title: Health warning messages on tobacco products: a review.
abstract: OBJECTIVE
  To review evidence on the impact of health warning messages on tobacco packages.
  
  
  METHODS
  Articles were identified through electronic databases of published articles, as well as relevant 'grey' literature using the following keywords: health warning, health message, health communication, label and labelling in conjunction with at least one of the following terms: smoking, tobacco, cigarette, product, package and pack.
  
  
  METHODS
  Relevant articles available prior to January 2011 were screened for six methodological criteria. A total of 94 original original articles met inclusion criteria, including 72 quantitative studies, 16 qualitative studies, 5 studies with both qualitative and qualitative components, and 1 review paper: Canada (n=35), USA (n=29) Australia (n=16), UK (n=13), The Netherlands (n=3), France (n=3), New Zealand (n=3), Mexico (n=3), Brazil (n=2), Belgium (n=1), other European countries (n=10), Norway (n=1), Malaysia (n=1) and China (n=1).
  
  
  RESULTS
  The evidence indicates that the impact of health warnings depends upon their size and
  
  
  METHODS
  whereas obscure text-only warnings appear to have little impact, prominent health warnings on the face of packages serve as a prominent source of health information for smokers and non-smokers, can increase health knowledge and perceptions of risk and can promote smoking cessation. The evidence also indicates that comprehensive warnings are effective among youth and may help to prevent smoking initiation. Pictorial health warnings that elicit strong emotional reactions are significantly more effective.
  
  
  CONCLUSIONS
  Health warnings on packages are among the most direct and prominent means of communicating with smokers. Larger warnings with pictures are significantly more effective than smaller, text-only messages.
authors: Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada. dhammond@uwaterloo.ca
authors: David
authors: D
authors: Hammond