Freakonomics Poll: Will New Cigarette Warning Labels Reduce Smoking?

Photo: kadavy

Soon, new warning labels on cigarette packs will have even scarier messages, and photos too. Canada has been doing this for years. Will it reduce smoking?

Here are three quick thoughts.

1)    I strongly doubt it will increase the quantity of information about smoking. Folks know it is bad for you already.

2)    This does not mean it won’t work. Maybe people try to forget the health risks in that moment of passion (folks know birth control helps prevent pregnancy, but similarly, when faced with impending temptations, magically forget such trivial details). Will these photos remind them at that moment of temptation? Maybe. Or maybe it will increase how often their kids or friends give them grief for it, thus creating some social pressure to stop. Naturally there is a counter-argument, that this may enhance teenage smoking, if “being bad” makes it cooler.

3)    We do have some related evidence on this. It doesn’t bode well for the messages and photos. A few years ago Levitt blogged here about a commitment contract randomized trial I did in the Philippines. The commitment contracts worked great to reduce smoking for those who would sign a contract (disclosure: these contracts are designed similarly to, a corporate wellness program and personal behavior modification website I co-founded with Ian Ayres, except minus the internet). And 11% signed a contract, which is really high for any consumer products or services firm, but low if your goal is to eliminate smoking entirely.

The commitment contracts treatment arm was the main point, but there was a placebo group which didn’t get much attention. Messages and photos!

A group also received a card to keep in their wallet or home. The card had nasty photos of black lungs and throat cancer. Spot checks conducted during the study found that folks knew where their card was, they didn’t just throw it away.


After one year, we found that the cue card barely made a dent in smoking, a reduction of 0.9 percentage points (at 95% confidence, +/- 3.1 percentage points). At six months the point estimate was slightly higher (1.5 – 2.2 percentage points), but still not statistically significant. Hardly a resounding success, and a decently small confidence interval, so the null effect we believe was truly a sign of an ineffective treatment.

In fairness to the CDC’s new messages and photos, this was not the same as putting the messages and photos on the cigarette packages themselves. There is a constancy in putting it on the packages themselves that maybe is essential to make this work? (Although I also suspect this policy will now create a new line of products for cigarette package covers, to cover up the nasty photos. This could be like a new fashion statement, changing every week with your ringtone.)

There is hope though: another study, here, found that sending frequent text messages to encourage individuals to stop smoking had a big effect. The timing here is different, and in a potentially important way. These messages came throughout the day, not at the moment of passion. Imagine sending someone frequent messages throughout the week to practice safe sex, compared to just tapping someone on the shoulder immediately before the act to remind them. I strongly suspect the former would be more effective than the latter.

So what will the net effect be, fewer smokers or more smokers?

Will more graphic warning labels and pictures on cigarette packs

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  1. Carolyn Thomas says:

    An Institute of Medicine study found that 85% of Canadian respondents, who first started seeing graphic warnings in late 2000, used tobacco packages as a source of health information, compared to 47% of American smokers. And there have been actual results in decreased smoking rates (although this could also be credited to a number of anti-smoking campaigns and the general disdain directed at smokers these days!) For example, a 2009 Health Canada study found:

    – 7% decrease in the overall smoking rates from 25% in 1999 to 18% in 2009.
    – 15% decrease in the 15 to 19 year olds who smoke, from 28% in 1999 to 13% in 2009.
    – 7% greater proportion of the population that were never smokers — 49% in 1999 and 56% in 2009

    So contrary to your readers’ poll results here, graphic illustrations do seem to work. Except for diseased body parts – pictures of diseased organs did not have as great an impact as images depicting poor life quality, according to another Health Canada survey in 2009.

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  2. Jed says:

    I’m from Malaysia and honestly when I was smoking normal ciggies I have never paid attention to those graphic warnings since our Govt launched such packaging back in year 2008. Coupled with the 500% increase of price within 10 years (It was only RM 2.00 for a pack of 20s back in year 1998 when I picked up this habit during my 9th grade) due to revision on taxes also did not deter me from continuing smoking then.

    My fellow smoking cliques then were joking about going to shops to purchase and collect different ciggie brands with different graphic warnings as a form of “collection” and some even requested their favorite brands with specific graphics request when they shop their packs and they parade them when we gather to smoke as if they have gotten their “trophy fix” of the day.

    The conclusion? Nah, it didn’t help at all to deter/reduce smoking. Maybe because of my working environment then, I saw an increase of smokers within my company too.

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  3. Jon Thomas (@Story_Jon) says:

    I saw these a few months ago in an airport in Mexico for the first time. I’m no fan of smoking and if something could be done to rid the world of them, I’d be all for it. But I’m just a little weary that this approach is enough, or if it’s even fair. I mean, are people really not aware of the negative effects?

    Why stop at cigarettes? Why not warn people about the adverse effects of alcohol? Or Keeping Up with the Kardashians? Or Ke$ha’s music? We mocked up a few of those at our blog here:

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  4. Shaun Wilde says:

    In Australia these images have been used for some time and now the government have introduced laws such that the packets are stored out of sight and soon it looks like they will also have to have be sold in plain packaging. These latter rules are supposed to prevent people, especially children, from taking up smoking.

    However I personally don’t know of any smoker that started by buying a packet of cigarettes from a shop, most start when they are given one to try by a friend or relative. If you want young people to not start perhaps we need to stop people from drawing people into their own hhabit; perhaps we should make giving away a ‘ciggy’ a drug dealing offence.

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  5. Makia says:

    The warning labels apply to only those who can read, understand basic human anatomy and trust the motives the regulators have. Why are there no homocide caused by knife wounds images displayed next to a kitchen knife on display in a mall? Or next to guns for that matter? Will putting pictures of gun shot wounds from sucide victims reduce sucide rates?

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