title: The evolution of health warning labels on cigarette packs: the role of precedents, and tobacco industry strategies to block diffusion.
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.
authors.affiliation: Social Insurance Institution of Finland, Research Department, Helsinki, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Hiilamo
authors.forename: Eric
authors.initials: E
authors.lastname: Crosbie
authors.forename: Stanton A
authors.initials: SA
authors.lastname: Glantz
mesh_terms: D014943:Global Health; D006291:Health Policy; D006801:Humans; D007055:Iceland; D011356:Product Labeling; D019064:Product Packaging; D016540:Smoking Cessation; D000074606:Smoking Prevention; D019460:Tobacco Industry; D062789:Tobacco Products / Q000009:adverse effects*; D014944:World Health Organization
keywords: Advertising and Promotion; Advocacy; Packaging and Labelling; Tobacco industry; Tobacco industry documents