NewPublicHealth Q&A with Danny McGoldrick, Campaign for Tobacco-Free Kids

Jun 22, 2011, 5:09 PM, Posted by

The graphic cigarette health warnings released by the Food and Drug Administration yesterday represent a milestone in the fight against tobacco use in the United States. According to the Campaign For Tobacco-Free Kids, “the stark new warnings will provide a much-needed boost to efforts to prevent kids from smoking, encourage smokers to quit and make sure all Americans fully understand the deadly consequences of cigarette smoking.” NewPublicHealth spoke with Danny McGoldrick, Vice President of Research at the Campaign, about the new labels.

NewPublicHealth: How important are the new graphic warnings to the goal of reducing cigarette smoking in the U.S.?

McGoldrick: Well, the new graphic warning labels are a huge step forward for the U.S. We are joining forty countries around the world in finally putting graphic warning labels on our cigarette packs. We haven’t changed the warning labels in over 20 years, so this is a dramatic step that will in fact both discourage kids from starting to smoke and educate everybody about the harmful effects of second hand smoke and encourage smokers to try to quit.

But it’s not going to solve the problem by itself. There are many other interventions that are evidence-based that we know if we put in place will help reduce smoking, which includes increasing tobacco taxes, passing comprehensive smoke-free laws, and funding for prevention and cessation programs, that not only protect everybody’s right to breathe clean air but also encourage smokers to try to quit and help them stay quit--as well as funding for prevention and cessation programs. We have a solid evidence base for all these interventions--they work wherever we do them. The warning labels are a wonderful complement to the other activities, but we can’t just think that this is going to solve the problem. But it’s a wonderful step forward.

NPH: What kind of an impact do you think the graphic warning labels will have on smokers?

McGoldrick: Well, the warning labels that are on the packs now are hardly noticed anymore. First of all, they are on the side of the pack, the color is not a great contrast to the color of the packs, often times, so I don’t think anyone really notices them anyway. They were news when this happened years and years and years ago, but this new effort is going to be dramatic. The warning labels are going to cover the top half of both the front and the back of cigarette packs with graphic images along with the text warnings, and help for smokers with the 1800 QUIT NOW number. So this is going to change dramatically what smokers see--every time they pick up a pack of cigarettes and what kids and others see when they see a pack of cigarettes. We hope kids don’t have them in their hands, but inevitably they see them from their parents or friends or others, so this is a dramatic change. And the evidence is very clear from studies around the world that the graphic warning labels increase knowledge about the health risks of smoking and motivate people to try to quit. Smokers report in a number of studies that the warning labels were instrumental in helping them stay quit.

NPH: What other measures do we need besides the warnings to get people to quit?

Danny McGoldrick: We need to continue to educate people about the dangers of smoking and we know that these graphic and emotional messages help them do that. But we can’t just do it on cigarette packs. You know the tobacco companies don’t just market through their packs--they spend 12 billion dollars a year promoting their products. They outspend our states 25 to 1, so we need a media campaign--we haven’t had a national anti-tobacco or smoking cessation media campaign in years, except for the Truth campaign, which is directed exclusively at kids by the Legacy Foundation, and that is also underfunded. So we need media campaigns to educate people and encourage them not to start smoking and to encourage them to try to quit. We need every smoker to have access to evidence-based smoking cessation therapies including counseling and medications that we know greatly enhance one’s chances of quitting. And we can raise tobacco taxes. Price is a huge factor in whether people smoke, particularly young people. And our smoke-free laws also help in creating an environment that is less conducive to starting to smoke and more conducive to trying to quit.

NPH: Some states facing budget cuts have slashed anti-smoking programs. What should be done to beef up programs in the face of less money to spend?

Danny McGoldrick: Yeah--our states are doing a terrible job of funding tobacco prevention cessation programs. They haven’t done a good job from the get-go, and now they are doing even worse in these tough budget situations. And they really have no excuse. They take in over 25 billion dollars a year in their settlement payments and their tobacco taxes, and devote only a tiny percentage of it to improving prevention and cessation programs. So even in tough budget times, just a small part of that money would fund tobacco prevention and cessation programs at the levels recommended by the CDC. Only one or two states funds programs at that level.

We know these programs work. So even in these tough budget times, there are a number of steps that our leaders can take, such as increasing taxes and having the double measure of the price hike and more money to spend on cessation and prevention programs. And the public supports them. The public is so far out in front of our legislative decision makers on doing something about the tobacco problem. If our elected officials did what the science shows works and what the voters tell them they want them to do, we would make great progress in reducing tobacco use.

NPH: Cigarette companies have until September 2012 to add the graphic warnings to the packages. Could there be bumps on the roads until then?

Danny McGoldrick: The companies already sued to stop the warning labels. They’ve sued over the entire FDA law that was passed two years ago and challenged a number of provisions in it. In Federal District Court, the warning labels were upheld and so we are confident that they will be upheld. Tobacco companies will probably find other reasons to litigate around this, but you know it’s been over twenty years since the last time we changed the warning labels, and we need to do everything we can to stop the tobacco companies from slowing us down again. Their opposition is just more evidence that these things work. If they are against it, it’s usually a good thing to do. So we are hopeful that if they do decide to file even more law suits than they already have to stop these warning labels, then the courts will dismiss them quickly. Every minute we wait, it’s more lives that are going to be lost and more we spend in healthcare costs.

NPH: You mentioned that smokers had gotten used to the warning messages on cigarette packs. If people become used to the new graphic warnings, what’s next?

McGoldrick: Well, the great thing about the FDA legislation is that it not only dictated these new warning statements and labels, but it also gave the FDA the authority to change them moving forward. So, it won’t take an act of Congress next time to change the warning labels. And the FDA will begin immediately to evaluate the impact of the new graphic warning labels, and they have the authority to issue a new rule to change the text of the warning labels if there is new science about the harms of tobacco or new science about what messages work best to motivate smokers to quit or to prevent kids from starting.

And the FDA can change the graphics as well. They have to go through the rule making process like they do with anything, but this flexible authority the FDA has to react to what the industry does or to new science is incredibly important. When the warning labels were announced yesterday, Dr. Deyton, [director of the FDA Office of Tobacco Products] said, “We are going to be looking at keeping these [labels] fresh and making sure that we always have the warning labels that the science tells us will have the biggest impact on public health.”

This commentary originally appeared on the RWJF New Public Health blog.