Shocking, graphic cigarette packages are a deterrent: study

CMAJ 2000;162:1601

The study, conducted by John Liefeld of the University's Department of Consumer Studies, was commissioned by Health Canada and was part of the reason the federal government proposed increasing the size of health warnings, printing them in colour and including a graphic image on the package.

"The content of the message is most important," Liefeld said. Some of the other messages he used in his study included: "This year, smoking will kill off the population of a small city." It was combined with a picture of a bar graph showing projected deaths from motor vehicle accidents, suicides, smoking and heart disease. Another message, "Smoking kills babies," is accompanied by a graphic of a baby lying on its back.

Liefeld studied a sample of 617 people in Ontario and Quebec. "It can be concluded from these results that the immediate impact of larger, stronger warning messages with pictures on one's thinking about smoking would be strong," he said.

Approximately one-third of the study sample were teenage smokers and another third were teenaged nonsmokers. An estimated 90 percent of all smokers begin smoking before age 20. The remaining participants were adult smokers.

The study also found that even warning messages that covered 60% of the package surface did not prevent smokers from recognizing their brand in a simulated store display. Liefeld said that for 95% of smokers, there was no difference in the time taken to locate their brand in the display.

"The incidence of smoking has decreased over 20 years because of the weight of combined actions from many agencies, including the CMA," he said. Because of those actions there has been a decrease in the smoking population — except among teenage girls. — Ken Kilpatrick, Hamilton

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