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Research paper
The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion
  1. Heikki Hiilamo1,
  2. Eric Crosbie2,
  3. Stanton A Glantz3
  1. 1Social Insurance Institution of Finland, Research Department, Helsinki, Finland
  2. 2Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA
  3. 3Department of Medicine, Center for Tobacco Control Research & Education, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
  1. Correspondence to Stanton A Glantz, Center for Tobacco Control Research and Education, UCSF, 530 Parnassus Ave., Box 1390, San Francisco, CA 94143-1390, USA; glantz{at}


Objective To analyse the evolution and diffusion of health warnings on cigarette packs around the world, including tobacco industry attempts to block this diffusion.

Methods We analysed tobacco industry documents and public sources to construct a database on the global evolution and diffusion of health warning labels from 1966 to 2012, and also analysed industry strategies.

Results Health warning labels, especially labels with graphic elements, threaten the tobacco industry because they are a low-cost, effective measure to reduce smoking. Multinational tobacco companies did not object to voluntary innocuous warnings with ambiguous health messages, in part because they saw them as offering protection from lawsuits and local packaging regulations. The companies worked systematically at the international level to block or weaken warnings once stronger more specific warnings began to appear in the 1970s. Since 1985 in Iceland, the tobacco industry has been aware of the effectiveness of graphic health warning labels (GWHL). The industry launched an all-out attack in the early 1990s to prevent GHWLs, and was successful in delaying GHWLs internationally for nearly 10 years.

Conclusions Beginning in 2005, as a result of the World Health Organisation Framework Convention on Tobacco Control (FCTC), GHWLs began to spread. Effective implementation of FCTC labelling provisions has stimulated diffusion of strong health warning labels despite industry opposition.

  • Tobacco industry
  • Advocacy
  • Advertising and Promotion
  • Packaging and Labelling
  • Tobacco industry documents

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