Text and Graphic Warnings on Cigarette Packages
Open accessAbstract
Background Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the United States. The current study examined the effectiveness of health warnings on cigarette packages in four countries.Methods Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (n=14,975): Canada (n=3687), United States (n=4273), UK (n=3634), and Australia (n=3381). Surveys were conducted between 2002 and 2005, before and at three time points following implementation of new package warnings in the UK.Results At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave.Conclusions Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.
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Quasi-experimental evidence supports these findings.
“Quasi-experimental evidence supports these findings.133,143”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [133]
Observational, quasi-experimental, and short-term controlled studies demonstrate that warning labels are most effective in countering the attractiveness and persuasiveness of cigarettes when they are visually noticeable, avoid the use of chemical names or ingredients, are specific rather than general, include pictorial and especially graphic warnings, are attributed to a specific source rather
“These studies demonstrate that warning labels are most effective in countering the attractiveness and persuasiveness of cigarettes when they are visually noticeable,132,133 avoid the use of chemical names or ingredients,134 are specific rather than general,135 include pictorial and especially graphic136 warnings, are attributed to a specific source (eg, “medical studies,” “the Ministry of Health”)”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [133]
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- Authors
- Hammond, D., Fong, G. T., Borland, R., Cummings, K. M., McNeill, A., & Driezen, P.
- Affiliations
- University of Waterloo (CA)
- Cancer Council Victoria (AU)
- Roswell Park Comprehensive Cancer Center (US)
- University of Nottingham (GB)
- Corresponding author
- Hammond, David
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2007-03
- Volume
- 32
- Issue
- 3
- Pages
- 202-209
- ISSN
- 0749-3797 (ISSN-L)
- PMC
- PMC1868456
- OpenAlex
- W2152630311
- Cited by
- 434
- References
- 22
- Citations by year
- 2026: 1 · 2025: 12 · 2024: 9 · 2023: 8 · 2022: 14 · 2021: 15 · 2020: 19 · 2019: 48 · 2018: 33 · 2017: 31 · 2016: 30 · 2015: 32 · 2014: 26 · 2013: 24 · 2012: 34
- FWCI
- 16.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P50CA111236, R01CA100362)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Keywords
- graphic health warnings, warning effectiveness, cross-national comparison, tobacco control, United States, United Kingdom, Canada, Australia
- MeSH terms
- Smoking Prevention, Adult, Australia, Canada, Consumer Product Safety, Female, United Kingdom, Health Promotion, Humans, International Cooperation, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Product Labeling, Smoking, United States
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