Exposure to graphic warning labels is associated with lower cigarettes per day among persons in drug abuse treatment

Background: The Tobacco Control Act of 2009 gave the FDA authority to regulate tobacco, and also mandated new warning labels for U.S. cigarette packs.  The FDA planned to implement graphic warning labels (GWLs) in 2012, but was stopped by R.J. Reynolds v. FDA which observed, in part, a lack of evidence that GWLs change smoking behavior.

Methods:  Working in residential drug abuse treatment programs, this study recruits smokers into cohorts that received 30 day exposure to either the FDA GWLs (experimental) or to clear stickers (control) placed onto their own cigarette packs.  After 30 days, expired carbon monoxide is measured along with self-report smoking behavior, nicotine dependence, intention to quit, and thoughts about health risks. In preliminary analyses using the first 110 cases, experimental and control cohorts were compared at follow up.

Results:  At 30 day follow-up, and compared to controls, GWL participants smoked fewer cigarettes per day (9.1 v. 11.8, p < .05) and had lower nicotine dependence (1.8 v. 2.3, p < .05).  There were no group differences for the proportions who made a recent quit attempt (36% v. 35%) or in the proportion who expressed interest in smoking cessation services (50% v. 48%).  Although not statistically significant, GWL participants expressed more intent to quit in the next month (42.6% v. 34.6%), thought more about the health risks of smoking (56% v. 46%), and thought that GWLs made them more likely to quit smoking (52% v. 44%)

Conclusions: This is one of few studies to experimentally examine whether prolonged (30-day) exposure to GWLs is associated with changes in smoking behavior.  Preliminary findings are mixed, but show small group differences which, if reliable, are meaningful at a population level. While findings are preliminary, the study will report results for over 400 cases at the time of the APHA convention.