Canada to require health warnings on individual cigarettes. Will it work?

Canada has taken an extraordinary step to curb tobacco use by requiring warning labels to be printed directly on individual cigarettes, becoming the first country in the world to do so, its health ministry said Wednesday.

The new packaging will feature warnings including “Tobacco smoke harms children,” “Poison in every puff” and “Cigarettes cause impotence.” The warnings will appear in both English and French, the health ministry said.

The government’s push to require warning labels is designed to help smokers quit, protect nonsmokers and young Canadians and reduce the appeal of tobacco use. It is also part of a federal strategy to lower tobacco use to less than 5% by 2035.

Tobacco kills an estimated 48,000 Canadians annually, said Carolyn Bennett, the associate minister of health.

“This bold step will make health warning messages virtually unavoidable,” Bennett said, adding that combined with the updated graphic on packaging, the warnings “will provide a real and startling reminder of the health consequences of smoking.”

The regulation goes into effect in phases starting Aug. 1. The warnings will first appear on king-size cigarettes in July 2024 and on regular cigarettes and small cigars with tipping paper, and tubes, by the end of April 2025, the health ministry said.

Canada has been at the forefront in the fight against tobacco use. According to the health ministry, the nation became the first to impose requirements in 2000 to feature graphic images of the health hazards of smoking on cigarettes and other tobacco packages.

In the U.S., health warnings first appeared on cigarette packages in 1966 and were updated in 1984 but remained unchanged for decades. The Food and Drug Administration imposed new rules in 2021 requiring packaging to feature written text statements “along with photo-realistic color images depicting some of the lesser-known, but serious health risks of cigarette smoking, including impact to fetal growth, cardiac disease, diabetes and more,” according to the agency.

Research has found such messaging to be varied in its effects. One 2020 study published in the journal Human Communication Research concluded that cigarette warning labels using images increase the chances that smokers will kick their habits, but they do not necessarily influence beliefs about smoking-related health hazards. A previous meta-analysis in 2016, conducted by some of the same authors behind the 2020 study, found that graphic images were more effective at preventing smoking or getting smokers to quit than text warnings.