POS Health Warnings

Policy Solutions

Resources:

See graphic warnings from across the world at the Tobacco Labelling Resource Centre

FDA’s report on cigarette warnings, including images and selection process

Keep up to date with recent graphic health warning court cases from the Center for Public Health & Tobacco Policy

New York City proposal to require health warnings where tobacco is sold

Next Steps:

Talk to a legal center about whether health warnings are right for your area.
Consider voluntary programs, as done in Jefferson County, Alabama.
Consider options for imagery. See the FDA image testing report and Jefferson County images and rationale.
See policies: New York Model Ordinance and FDA’s requirements.
See NYC’s Frequently Asked Questions guide for store owners and the public.

What Is It?

Health warnings displayed at the point of sale have the potential to be a strong tool in the fight against tobacco. This counter-advertising mechanism involves placing written and pictorial warnings of the health impacts of tobacco usage in a retail environment, together with information about cessation services.

The intent of POS health warnings are to ensure both that smokers and non-smokers are aware of the specific health effects of tobacco products. Armed with knowledge about the risks of using tobacco, consumers report that health warnings have successfully inspired quit attempts and have helped put those who want to quit reach resources that can help them be more successful.

POS Health Warnings Across the World

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) requires health warnings on product packages in the 174 countries that ratified the WHO FCTC treaty, warnings which must cover at least 30% and ideally 50% of the most visible package areas. Unfortunately, this list does not yet include the United States, although strides have been made to use POS health warnings in recent years.

According to data from the Global Adult Tobacco Survey (GATS), in 14 WHO FCTC countries with graphic cigarette package health warnings:

Greater than 90% of smokers noticed a health warning in the previous 30 days
Greater than 50% of smokers were thinking about quitting because of the warnings in 6 countries
Greater than 25% of smokers were thinking about quitting because of the warnings in all countries except one

Evidence shows health warnings can help prevent tobacco use initiation among youth as well, especially with powerful pictures included. See examples below, used on cigarette packs in Canada.

Graphic cigarette health warning labels from Canada. Photo credit: Physicians for a Smoke-Free Canada

POS Health Warnings in the United States

While smokeless tobacco products in the U.S. already carry large rotating warning labels, such as the ones shown below, strides are being made to require such warnings on other products. Currently, health warnings are required to cover at least 20% of smokeless tobacco advertisements, and at least 30% of both principle sides of smokeless tobacco packages. Current legislation expands these existing smokeless tobacco warning rules, requiring the placement of graphic, not just written, health warnings on cigarette advertisements and packages as well.

Existing POS warning labels on smokeless advertisements and packages. Photo credit: FDA

Smokeless tobacco product advertisement before and after warning label requirement. Photo credit: New York Times.

U.S. Food and Drug Administration Federal Policy

At a national level, the U.S. Food and Drug Administration (FDA) will soon require graphic health warning labels on all cigarette packages and advertisements in stores across the country. These labels will cover the top 50% of the front and rear panels of packages and at least 20% of the space in advertisements. This is the first time that the U.S. is requiring such labels, despite wide usage of graphic cigarette health warning labels internationally. Images for the labels were selected after a reviewing scientific literature on graphic health warnings and image testing in a study of 18,000 people. See the nine selected images here. The warning labels will also promote use of the quitline, a free resource to support those who want to quit using tobacco. See the FDA's simulation of what these cigarette health warnings will look like at the point of sale.

The constitutionality of this policy is currently being challenged in court by the tobacco industry. In March of 2012, the Court of Appeal for the Sixth Circuit in Commonwealth Brands v. FDA upheld the law. However, in the most recent case, R.J. Reynolds v. FDA, the Court of Appeals for the D.C. Circuit ruled against the policy contesting that the graphic warnings contain anti-smoking advocacy messages rather than just factual information. Groups such as the Campaign for Tobacco-Free Kids however argue that this latest ruling is wrong based on science and the law, contending that the warnings promote solid scientific evidence about the harms of tobacco, and fall within the authority of the government to regulate as commercial speech.

This latest ruling is likely not to be the final word, and the law may be ultimately decided upon by the U.S. Supreme Court. The timeline for implementation of this policy will depend on the outcome of this continued litigation.

New York City, New York

New York City passed a resolution in September, 2009 that required health warnings and cessation information to be placed near the cash register or near the tobacco product display everywhere tobacco is sold in New York City. Encouragingly, interviews conducted with adult current smokers and recent quitters both before and after the signs were posted showed an 11% increase in respondents who were thinking about quitting smoking.

In June, 2010, the regulation was challenged in court by Phillip Morris, R.J. Reynolds and Lorillard, the three largest tobacco companies in the United States, as well as a convenience store trade group. By December, 2010, the NYC regulation was struck down by a federal judge. According to a January 3, 2011 news update from the Public Health Law Center, a judge ruled that while the law was well-intentioned, only the federal government has the authority to regulate advertising or marketing of cigarettes

Jefferson County, Alabama

Avoiding a court battle over first amendment rights, Jefferson County, Alabama has pioneered an innovative program based on voluntary commitments of store owners to the health of their communities. The United Way of Central Alabama and the Jefferson County Department of Health have worked together to start a program in which retailers can post health warning signs in their stores. Signs were created based partially on the new graphic warning labels required by the 2009 Food and Drug Administration Family Smoking Prevention and Tobacco Control Act. Encouragingly, 51 convenience store owners voluntarily agreed to post the warning signs in their place of business, demonstrating strong commitment to the health of their communities. Through these signs and other communication strategies, the number of callers to the quitline (1-800-QUIT-NOW) exposed to this service by the media has more than doubled. For practitioners, the Jefferson County health warnings can be found here, together with a summary of the research that informed their work.