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. 2014 Jan;23(1):e2.
doi: 10.1136/tobaccocontrol-2012-050541. Epub 2012 Oct 23.

The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion

Heikki Hiilamo  1 , Eric Crosbie, Stanton A Glantz
Affiliations

The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion

Heikki Hiilamo et al. Tob Control. 2014 Jan.

Abstract

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.

Keywords: Advertising and Promotion; Advocacy; Packaging and Labelling; Tobacco industry; Tobacco industry documents.

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Conflict of interest statement

Competing interests HH served as an expert witness for a plaintiff in tobacco litigation, Salminen v Amer Sports Oyj and BAT Finland, in 2008 and in 2009. EC and SAG have nothing to declare.

Figures

Figure 1
Figure 1
Examples of different generations of HWLs. (Sources: 1. China, export, 2010, http://www.tobaccolabels.ca/gallery/chinapacks/marlboromenthollightschinamay2010jpg; 2. Costa Rica, 2008, http://www.tobaccolabels.ca/gallery/costaricapacks/marlborolightsmentholcostaricasept2008rightsideang; 3. Australia, c. 1990, http://www.tttt.ru/03819.jpg; 4. Belgium, 2007, http://www.tobaccolabels.ca/gallery/belgiumpacks/marlbororedbelgium2007rightsideanglejpg; 5.Uruguay, 2010, http://www.tobaccolabels.ca/gallery/uruguaypacks/marlbororeduruguaynov2010rightsideanglejpg. All accessed 7 July 2012). This figure is only reproduced in colour in the online version.
Figure 2
Figure 2
Evolution of HWLs by Generation type 1966–2012.
Figure 3
Figure 3
English language presentation of fourth-generation HWLs implemented in Sweden in 1977.
Figure 4
Figure 4
Diffusion of HWLs among countries with voluntary tobacco industry foreign (English) language HWLs in 1992.
Figure 5
Figure 5
Graphic health warning labels implemented in Iceland in 1985. Text reads: 1. Smoking during pregnancy causes damage to infants; 2. Smoking causes blockage of the arteries; 3. Let’s protect children against tobacco smoke; 4. To stop smoking improves health and prolongs life; 5. Smoking is a health problem that you can help solve; 6. Annually, hundreds of Icelanders die from tobacco smoking.
See this image and copyright information in PMC

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