title: Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior.
abstract: We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.
authors.affiliation: Joel Monárrez-Espino, Bojing Liu, Felix Greiner, Sven Bremberg, and Rosaria Galanti are with the Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Rosaria Galanti is also with the Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden.
authors.forename: Joel
authors.initials: J
authors.lastname: Monárrez-Espino
authors.forename: Bojing
authors.initials: B
authors.lastname: Liu
authors.forename: Felix
authors.initials: F
authors.lastname: Greiner
authors.forename: Sven
authors.initials: S
authors.lastname: Bremberg
authors.forename: Rosaria
authors.initials: R
authors.lastname: Galanti
mesh_terms: D006801:Humans; D033182:Intention; D009042:Motivation; D011356:Product Labeling / Q000379:methods*; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D062789:Tobacco Products