Pictorial warning labels are an important opportunity to
communicate the risks of tobacco use “...if you smoke, a
cigarette pack is one
The tobacco industry uses the tobacco package as a promotional opportunity.
of the few things you
Public awareness is low about the true risks of tobacco use, even in countries with
widespread anti-smoking campaigns.2 use regularly that
makes a statement
• Most smokers cannot recall the specific health effects associated with smoking.3
about you. a cigarette
• Even smokers who understand the dangers of smoking underestimate the severity pack is the only thing
of its impact on health.4
you take out of your
• Most smokers perceive other smokers to be at greater risk from smoking than
pocket 20 times a
day and lay out for
• Smokers tend to be even less aware of the risks of secondhand smoke to others.6
everyone to see.”1
• An understanding of both the risks and severity of smoking are important factors
in motivating smokers to quit.
brown & Williamson (1985)
Public health proponents see the tobacco package as an educational opportunity.
Pack-a-day smokers are exposed to images printed on packs at least 20 times a day
(and 7,000 times a year), when they buy and use cigarettes. That’s 20 opportunities a
day to deliver anti-smoking messages at critical junctures: the point of purchase and
the time of smoking.7
Pictorial warning labels increase knowledge about smoking
Research shows that effective warning labels, increase knowledge about risks
associated with smoking, and can persuade smokers to quit.8,9 Smokers report
that they receive more information about the risks of smoking from the tobacco
product package than from any other source except television.10,11 As more countries
introduce stronger labels and evaluate their effectiveness, growing evidence shows
that larger, bold, and graphic labels have an impact on awareness of the risks of
Warning label, Australia
A major study which compares warning label data from four countries with widely
varying labeling policies (Australia, Canada, the United Kingdom [U.K.], and the
United States [U.S.]), found the following:12,13
• Larger, more comprehensive warnings were more likely to be noticed and rated
as effective by smokers.
• Pictorial warning labels increased awareness about the association between
smoking and specific health hazards (e.g., lung cancer, heart disease, stroke,
• Knowledge about smoking health hazards was greater in countries that listed
specific hazards on their warning labels.
• 84% of smokers living in Canada, where pictorial warnings are required, saw Warning label, European Union
health warning labels as a source of health information, compared with 47%
smokers living in the U.S., where only text-only labels are required.
1 Warning labels: The evidence October 2008 www.tobaccofreecenter.org
Warning LabeLs: The evidence
Single-country studies report similar findings about the effectiveness of highly visible
warning labels on cigarette packaging:
• After Canada introduced large pictorial warning labels in 2000, 91% of smokers
surveyed said they had read the warnings and were able to demonstrate a
thorough knowledge of the subjects the warnings covered.14
• When Australian law mandated new labeling in 1995, smokers became more
knowledgeable than nonsmokers about the main components of tobacco smoke
and could identify more diseases related to smoking.15
Pictorial warning labels influence plans to smoke
• After Brazil introduced new pictorial warnings in 2002, 73% of smokers said
they approved of them, 54% said they had changed their opinion about the health Warning label, New Zealand
consequences of smoking, and 67% said the new warnings made them want to
• In a 2004 study that evaluated the effectiveness of a range of pictorial and text
warning labels in New Zealand, 78% of respondents agreed that quit information
on a cigarette package would encourage smokers to call a Quitline.17
• A study in Canada (where large, graphic pack warnings are required) suggested
that reading and thinking about warning labels was positively associated with
intentions to quit smoking.18
• A four-country study indicated that text-only labels (as seen in the U.S.) were
associated with lower levels of awareness (about the health risks of smoking,
for example) than prominent, graphic warning labels (as seen in Canada and
Australia). Furthermore, the study indicated that graphic warning labels were
more effective than text-only labels in leading people to think about quitting and
deterring them from having a cigarette.19
• Following the introduction of Australia’s graphic health warning labels in 2006,
adolescent experimental and established smokers were more likely to think Warning label, Brazil
about quitting and that intention to smoke was lower among those students who
discussed the new warning labels.20
• Pictorial warning labels communicate the risks of tobacco use.
• Effective warning labels increase knowledge about risks associated with
smoking, reduce adolescents’ intentions to smoke,21 and motivate smokers to
• Graphic warning labels have a greater impact than text-only labels and can be
recognized by low-literacy audiences and children—two vulnerable population
• Parties to the FCTC are required to implement effective measures to warn against
the harmful impact of tobacco use on all tobacco product packaging within three
years of ratifying the FCTC.26 Warning label, Singapore
2 Warning labels: The evidence October 2008 www.tobaccofreecenter.org
Warning LabeLs: The evidence
1 Sandefuer TE. Remarks of T.E. Sandefuer (internal industry 12 Hammond, 2006.
document.) Brown and Williamson. 1985. Bates No. 13 Hammond, 2007.
14 Hammond et al, 2003.
2 Ayanian J, Cleary P. Perceived risks of heart disease and cancer
among cigarette smokers. JAMA. 1999; 281(11):1019-21. 15 Borland R. Tobacco Health Warnings and Smoking-Related
Cognitions and Behaviours. Addiction. 1997; 92(11):1427-
3 Hammond D, Fong G, Borland R, Cummings M, McNeill A, 1435.
Driezen P. Text and Graphic Warnings on Cigarette Packages:
Findings from the International Tobacco Control Four Country 16 Costa e Silva VL. Presentation to EU Commission on
Study. Amer J Prev Med. 2007; 32(3):210-217. enforcement of health warnings in Brazil. Brussels 2002.
4 Hammond et al, 2007. 17 BRC. Smoking Health Warnings Study: The effectiveness
of different (pictorial) health warnings in helping people
5 Hammond, D. Tobacco Labeling Toolkit: Implementation, consider their smoking-related behaviour. Wellington: BRC
Chapter 5. Waterloo: University of Waterloo. 2008. Available Marketing & Social Research. 2004. Available online:
online: http://www.igloo.org/tobacco_labelling/download- http://www.ndp.govt.nz/moh.nsf/pagescm/909/$File/
nocache/tobaccolab/iuatld_lab~5 [cited on 2008 April 9]. smokinghealthwarningsmay2004.pdf.
6 Environics Research Group. Assessment of perceived health 18 Hammond et al, 2003.
risks due to smoking. Prepared for Health Canada, Office of
Tobacco Control. Ottawa: Health Canada; 1999. 19 Hammond, 2007.
7 Hammond D, Fong GT, McDonald PW, Cameron R, Brown 20 White V, Webster B, and Wakefield M. 2008. Do graphic health
KS. Impact of the graphic Canadian warning labels on adult warning labels have an impact on adolescents’ smoking-related
smoking behaviour. Tob Control. 2003; 12(4):391-395. beliefs and behaviours? Addiction. 103: 1562-1571
8 Hammond D, Fong G, McNeill A, Borland R, Cummings KM. 21 White V et al, 2008.
Effectiveness of cigarette warning labels in informing smokers 22 Hammond D et al. Text and Graphic Warnings on Cigarette
about the risks of smoking: findings from the International Packages: Findings from the International Tobacco Control
Tobacco Control (ITC) Four Country Survey. Tob Control. Four Country Study. Amer J Prev Med. 2007; 32(3):210-217.
2006;15(Suppl III):iii19–iii25 23 Hammond, D. Tobacco Labeling Toolkit: Implementation,
9 Hammond, 2008. Chapter 5. Waterloo: University of Waterloo. 2008. Available
10 Hammond D. FCTC Article 11 Fact Sheet. Health Warnings on online: http://www.igloo.org/tobacco_labelling/download-
Tobacco Packages: Summary of evidence and legal challenges. nocache/tobaccolab/iuatld_lab~5 (cited on 2008 April 9).
Waterloo: University of Waterloo; 2008 (cited on 2008 Apr 24 Hammond D et al. 2006.
10). Available online: http://www.igloo.org/community. 25 Hammond D et al. 2007.
download.script&r0_pathinfo=%2F%7Bf0ce20c6-7a3c- 26 World Health Organization (WHO). WHO Framework
409a-a5c9-15e2b251a129%7D%2Ffactshee%2Farticl~2& Convention on Tobacco Control. Geneva: WHO; 2003.
r0_output=xml Available from: http://www.who.int/fctc/text_download/en/
11 Hammond D, Fong G, McNeill A, Borland R, Cummings KM.
Effectiveness of cigarette warning labels in informing smokers
about the risks of smoking: findings from the International
Tobacco Control (ITC) Four Country Survey. Tob Control.
3 Warning labels: The evidence October 2008 www.tobaccofreecenter.org