title: From directive to practice: are pictorial warnings and plain packaging effective to reduce the tobacco addiction?
abstract: OBJECTIVE
  Tobacco packaging represents an important form of promotion of tobacco products and for this reason plain packaging (PP) can be considered an additional tobacco control measure. In Italy the current tobacco packaging is branded with textual warnings. The study investigated the perception of PP with textual warnings (PPTWs) and pictorial warnings (PPPWs) in Italy.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  The study was conducted on adults who were current, never and former smokers. The participants watched out three types of packages (current packaging, PPTWs and PPPWs) and eight pictorial warnings, and indicated which they considered the most effective ones to motivate smoking cessation or reduction and to prevent the onset.
  
  
  RESULTS
  1065 subjects were recruited. The PPPWs were considered the most effective in motivating to quit, reduce and prevent the smoking habits (ranged 83.4%-96.1%) in all tobacco users and age groups (≤40/>40 years) (P < 0.005). In general PP does not seem to be very effective in quitting for three-quarters of the smokers and 60% declared that they would have still started smoking with PP. The younger group believed less than the older one that PP gives a motivation to quit (29.4% vs 39.1%, P = 0.002). The pictures perceived as most effective in communicating the smoking effects were lung cancer and gangrene (about one-third of the sample).
  
  
  CONCLUSIONS
  The textual warnings on tobacco products are a measure of control now outdated. Countries still using them should consider the idea of replace them with pictorial warnings that seem to be more effective. It is also desirable in the near future that these countries introduce the PPPWs.
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. Electronic address: alice.mannocci@uniroma1.it.
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Colamesta
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Mipatrini
authors.affiliation: Department of Molecular and Developmental Medicine, Area of Public Health, Siena, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Messina
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Gualano
authors.affiliation: Research Centre in Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy; Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo NEUROMED, Pozzilli, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Gianfagna
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Boccia
authors.affiliation: Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Langiano
authors.affiliation: Medical Direction, Local Health Unit 1, Massa and Carrara, Tuscany, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolotti
authors.affiliation: Research Centre in Epidemiology and Preventive Medicine, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Department of Public Health Sciences and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Siliquini
authors.affiliation: Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: De Vito
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011356:Product Labeling / Q000379:methods*; D019064:Product Packaging / Q000379:methods*; D016540:Smoking Cessation / Q000523:psychology; D062789:Tobacco Products; D014029:Tobacco Use Disorder / Q000517:prevention & control* / Q000523:psychology
keywords: Cessation; Health warnings; Packaging and labelling; Plain packaging; Prevention