Illustration by Open, N.Y.
Illustration by Open, N.Y.

Over the past few decades, cigarette makers have gradually lost many of the platforms they once used to promote their products. Their advertisements are no longer on TV, in most magazines or on billboards. But the most pervasive and effective advertising placement still exists: the cigarette package itself.

Each one bears the brand logo, colorfully designed not only to help smokers distinguish it from the competition, but also to give them a sense that this particular brand can play a special role in their life.

In an attempt to counteract the logo’s allure, beginning in September 2012, federal health officials will require graphic warning labels to cover the top half of all cigarette packs. This week, the Food and Drug Administration unveiled 36 of the new labels -- including images of rotten teeth, cancer-darkened lungs, an infant in an incubator, a man in an oxygen mask, even a corpse. Along with the pictures will be blunt warnings such as “Cigarettes cause fatal lung disease,” “Cigarettes are addictive” and “Smoking during pregnancy can harm your baby.”

It stands to reason that these stark and gruesome messages might persuade smokers to quit. Unfortunately, the scientific evidence suggests it isn’t so simple. In truth, graphic warning labels have only a marginal effect on cigarette smoking.

The pictures can be alarming at first, but smokers quickly grow accustomed to them and tune them out. Some evidence suggests that mortality reminders on cigarette packs may actually increase the urge to smoke.

Watching the Brain

In one study, for example, smokers underwent functional MRI scanning of their brains while they looked at cigarette-pack warning labels. This technique can show how much oxygen and glucose are being used by various parts of the brain, indicating which regions are active. The warning labels clearly activated not the parts of the brain that register alarm or disapproval, but rather the nucleus accumbens, the area that is activated when someone craves something.

Other research at New York University involved having smokers watch movies, some containing warnings reminding smokers about the potentially fatal consequences of their habit, and some with warnings that had nothing to do with mortality -- statements such as “Smoking makes you unattractive.” The death-related warnings actually pushed smokers to have more positive attitudes about their habit.

A study conducted at the University of Missouri likewise found that students with heavy smoking habits inhaled more deeply on their cigarettes when confronted with reminders of their own mortality.

Stress Causes Craving

What these studies remind us is that most smokers smoke even though they already know cigarettes pose a grave health risk. By the time they’ve bought a pack of cigarettes, it’s already too late to persuade them not to have one. A warning label, no matter how graphic, is no match for the addiction. It may be just the kind of stress-producer that gives them the urge for another cigarette.

Young people, especially adolescents, are undeterred by health warnings because they tend to discount the future consequences of smoking. Many surveys have verified what is fairly obvious: In making decisions regarding their health, young people weigh future effects very little. To the contrary, the risk of danger helps lure many adolescents to experiment with cigarettes in the first place.

A further indication that the warning labels might have a minimal effect on smoking rates is that cigarette maker Philip Morris not only supports them but even negotiated and promoted the legislation that imposed them in the first place.

Blank Packages

A better approach is one that is being proposed in Australia. If the law is passed, then beginning in July of next year, cigarette packs will be required to carry graphic warnings, just as they will a few months later in the U.S. What’s different in Australia is what the law would require for the rest of the pack: It would need to be blank, with only the brand name written in a small, plain font. No logos, no color. Because the pack’s design plays such a critical role in establishing the brand’s identity, the empty half could, over the long term, erode the cigarette makers’ ability to make their brand appealing.

Witness how tobacco companies are vigorously opposing Australia’s proposed policy and working to block the regulation. Imperial Tobacco, maker of brands including Davidoff and Gauloises, complained that plain packaging would “seriously harm our brands.”

Australia’s regulation -- and the U.S.’s, too -- might be stronger if it dispensed with the scary pictures and required all cigarette packs to be blank, nothing more than a white or tan covering with the brand name in small, nondescript letters. The cancer photos and strong warnings would be little or no loss to anyone. But banishment of the logo would take away the cigarette makers’ last best chance to build their brand.

(Michael Siegel is a professor of community health sciences at the Boston University School of Public Health. The opinions expressed are his own.)

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To contact the author of this column: Michael Siegel at mbsiegel@bu.edu.

To contact the editor responsible for this column: Mary Duenwald at mduenwald@bloomberg.net.