Tobacco products are the leading cause of lung cancer death in the United States, accounting for up to 90% of all lung cancer deaths.

Without a question, avoiding cigarettes is the safest approach to protect against lung cancer, and to keep you away from smoking, more than 120 countries have adopted graphic warning labels on cigarette packets.

But, a new interesting study found that instead of avoiding cigarettes, Americans are hiding their packs.

In the US, smokers who got cigarette packs with pictures of health risks on them hid them 38% more often.

According to a multi-institutional panel of public health, specialists led by the University of California San Diego, users ceased hiding their smokes when they reverted to standard packs without the graphic labels.

“In a randomized clinical trial, we demonstrated that smokers in the U.S. who received cigarettes in packs with graphic warning labels were less willing to display the packs in public,” says first author John P. Pierce, adding “It has been hypothesized that this behavior could reduce perceptions by teens that it is socially acceptable to smoke, perhaps explaining why mandated graphic warning label packs are associated with reductions in teen smoking.”

Pierce and colleagues at UC San Diego Moores Cancer Center, California State University San Marcos, and San Diego County Public Health Services created special cigarette packs that included graphic pictures of a diseased foot, a newborn with a breathing tube, or throat cancer on cigarette packs in Australia in a paper published today in JAMA.

Participants included 357 San Diego-based smokers who consented to purchase their preferred cigarette brand from a study website. Participants were assigned to one of the three-pack designs: one with a graphic warning label, one with a blank pack, or one with a typical commercially available U.S. pack. A total of 19,000 packets were distributed to the attendees.

More than 120 countries use graphic warning labels on cigarette packets. Despite being ordered by Congress in 2009, the tobacco industry has successfully challenged the use of graphic warning labels in court.

“Prior to the study, we found that many smokers in the U.S. were discrete and reported hiding their usual pack in public settings. The packs with graphic warning labels had their main effect on those who were least likely to hide their packs prior to the study,” adds senior author David R. Strong. “We found no evidence that graphic warning-labeled packs changed smoking behavior over the year-long study.”

People continued to smoke at the same rate before and after the trial.

During the study, participants were asked via interactive text messaging if they had stored their packs where others would not see them in the preceding four hours. At the completion of the three-month intervention and at the end of the 12-month trial, changes in intake and smoking status were examined.

Participants who were given cigarettes in either a normal U.S. pack or a blank pack with no marketing did not modify their pack hidden behavior. Smokers who were randomly assigned to the graphic warning label arm stated that they increased pack burying throughout the first four weeks of the intervention and maintained it until the end. They soon reverted to baseline pack hide levels after they stopped receiving the packs tagged with graphic warnings.

According to the authors, when social reactions to the cigarette packs were asked about at the end of the study, the group with graphic warning label packs noted that observers had aversive reactions to the packs, whereas the blank pack group reported that observers expressed a positive interest in the study.

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