How effective are warning labels on cigarette packets?

Five years ago this month, the Court of Appeal gave Kenya the go-ahead to continue imposing on cigarette manufacturers what more than 60 other countries in the world have done: have producers print health warnings on packets.

And so no cigarette brand should be sold in Kenya unless a good portion of its packet has a full-colour cautionary picture on the front and back plus the word “warning” written in red and underneath it a cautionary message in white font against a black background. It is a measure that, according to the Ministry of Health, has created more awareness of the dangers of smoking.

“Knowledge of many of the health effects caused by smoking increased between 2012 and 2018 as a result of the three picture-based health warnings on cigarette packages introduced in 2016,” it said in a report last year.

But whether there is a drop in cigarette smoking in Kenya due to the measures, which resulted from subsidiary legislation enacted in 2014, the jury is still out. Sellers interviewed by Sunday Nation said most smokers only grew to hate the package but hardly the product.

“Some customers don’t want to see it,” said Kinyilai ole Maiyan, a shopkeeper in Nairobi’s Buruburu.

And Mr Lawrence Njogu, a habitual smoker, said “we never take them seriously”, in reference to the warnings. “By the way, I know some of the warning images but don’t take a keen look at them. Again, for some cigarettes, we buy like five pieces and so there is no pack to frighten us,” he said.

As per a May 2021 report by the Health ministry, more than 2.7 million adults and more than 220,000 children use tobacco in Kenya every day. It noted that every year, 8,100 Kenyans die of tobacco-related diseases.

Packaging and marketing

The regulations dictating inclusion of scary images that feature a coffin, sobering images of sick body parts and terse messages were considered to open a new chapter in Kenya where people would dread touching a cigarette.

But Dr John Oteyo, a psychologist at Kenyatta University and an expert in addiction counselling, says such images have little impact on those already hooked.

He said the images can work to some extent among those who have never tried smoking, or the so-called primary-level users in some addiction models.

“At the primary level, the perceived harm is a very strong protective factor,” he said. “At that level, you have not even begun. You give this information to young people who have not even begun at all. You can influence their attitude on using or not using.”

Then there is the secondary level where people have started trying out drugs but not hooked. At the tertiary level, warnings will be of little impact.

“When the person has begun using the substance — and nicotine is very addictive — it affects the brain. In fact, we talk about addiction as a brain disease. Part of the affected region is the frontal area of the brain, which is responsible for judgment, decision-making. So, even if you give this person these warnings, the frontal part of the brain has already been destroyed,” argued Dr Oteyo, adding most of the messages on cigarette packs amount to scare tactics, a controversial approach.

“That approach has failed most of the time. Do you remember the way HIV advertisements came and the names we could give it? It didn’t work. Of course, it gives a temporal barrier, but when other factors come, they override the temporal fear it causes on the person.”

Dr Oteyo recommends a holistic approach to addressing smoking. He said the scary messages could be part of the intervention that should involve detoxification and counselling.

“The addict is already sick. It is like being given a painkiller when you have malaria. Of course, the pain will be relieved. But the parasite or whatever caused the malaria has not got out of the body,” he said.

All over the world, countries have been dictating how the packaging and marketing of cigarettes should be done. In some countries, packets are supposed to have the warning as the main part of the design and the brand name as a smaller footnote.

Cigarette consumption

According to Tobaccolabels.ca, Kenya is in a list of countries that demand the printing of health warnings on packets. Others include Australia, Brazil, Belgium, India, Colombia, Russia, Switzerland, the UK and the US.

A survey conducted in Kenya involving 1,500 tobacco users and 600 non-users in 2012 and 2018 claimed that messages on packaging have an impact.

“The surveys found that introduction of picture warnings significantly increased the effectiveness of warnings. Awareness of the warnings increased from 64 per cent to 72 per cent of smokers; thinking about the health risks of smoking increased from 28 per cent to 43 per cent of smokers,” it said.

But have cigarette consumption trends changed?

A Sunday Nation analysis of annual results from British American Tobacco (BAT) — the biggest producer of tobacco products in Kenya with a market share of about 78 per cent — reveals that profits from the sale of tobacco products hardly changed.

The annual profit after tax for the three years before 2016 was Sh11.3 billion, which was incidentally identical to the Sh11.3 billion total of the annual profit after tax for the three years after 2016.

Last month, BAT posted a Sh6.5 billion profit after tax for the period ended December 31, 2021. This was the highest net profit in a decade, breaking the record set by the 2020 profit of Sh5.5 billion.

That means it is business as usual, if not more business, five years after the introduction of the regulations. BAT, a publicly listed firm, made reference to the packaging regulations in its annual report for 2016, telling investors how it appealed against some of the provisions in the Tobacco Control Regulations 2014 but lost in a Court of Appeal decision of February 17, 2017.

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