Putting graphic pictorial health warnings on cigarette packages was required by a law passed in 2009, but a tobacco company convinced a federal appellate court to delay implementation, claiming there was no evidence that pictures helped people quit.
Now a randomized controlled trial, published in JAMA Internal Medicine, has provided the evidence.
In a four-week trial, 2,149 smokers were randomly assigned to use packs of cigarettes with either pictorial or text-only warnings. At the end of each week, researchers surveyed the participants about their smoking.
The two groups had the same baseline desire to quit and similar understanding of the harms of smoking. But by the end of the study, 40 percent of those in the pictorial warning group had quit for at least a day, and 5.7 percent were not smoking during the seven days before their final interview, compared with 34 percent and 3.8 percent respectively in the text-only group.
The pictorial warnings were more effective for both sexes and across races, ethnicities and socioeconomic levels.
“This is the first well-controlled study that demonstrates a change in behavior,” said the lead author, Noel T. Brewer, a professor of health behavior at the University of North Carolina. “It’s time for the U.S. to adopt pictorial warnings. Delaying is causing people to continue smoking and die as a result.”