WHY ARE HEALTH WARNINGS ON PACKAGES EFFECTIVE?
Health warnings on cigarette packages are among the most prominent sources of health information: more smokers report getting information about the risks of smoking from packages than any other source except television.¹ Health warnings are an extremely cost-effective public health intervention and have tremendous reach. Pack-a-day smokers are potentially exposed to the warnings over 7,000 times per year. Non-smokers, including children and youth, also report high exposure and awareness of health warnings on packages.²

HOW CAN WE INCREASE THE IMPACT OF HEALTH WARNINGS? 
The size and position of health warnings are critical to their effectiveness. Obscure health warnings on the side of packages have little impact. Large warnings located on the top portion of the principal display areas are considerably more likely to be noticed and recalled.^3,4

Health communications must be regularly updated in order to maintain their effectiveness over time. Health warnings should be updated every two years to maximize their impact.⁴ Linking public health campaigns (such as those involving mass media) to health warnings can provide effective reinforcement for both.³

ARE PICTURE WARNINGS MORE EFFECTIVE THAN TEXT-ONLY WARNINGS?
Yes. Pictures increase the salience and vividness of health communications, and are consistently rated by smokers to be more effective and engaging than text-only warnings.^5,6,7 Picture warnings are associated with greater health knowledge, perceptions of risk, motivation to quit, and cessation
behaviour.^1,3-8

Picture warnings appear to be especially effective among youth: more than 90% of Canadian youth agree that picture warnings on Canadian packages: have provided them with important information about the health effects of smoking
cigarettes, are accurate, and make smoking seem less attractive.²

Picture warnings are essential for reaching smokers with low education and literacy, and may help to reduce disparities in health knowledge. Pictures are also important in countries where multiple languages are common.

ARE FRIGHTENING PICTURES OF DISEASE EFFECTIVE?
Yes. Pictures that arouse emotion through “graphic” depictions of health risks are most likely to be recalled and rated as effective by smokers.^5,6,8 Pictures that do not include frightening health information fail to communicate the real health effects of smoking in an honest and straightforward way. There is no evidence to date that graphic warnings are associated with “adverse” outcomes, such as increases in smoking or decreases in credibility of the information.

Supportive “efficacy” information that provides encouragement and concrete information on how to quit smoking should accompany graphic pictures. This is strongly indicated both theoretically and by past research in effective health communication.⁹ Health warnings that include information on cessation services – such as a tollfree telephone “quitline” number – have a significant impact on the use of these services and represent a low-cost method of promoting cessation and supporting smokers’ efforts to change.¹⁰

DOES THE PUBLIC SUPPORT LARGE PICTURE WARNINGS?
Yes, there is strong public support for picture warnings, including among smokers themselves. Most smokers would like to see more health information on their packages, including smokers living in countries that already have large picture warnings, such as Canada, Thailand, and Uruguay.^11,12

Click here for an overview and list of countries with picture health warnings. 

Prepared by David Hammond, University of Waterloo (Canada) with support from IUATLD.

To download a copy of the fact sheet, click here