost to governments. Warnings on both the front and back of packaging are extremely important so that smokers cannot overlook them, but most countries do not require warning labels of this size on both sides of packaging.
Warning labels should describe specific health effects and diseases caused by tobacco use, and should be periodically rotated to continue to attract the attention of the public. Pictorial warnings are more effective than text-only warnings (143), and are essential for persons who cannot read and for young children whose parents smoke. Deceptive terms such as “low tar”, “light”, or “mild” should also be banned; these terms suggest incorrectly that some products are less harmful (144).
Anti-tobacco advertising in all forms of media can help publicize the full extent of tobacco’s dangers and can counter tobacco use as a social norm. When exposed to effective television antitobacco messages, teenagers are half as likely to become established smokers (145) and adult smokers are more likely to quit (146). Hard-hitting campaigns using graphic images that demonstrate the physical harm caused by tobacco use are especially effective in convincing users to quit (147). The tobacco industry has created its own anti-tobacco advertising, but its advertisements are ineffective in reducing smoking and may even increase smoking, especially among the young (148). In addition to paid advertising, anti-tobacco educational campaigns can also be supplemented effectively and inexpensively through public relations efforts that generate free media coverage (a process sometimes referred to as “earned media”) (149). Only 8% of the world’s population live in a country with strong graphic warnings on cigarette packs
■■ Five countries (Djibouti, Egypt, Iran, Malaysia and Mauritius, totalling 178 million people) joined the group of countries that fully meet WHO FCTC Article 11 guidelines for pack warning labels in 2008. Fifteen countries covering 7.6% of the world’s population (compared with 4.9% in 2007) now require warning labels that cover at least half of both the front and back of cigarette packs and also include pictures and all other listed characteristics.
■■ All of the countries newly implementing comprehensive warning label requirements in 2008 were middle-income countries.
■■ Less than 10% of high-income countries require warning labels with all appropriate characteristics. Although more than a quarter of low-income countries have warning labels covering at least 30% of packages, all are missing other important characteristics most notably, they lack pictures or pictograms that can be easily understood by people who are less educated or who are unable to read.
■■ More than 70% of low-income countries and nearly 55% of middleincome countries require either no warning labels of any kind or labels that cover less than 30% of cigarette packs.
■■ In most countries, there are essentially no health warnings at all on smoked tobacco products other than manufactured cigarettes (e.g. bidis, kreteks, roll-your-own and water pipe tobacco). Only one high-income country and six middleincome countries require strong health warnings on these other smoked tobacco products.
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