US: New health warnings could help save half a million lives

According to a study[1] The new health warnings that are expected to appear on all cigarette packages manufactured in the United States starting in October 2022 could save an estimated 539,000 lives over the rest of this century, according to a Yale School of Public Health researcher.

The United States lags behind other countries in health warnings on manufactured cigarette packages, with the FDA not having updated those warnings in 37 years. New warnings covering the front and back of the pack are expected to be added in October 2022.[2]. These new warnings take up the major risks, opening up to other lesser known, although severe, risks. A measure initially planned for 2012 but which has been delayed on numerous occasions due to legal action taken by the tobacco industry.

Health warnings could help reduce tobacco-related deaths

The model reproduced trends in smoking and associated mortality observed in the United States from 2010 to 2018. On this basis, smoking prevalence and mortality attributable to smoking in the United States from 2012 to 2100 were simulated. In the scenario with the new health warnings implemented in 2022, the model estimated that smoking prevalence would decrease from 13.6 % in 2022 to 4.2 % in 2100.

Thus, in the baseline scenario, the model estimated 13.2 million deaths attributable to smoking from 2012 to 2100, including 8.8 million in men and 4.4 million in women. With the implementation of the warnings in 2022, according to the model, approximately 539,000 deaths attributable to smoking would be averted and 7.9 million life-years gained from 2022 to 2100. This would represent 4.1 % of the estimated number of deaths attributable to smoking in the baseline scenario. If the measure had been implemented as early as 2012, 718,000 deaths would have been averted and 11.2 million life-years gained by 2100. This would have averted 5.4% of the estimated number of deaths attributable to smoking. The lessons of the model highlight the magnitude of the results of the policies but also point out the consequences in the event of delay in implementing effective measures.

The need to implement a comprehensive arsenal of anti-smoking measures

Cigarette warnings first appeared in the United States in 1966 and were last updated in 1984. Over the past 37 years, cigarette packages have carried the same warnings emphasizing the link between smoking and lung cancer, emphysema, and cardiovascular disease. Their limited content, small size, and lack of images explain their now limited effects on smokers' smoking behavior. Evidence from the scientific literature emphasizes the need to renew messages very regularly to avoid the so-called "wallpaper" effect and to insert them in a setting that highlights them, like the graphic warnings on a plain package.[3].

The authors say these findings suggest the need for comprehensive policy action that goes beyond health warnings. The Biden administration’s recent commitment to implement a federal ban on menthol in cigarettes and cigars/cigarillos and to reduce the level of nicotine in manufactured cigarettes could have positive public health consequences. One study estimated that banning menthol would save 650,000 lives by 2060[4]. A recent bill introduced in the House of Congress also seeks to raise federal tobacco taxes for the first time in more than a decade. This provision would double the current federal tax, and bring taxes on other tobacco products into line with those on manufactured cigarettes. The impact of this measure could reduce the number of adult smokers by 1.1 million in the first year, and prevent 500,000 adolescents from starting to smoke. In doing so, researchers estimate that more than 418,000 lives would be saved from premature death.[5].

Delayed implementation of measures following appeals by the tobacco industry

The implementation of the new health warnings planned by the Food and Drug Administration (FDA) in 2012 has been postponed until 2020, following appeals filed by the tobacco industry against the measure.[6]Several public health organizations then sued the FDA over the delays, and a court-ordered deadline forced the FDA to finalize new graphic health warnings nearly a decade later.

In March 2020, the FDA finalized 13 new health messages: “Mandatory Health Warnings to Be Placed on Cigarette Packages and Advertisements,” with an effective date of July 13, 2022. April 3, 2021[7], North Carolina-based RJ Reynolds, along with other manufacturers and retailers, then filed a lawsuit in Texas court seeking to invalidate the FDA’s provisions and Congress’ request that the FDA impose the measure. New York-based Philip Morris USA Inc. and Sherman Group Holdings LLC, owned by Altria Group Inc., filed a similar lawsuit in the District of Columbia against the FDA seeking the same ruling. The U.S. District Court for the Eastern District of Texas issued an order on Aug. 18, 2021, in RJ Reynolds Tobacco Co. et al v. FDA to delay the effective date of the final rule to October 2022.

Keywords: United States, health warnings, health,

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[1] Tam J, Jeon J, Thrasher JF, et al. Estimated Prevalence of Smoking and Smoking-Attributable Mortality Associated With Graphic Health Warnings on Cigarette Packages in the US From 2022 to 2100. JAMA Health Forum. 2021;2(9):e212852. doi:10.1001/jamahealthforum.2021.2852 [2] Food and Drug Administration, Cigarette Labeling and Health Warning Requirements, Last updated August 25, 2021, accessed September 29, 2021 [3] CNCT, Plain packaging: how effective is it in the fight against smoking?, September 24, 2014, accessed October 4, 2021 [4] Tobacco Free Generation, US: Menthol Ban Would Save 650,000 Lives by 2060, September 13, 2021, accessed September 29, 2021 [5] Tobacco Free Generation, United States: Raise tobacco taxes to save 418,000 lives, September 17, 2021, accessed September 29, 2021 [6] Holly Honderich, Why US lags behind on graphic cigarette warnings, BBC, August 16, 2019, accessed September 29, 2021 [7] Hannah Prokop, Postponed Again: Retailers Have More Time to Submit Cigarette Warning Plans, CSP Daily News, September 1, 2021, accessed September 29, 2021 National Committee Against Smoking |