ArticleTobacco control2009
Impact of graphic and text warnings on cigarette packs: findings from four countries over five years.
Article in Tobacco control, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 158 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
158 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions.BMC public health · 2021Pooled it
- A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes.Systematic reviews · 2019Pooled it
- Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior.American journal of public health · 2014Pooled it
- Assessing Responses to Cannabis Health Warnings Among Adults in U.S. Recreational States.American journal of preventive medicine · 2025Trial
- Combining Inserts With Warning Labels on Cigarette Packs to Promote Smoking Cessation: A 2-Week Randomized Trial.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2024Trial
- Effects of pictorial warning labels depicting lesser-known and well-known risks of smoking on viewing patterns, recall, and knowledge of smoking harms.Drug and alcohol dependence · 2023Trial
- Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults.Tobacco control · 2023Trial
- Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers.Tobacco control · 2020Trial
- Awareness and Perceptions on Health Warning Labels on Cigarette Packs among Smokers: A Cross-Sectional Study.BioMed research international · 2020Trial
- Adolescent males' responses to blu's fake warnings.Tobacco control · 2019Trial
- How should sugar-sweetened beverage health warnings be designed? A randomized experiment.Preventive medicine · 2019Trial
- Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2019Trial
- Why smokers avoid cigarette pack risk messages: Two randomized clinical trials in the United States.Social science & medicine (1982) · 2018Trial
- The Effect of Graphic Warnings on Sugary-Drink Purchasing.Psychological science · 2018Trial
- Frequency and Content of Conversations About Pictorial Warnings on Cigarette Packs.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2018Trial
- Trial
- Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2017Trial
- Effect of Pictorial Cigarette Pack Warnings on Changes in Smoking Behavior: A Randomized Clinical Trial.JAMA internal medicine · 2016Trial
- Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults.Psychology & health · 2016Trial
- Trial
98 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
objectivesTo examine the impact of health warnings on smokers by comparing the short-term impact of new graphic (2006) Australian warnings with: (i) earlier (2003) United Kingdom larger text-based warnings; (ii) and Canadian graphic warnings (late 2000); and also to extend our understanding of warning wear-out.
methodsThe International Tobacco Control Policy Evaluation Survey (ITC Project) follows prospective cohorts (with replenishment) of adult smokers annually (five waves: 2002-2006), in Canada, United States, UK and Australia (around 2000 per country per wave; total n = 17 773). Measures were of pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings.
resultsAll four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, they stimulated more cognitive responses than the UK (text-only) changes, and were avoided more, did not significantly increase forgoing cigarettes, but were read and noticed less. The findings also extend previous work showing partial wear-out of both graphic and text-only warnings, but the Canadian warnings have more sustained effects than UK ones.
conclusionsAustralia's new health warnings increased reactions that are prospectively predictive of cessation activity. Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings. While there is partial wear-out in the initial impact associated with all warnings, stronger warnings tend to sustain their effects for longer. These findings support arguments for governments to exceed minimum FCTC requirements on warnings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.