THURSDAY, Aug. 27, 2009 (HealthDay News) -- Would a gruesome picture of a cancer-ravaged mouth with rotting teeth make you think twice about buying a pack of cigarettes?
That's the goal of new federal regulations expected to go into effect within three years. The rules will require tobacco companies to cover at least half of the front and back of packages with graphic -- and possibly gruesome -- images illustrating the dangers of smoking.
If U.S. regulations are modeled after those already in place in Canada and other countries, the warnings will be shocking: blackened lungs, gangrenous feet, bleeding brains and people breathing through tracheotomies.
Though hard to look at, the more graphic the image, the more effective in discouraging smoking, said Stanton Glantz, a professor of medicine at the University of California, San Francisco and director of the university's Center for Tobacco Control, Research and Education.
"The graphic warnings really work," Glantz said. "They substantially increase the likelihood someone will quit smoking. They substantially decrease the chances a kid will smoke. And they really screw up the ability of the tobacco industry to use the packaging as a marketing tool."
Over the last decade, countries as varied as Canada, Australia, Chile, Brazil, Iran and Singapore, among others, have adopted graphic warnings on tobacco products. Some are downright disturbing: in Brazil, cigarette packages come with pictures of dead babies and a gangrened foot with blackened toes.
In the United States, the authority to force packaging changes was granted on June 22, when President Barack Obama, who has struggled with cigarette addiction since he was a teen, signed into law the Family Smoking Prevention and Tobacco Control Act. The landmark legislation gives the U.S. Food and Drug Administration broad new authority to regulate the marketing of tobacco products.
Under the law, the FDA has two years to issue specifics about the new graphic warnings tobacco products will be required to carry. Tobacco companies then have 18 months to get them onto packages.
Currently, the United States has some of the weakest requirements for cigarette package warnings in the world, said David Hammond, an assistant professor in the department of health studies at the University of Waterloo in Ontario, Canada. The text-only warnings on packages have changed little since 1984.
"Consumers in many Third World countries are getting more and better information about the risks of cigarettes off their packs," Hammond said.
With much at stake for tobacco companies, there will be much wrangling over the details, Glantz said.
Yet research shows the FDA shouldn't compromise, Glantz said. The more frightening the image, the greater the anti-smoking effect, he said.
Despite some research that has suggested images that are too stomach-turning may backfire because people eventually ignore them, new research is showing the most graphic images pack the most punch, said Jeremy Kees, an assistant professor of marketing at Villanova University.
In a yet-to-be published study, Kees had 541 adult smokers in the United States and Canada view a mild image of a smoker's mouth with yellowed teeth; a moderately graphic image of a diseased mouth; and a third photo of a grotesque, disfigured mouth.
The most disturbing photo evoked the most fear, prompting more smokers to say they intended to quit, Kees said.
While the new regulations may also include no-nonsense, text warnings such as "Smoking Makes You Impotent" and "Smoking Kills," the images will have the broadest reach, Hammond said.
Non-English speakers can understand the picture of a diseased mouth, as can people who are illiterate. Smokers tend to have lower literacy levels, Hammond noted.
And kids will get the message too, potentially stopping them from ever lighting up. "You have 4-year-olds and 5-year-olds who can understand that picture," Hammond said.
Elsewhere, graphic warnings seem to be helping to drive down smoking rates. In Canada, about 13 percent of the population smokes daily, a 5 percent drop since the graphic warnings were adopted in 2000, Hammond said.
About 21 percent of the U.S. population smokes daily, according to the U.S. Centers for Disease Control and Prevention.
While powerful, the gruesome warnings won't get everyone to quit.
"Nicotine is highly addictive," Hammond said. "Health warnings are not a magic bullet, but they help move people closer to quitting and provide a constant reminder of why many people want to change."
The Tobacco Labelling Resource Centre has images of cigarette packages from around the world.