Warning labels depicting gruesome images, such as a toilet filled with bloody urine or a skeletal woman ravaged by cancer, have graced cigarette packages in Canada for decades. The aim is to provide a smoker with a stark reminder of the risk they are taking every time they light up and inhale.

The effectiveness of these images has been the topic of numerous studies, most of which show an association between the content of these warnings and cessation attempts. It also appears to be a great public-health teaching tool, with those exposed to images reporting an increase in their smoking-related knowledge.

A 2018 study suggests that specific themes or visual features are more powerful when it comes to making individuals think twice before they indulge in a cigarette. A sample of 1,392 smokers rated a few different label sets on their perceived effectiveness, their ability to provoke negative emotion and if the labels deterred them from smoking.

It appears that the more graphic the image, the less likely smokers are to reach out for their pack of cigarettes. Unsurprisingly, diseased body parts and organs produced a high negative emotional response in this sample population.

Fear is a powerful motivator, and according to this study, the images that were the most fear-provoking were likely to correlate with quitting attempts. Testimonials were also effective if they included the image of a person with a story about how cigarettes have affected their health.

Stuart McGeein, a recent graduate from the College of Nursing at the University of Saskatchewan and an occasional smoker, gives his opinion on graphic warning labels.

“These things do deter people from smoking and help people come to [the] decision to quit, but if you’re going to smoke, you’re going to smoke,” McGeein said.

McGeein admits that he barely notices the warnings on cigarettes. He says, after the initial impact of a graphic image, the effect wears off and he rationalizes his decision to smoke. McGeein doesn’t believe that the packages make a big enough impact, considering that the amount of time that you are visually exposed to the images is too limited.

“You can’t see the package any more in the stores because they are hidden behind a curtain, and you can’t have them out on a table in a bar or restaurant because you can’t smoke in those places, so they are always in your pocket,” McGeein said.

Another 2018 study found that graphic warnings do not appear to produce a reduction of smoking behaviours or an increase in quitting attempts.

In fact, when assaulted with gruesome negative images, smokers may build up a psychological reactance to them. Reactance is a common response when people believe their right to choose is being threatened or their behavioural freedoms are being strangled by rules or regulations, which tends to cause people to double down on their beliefs.

This study did find some common ground when it came to testimonial labels. They, too, found that real people along with personal accounts of how their health has been impacted by smoking produced less of a reactance response — which, in turn, would increase a smoker’s chances of quitting.

Reactance may be a large and somewhat overlooked obstacle when it comes to butting out a cigarette addiction. When people feel as if they are being personally attacked and having their freedoms stripped from them, they tend to dig their heels in a little harder. We humans are stubborn creatures.

On Oct. 31, 2018, Health Canada revealed a new warning label they plan to introduce to tobacco consumers: An individual text warning, such as “this causes cancer,” stamped on each individual cigarette as a reminder that you are burning away your health with each puff you take. But will this authoritarian style of warning be effective in deterring users from lighting up?

—

Erin Matthews / Opinions Editor

Graphic: Prince Olubiyi