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Medical News & Perspectives
February 23, 2000

Picture This: Smoking Kills

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JAMA. 2000;283(8):993. doi:10.1001/jama.283.8.993-JMN0223-4-1

They say a picture is worth a thousand words. Health Canada hopes it's also worth thousands of lives saved from tobacco use.

Canada's national health department wants tobacco manufacturers to use 50% of the front panel of cigarette packages for graphic images of the effects of tobacco use, such as diseased lungs and damaged hearts. The government also wants smoking cessation and disease information to appear elsewhere on the package. Proponents of the images said the impact of current warning labels on tobacco products is waning and that the labels do not reflect the true level of hazard associated with tobacco use.

Messages such as these could be adorning the front half of Canadian cigarette packages starting next year. (Photo credit: Health Canada)

Messages such as these could be adorning the front half of Canadian cigarette packages starting next year. (Photo credit: Health Canada)

Health Canada argues that such information is needed to enhance the public's awareness of the dangers of tobacco use, as required by the country's 1997 Tobacco Act. The department's draft regulations propose that packages or cartons of cigarettes, cigarette tobacco, pipe tobacco, leaf tobacco, cigars, smokeless tobacco, and exotic products such as kreteks (clove cigarettes), bidis (smaller, flavored cigarettes), and tobacco sticks (inserted into filters to be smoked) display one of 16 prescribed health warnings on 50% of the principal display surface in English and French.

For example, one proposed image is a color illustration of a diseased lung along with the phrase "Warning: Cigarettes Cause Lung Cancer."

In announcing the regulations, Allan Rock, the Canadian minister of health, said the proposed packaging changes are just part of a larger effort by the government to reduce tobacco use in Canada.

National evil

"Let's take on smoking for the national evil that it is," he told his audience at the University of Ottawa. "Let's identify it as the single most important public health issue in our country. Let's recognize the connection between the efforts of the tobacco industry to promote their product and the consequences for the health of our children, and let's do something about it."

Health Canada said about 6 million of the country's 31 million residents use tobacco products. And while the percentage of those who smoke has declined from 30% in 1990 to 25% in 1999, the smoking rate for youths aged 15 to 19 years rose from 21% to 28%.

The Canadian tobacco industry objects to the new regulations, as do some industry union leaders who worry about job losses resulting from a decrease in sales.

Following the January 22 publication of the proposed regulations, a 30-day comment period followed. The proposal will now return to the government, where it will be reviewed for another 30 days by the Health Ministry. If approved there, the regulations will become effective early in 2001.