A new study published in JAMA Network Open found that graphic warning labels on cigarette packages increased awareness of health concerns but did not trigger quitting. According to researchers, even gross images of gangrene feet or a newborn with a breathing tube and throat cancer didn’t trigger smoking cessation among hardcore smokers.

“Graphic warning labels are used in more than 120 countries to counter marketing that promotes cigarette smoking. We wanted to know what effect such cigarette packaging would have on United States smokers,” said David Strong, Ph.D., a professor in the department of Family Medicine and Public Health at the University of California San Diego.

According to UC San Diego News Center, graphic warning labels or GWL’s were mandated by the United States Congress in 2009 but implementation has been halted pending the results of legal challenges by the tobacco industry. Strong and his colleagues at UC San Diego Moores Cancer Center, California State University San Marcos, San Diego County Public Health Services, and San Diego State University enlisted 357 smokers living in San Diego for their study. The researchers wanted to find out how GWL’s affected smokers’ behavior.

They divided the participants into three groups who agreed to buy their favorite brands of cigarettes online. One group received their cigs in packages that incorporated the graphic health warnings that are used in Australia. The second group received a standard, commercially available U.S. package, while there were no labels on the packages received by the third group.

During the three-month study, researchers quizzed the participants through text messages on how they perceived their smoking habit. According to UC San Diego News Center, all three groups acknowledged that they had increased health concerns possibly because they were part of the study, but the group with the GWLs on their cigarette packs admitted they perceived their habit in a much less favorable light.

But not enough to quit, said researchers.

“While these labels make smokers more likely to think about quitting, it did not make them more likely to make a serious quit attempt, nor was it sufficient to help them quit their nicotine addiction,” said Dr. Karen Messer, one of the senior authors of the study who is a professor of biostatistics at UC San Diego. “Thus, graphics warning labels are an integral component of tobacco control strategies, but they are only one tool for governments to reduce the societal costs from the death and disease caused by tobacco smoking.”

According to data from the Centers for Disease Control and Prevention, cigarette smoking remains the leading cause of preventable disease, disability and death in the United States, accounting for 480,000 deaths annually, or about 1 in 5 deaths. Statistics from 2019 indicate that there are currently 34.1 million Americans who smoke cigarettes. More than 16 million people in the U.S. are living with a smoking-related disease.