Table 1

Five generations of health warning labels, and tobacco industry strategies to block diffusion

HWL generation (year)HWL descriptionFirst implemented example (country, year)Tobacco industry strategyDiffusion outcome/local outcome
First generation (1966)Government requirement and vague health message warning on the side of the pack‘Caution: cigarette smoking may be hazardous to your health’ (USA, 1966)Voluntary agreementsVoluntary agreements in 17 countries between 1971 and 1995
Second generation (1969)Smoking established as a definite health hazard, or specific diseases mentioned, message on the side of the pack (or innocuous message on the front)‘Warning: Cigarette smoking can cause lung cancer and heart diseases” (Iceland, 1969–1971)Suspended shipments to Iceland, publicising Iceland's decision to withdraw HWLsLaw repealed in Iceland in 1971
Third generation (1987)Affirmative and visible health message on the front of the pack and or on the back of the pack‘Smoking is a main cause of cancer, diseases of the lung, and diseases of the heart and the arteries’ (Saudi Arabia, 1987)Lobbying, defending united frontGeneration III HWLs dropped in Norway in 1973, delayed progress in placing HWLs on the front of the pack
Fourth generation (1977)Rotating detailed health messages on the front of pack‘Smokers run an increased risk of heart attacks and certain diseases of the arteries. National Board of Health and Welfare’ (one of 16 HWLs) (Sweden, 1977)Lobbying, developing global strategies to oppose HWLsRotating HWLs quickly diffused beginning in 1979
Fifth generation (1985)Graphic health warnings, pictures to reinforce the health message on front and or back of the packEight cartoon GHWLs with images such as a pair of black lungs, a patient in bed or a diseased heart (Iceland, 1985–1996)Corporate social responsibility, trade agreementsGeneration V HWLs stopped in Sweden 1991
  • GHWL (HWL), graphic health warning labels.