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Tobacco pack health warnings certainly affect thoughts and behaviour that we know are associated with quitting; especially taking steps to avoid viewing the warnings (particularly graphic warnings), and making calls to telephone quit lines.

Evidence from surveys suggests that health warnings can promote smoking cessation among adults and youths, and that larger pictorial warnings are most effective in doing so.¹ In at least two cases, longitudinal studies have demonstrated an association between reading and thinking about health warnings and subsequent cessation behaviour.^2,3 Large pictorial warnings increase knowledge of the harms of smoking, thoughts about the health risks, and behaviours (avoiding the warnings, forgoing a cigarette) that can then motivate intentions to quit, and then quit attempts. Smokers report that large comprehensive warnings have reduced their consumption levels, increased their likelihood of quitting, increased their motivation to quit, and increased the likelihood of remaining abstinent following a quit attempt. ^4,5,6,7,8,9 Additional evidence that health warnings can promote smoking cessation comes from studies conducted in Brazil, the UK, the Netherlands, and Australia showing significant increases in call volumes to quit lines after contact information was included in package warnings.^{1, 10}

The introduction of pictorial warnings in Australia resulted in an increase in noticing and reading of warning labels, thinking about the health risks and quitting, reporting that the labels had made them forgo a cigarette they were about to smoke, and avoiding warning labels, plus the new graphic warnings led to a greater increase in avoiding warning labels than did the text-only warnings in the UK (2004) .¹¹ It has been established that all these outcomes are associated with increases in quitting.¹²

1.     Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong H-H, Hosking W, Hastings G, Thrasher J and McNeill A (2009) Impact of Graphic and Text Warnings on Cigarette Packs: Findings from Four Countries over Five Years, http://static.mgnetwork.com/rtd/pdfs/20090711_toba2.pdf  

2.     Hammond D, Fong GT, McDonald P, Cameron R, Brown SK (2003) Impact of graphic Canadian warning labels on adult smoking behaviour. Tobacco Control. 12: 391-395

3.     White V, Webster B, Wakefield M. (2008) Do graphic health warning labels have an impact on adolescents’ smoking-related beliefs and behaviours? Addiction. 103(9):1562-71.

4.     Health Canada (2005). The Health effects of tobacco and health warning messages on cigarette packages—Survey of adults and adults smokers: Wave 9 surveys. Prepared by Environics Research Group;January, 2005

5.     O'Hegarty M, Pederson LL, Nelson DE, Mowery P, Gable JM, Wortley P. (2006) Reactions of young adult smokers to warning labels on cigarette packages. Am J Prev Med 30(6): 467-73.

6.     Willemsen MC. (2005) The new EU cigarette health warnings benefit smokers who want to quit the habit: results from the Dutch Continuous Survey of Smoking Habits. Eur J Public Health. 15(4): 389-92.

7.     Canadian Cancer Society Evaluation of New Warnings on Cigarette Packages (2001). Prepared by: Environics, Focus Canada, 2001-3.

8.     Hill D. (1988) New cigarette-packet warnings: are they getting through? Med J Aust. 148: 478-480.

9.     Cavalcante TM. Labelling and Packaging in Brazil National Cancer Institute, Health Ministry of Brazil; World Health Organiziation. Available at: http://www.who.int/tobacco/training/success_stories/en/best_practices_brazil_labelling.pdf

10.   Impact on the Australian Quitline of New Graphic Cigarette Pack Warnings Including the Quitline Number (Tob Control - Miller et al.) Australia 2009 

11.   Hammond D 2009. FCTC Article 11. Chapter 1. Tobacco Labeling Toolkit. Evidence Review.

12.   Borland R, Yong H-H, Wilson N, Fong GT, Hammond D, Cummings KM, Hosking W & McNeill A (2009) How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey. Addiction. 104(4):669-675.