Frequently asked questions (FAQ)

1. Why do we need picture-based warnings on all tobacco packages?

Tobacco kills more than 5 million people each year. It is the leading preventable cause of death – and the only legal consumer product that kills when used exactly as the manufacturer intends.
Up to half of all smokers will die from a tobacco-related disease. Second-hand smoke harms everyone who is exposed to it. Yet studies reveal that too few people understand the real health risks of tobacco.
The tobacco industry spends millions of dollars marketing its products, designing attractive packages to ensnare new users and keep them using tobacco. Its work is made easier because tobacco packages in most countries do not warn consumers about tobacco’s deadly effects.
Health warnings that combine words and pictures are one of the most cost-effective ways to increase public awareness of the serious health risks of tobacco use and to reduce tobacco consumption.

2. But why use pictures? Aren’t text-based warnings effective?

Warnings that graphically show the terrible effects of using tobacco are more visible on packages than text-only warnings. They compete more successfully with the rest of the package design, standing out and sending a clear message.
Not everyone can read. Picture-based warnings are critical for communicating health risks to the large number of people who are illiterate and for reducing health inequality.
Picture-based warnings help counter the tobacco industry’s use of branding and imagery. By detracting from the overall attractiveness of tobacco packaging, the warnings deter new users, who are often the most vulnerable to manipulation.

3. Do picture-based warnings work?

Carefully designed warnings, especially those that include pictures, have been proven to motivate users to quit and to reduce the appeal of tobacco to those who are not yet addicted.
Studies carried out in countries that require picture-based warnings on tobacco packages reveal remarkably consistent findings on their positive effect. For example:

-in Canada, 58% of smokers said the warnings made them think more about the health effects of smoking;

-in Brazil, 67% of smokers said the warnings made them want to quit, and 54% said they made them change their opinion about the health consequences of smoking;

-in Singapore, 28% of smokers said the warnings made them smoke fewer cigarettes, and one out of six said they avoided smoking in front of children as a result of the warnings;

-in Thailand, 44% of smokers said the warnings made them “a lot” more likely to quit over the next month, and 53% said they made them think “a lot” about the health risks.

Evidence shows that picture-based warnings that arouse emotions are the most effective, particularly when combined with information to help or empower smokers to quit smoking, such as the telephone number of a tobacco helpline (a “quitline”).

4. Don’t people become indifferent to the pictures over time, or just cover or hide them?

Countries that have introduced picture-based warnings on tobacco packages have seen a rapid, dramatic increase in the awareness of tobacco health risks and the likelihood of quitting.
People may become indifferent to particular pictures over time. That is why changing the warnings from time to time is so important.
Although tobacco users can cover or hide the pictures, studies show that few do and that such avoidance does not decrease the warnings’ effectiveness in motivating behavioural change among smokers (such as quitting) and may actually increase it.
Tobacco companies meticulously study their target users and finesse their package designs to make them as tempting as possible. Tobacco-free campaigns should try to counter these schemes. Using a variety of warnings, and changing them regularly, makes the messages more relevant to a variety of audiences and helps prevent them from becoming stale.

5. Are picture-based warnings fair and legal for the tobacco industry?

Tobacco companies oppose picture-based warnings because they correctly see them as a threat to their business.
Consumers of tobacco products have a right to know about the dangerous health consequences of tobacco use. Requiring tobacco companies to place warnings on packages is fair, just and legal.
The tobacco industry has challenged the legality of picture-based warnings in court and failed. The industry lost its only serious court challenge against picture-based warnings before the Supreme Court of Canada in 2007.
The tobacco industry’s arguments that it takes too long and costs too much to implement picture-based warnings have no factual basis. Most of the costs of these consumer warnings are paid by the company itself – not by governments – and the savings from reduced health-care costs are enormous. Picture-based warnings can also be implemented quickly: the tobacco industry has demonstrated that it can produce packages with these warnings in as little as six months.

6. What countries are using picture-based warnings?

More and more countries are requiring picture-based warnings on tobacco packaging. As of 31 May 2009, 23 jurisdictions with a combined population of nearly 700 million require large graphic health warnings on packaging. Several others – Djibouti, Latvia, Mauritius and Switzerland – have finalized legislation to implement pictorial warnings later in 2009 and in 2010.
More than 160 countries have ratified the WHO Framework Convention on Tobacco Control, making it one of the most widely embraced treaties in United Nations history. The treaty commits its Parties to requiring that tobacco products “carry health warnings describing the harmful effects of tobacco use”. The Article 11 best-practice guidelines to the treaty stipulate that warnings should be large and clear, appear on both sides of tobacco packages and describe specific illnesses caused by tobacco.
Yet only 10% of people live in countries that require warnings with pictures on tobacco packages.

7. What is WHO doing to control the epidemic of tobacco and to help countries meet their commitments under the WHO Framework Convention on Tobacco Control?

In 2008, WHO unveiled MPOWER – a technical assistance package of proven cost–effectiveness and ability to save lives.
By implementing the six tobacco control measures comprising MPOWER, even low-income countries can go far towards countering the epidemic and meeting their commitments under the WHO Framework Convention on Tobacco Control.

8. A recent study by the United States of America’s National Institutes of Health suggests that smokers are more likely to remember low-key anti-smoking advertisements on television than attention-grabbing advertisements. Given that, why should governments use shocking photos on tobacco warnings?

One study does not negate the broad body of research showing that graphic or shocking images are more effective than low-key images at motivating people to quit.
Although participants in the study were said to have been more likely to remember low-key ads than attention-grabbing ads, the other important question is: what do people do with the information after they receive it? In other words, which type of advertisement is more effective at convincing people to stop using tobacco? So far, the preponderance of the evidence confirms that those showing the physical harm and suffering caused by tobacco work best.
Whether the lessons from the study of televised messages would apply to static warnings on tobacco packages is still not clear. Nevertheless, we must continue to refine the tools used to communicate the risks of tobacco. Studies of how the brain responds to tobacco warnings can be used, in balance with other research and experience, to plan even more effective communication strategies.
Such health communications research is needed if we are to continue making progress against the tobacco epidemic. WHO applauds all efforts to bring new evidence to light.