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Evaluating the pictorial warnings on tobacco products in Arabian Gulf countries against other international pictorial warnings
  1. Nasser F BinDhim1,2,
  2. Kevin McGeechan3,
  3. Anwar K T Alanazi4,
  4. Hossam M S Alanazi4,
  5. Sasoun A J Alanazi4,
  6. Solaiman M Al-Hadlaq5,
  7. Hisham Aljadhey2,
  8. Tariq M Alhawassi4,6,
  9. Nadia A Alghamdi7,
  10. Ahmed M Shaman4,
  11. Meshari S Alquwayzani2,
  12. Mada H Basyouni8,9
  1. 1Department of Health Informatics, Saudi Electronic University, Riyadh, Saudi Arabia
  2. 2Saudi Food and Drug Authority, Riyadh, Saudi Arabia
  3. 3Department of Public Health, University of Sydney, Sydney, Australia
  4. 4College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
  5. 5College of Dentistry, King Saud University, Riyadh, Saudi Arabia
  6. 6Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
  7. 7Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
  8. 8The Smart Health Project, Riyadh, Saudi Arabia
  9. 9Investigational Drugs and Research Unit, King Khalid University Hospital, Riyadh, Saudi Arabia
  1. Correspondence to Dr Nasser F BinDhim, Saudi Food & Drug AuthoritySaudi Arabia – Riyadh; nd{at}


Background Few assessments of pictorial warnings (PWs) on cigarette packs implemented in Gulf Cooperation Council (GCC) countries have been done.

Methods This article includes two cross-sectional studies. In Study 1, convenience samples of adults from the Kingdom of Saudi Arabia (n=111) and USA (n=115) participated in a consumer survey to rate a total of nine PWs from the GCC, Australia and the UK. Outcome measures were affective responses to PWs and concerns about smoking. In Study 2, tobacco control experts (n=14) from multiple countries rated the same PWs on a potential efficacy scale and completed one open-ended question about each. The PWs were altered to mask their country of origin. Analyses compared ranking on multiple outcomes and examined ratings by country of origin and by smoking status.

Results In the consumer survey, participants from both countries rated the PWs from GCC lower than PWs from other countries on the two measures. The mixed-model analysis showed significant differences between the PWs from Australia and those from the GCC and between the PWs from the UK and those from the GCC (p<0.001) in the consumer and expert samples. The experts’ comments about the PWs implemented in the GCC were negative overall and confirmed previously identified themes about effective PWs.

Conclusion This study shows PWs originating from the GCC had significantly lower ratings than those implemented in Australia and the UK. The GCC countries may need to re-evaluate the currently implemented PWs and update them periodically.

  • Pictorial Warnings
  • Tobacco
  • Warning Messages
  • Public Health
  • Packaging and Labelling

Statistics from


  • Contributors NFB designed the study and wrote the first draft of the manuscript. NFB and KMG analysed the data. AKTA, HMSA, and SAJA managed the data collection, MHB and NFB designed the web applications. All authors contributed to and have approved the final manuscript.

  • Funding This research was funded by the Deanship of Scientific Research at Saudi Electronic University.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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