Printer-friendly version

All the available evidence indicates that there are no significant adverse effects, even from the strongest and most graphic health warnings. 

First of all, there has been a high level of public acceptance of health warnings, even the most graphic.^1,2,3 The graphic warnings were criticised on the basis that they could cause defensive reactions among smokers and lessen the likelihood of them quitting.⁴ There is no doubt they do cause strong emotional reactions^{5, 6}, but strong emotional reactions are associated with increased effectiveness of warnings⁵ and adolescents displayed more favourable attitudes toward messages that graphically depicted the costs of smoking as opposed to the gains of not-smoking, and those only exposed to the costs messages had lower intentions of smoking in the future. ⁶ It is also important that smokers who develop strategies to hide the warnings are more inclined to make quitting attempts, rather than “tune out”.^7,8

A qualitative Canadian study⁹ found that “Participants in all groups consistently expected or wanted to be shocked by health warning messages, or emotionally affected in some way. Even if the feelings generated were unpleasant ones to tolerate, such as disgust, fear, sadness or worry, the emotional impact of a warning appeared to predict its ability to inform and/or motivate thoughts of quitting…... When a strong emotion generated by a HWM was supported by factual information, that was the best combination possible”. Overview of Findings, p.3

1.     Hammond D, Fong GT, McDonald P, Brown, KS, Cameron R. Graphic Canadian warning labels and adverse outcomes: evidence from Canadian smokers. Am J Public Health 2004; 94 (8): 1442-45. 

2.     Environics Research Group. Canadian adult and youth opinions on the sizing of health warning messages. Environics Research Group Limited, 1999. 

3.     Borland R, Hill, D. The path to Australia's tobacco health warnings. Addiction 1997; 92: 1151-1157. 

4.     Ruiter RAC, Kok G. Saying is not (always) doing: cigarette warning labels are useless. Eur J Public Health 2005;15:329 

5.     Hammond D, Fong GT, McDonald P, Brown, KS, Cameron R. Graphic Canadian warning labels and adverse outcomes: evidence from Canadian smokers. Am J Public Health 2004; 94 (8): 1442-45. 

6.     Nascimento BEM, Oliveira L, Vieira AS, Joffily M, Gleiser S, Pereira MG, Cavalcante T, Volchan E. Avoidance of smoking: the impact of warning in Brazil. Tob. Control 2008;17;405-409.

7.     Goodall C, Appiah O. Adolescents' perceptions of Canadian cigarette package warning labels: Investigating the effects of message framing. Health Communication 2008; 23: 117–127.

8.     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.

9.    Les Etudes de Marche Createc. Final Report: Qualitative testing of health warnings messages. Prepared for the Tobacco Control Programme Health Canada, June 2006