1 October 2008: Implementation of picture warnings on tobacco products.
This briefing sets out the facts relating to the implementation of pictorial health warnings on tobacco packaging in the UK which will take effect from 1 October 2008 and summarises research on their impact.
For further information or comment, please contact Deborah Arnott or Amanda Sandford on 020 7739 5902. ISDN available.
The 14 new warnings can be viewed here.
From 1 October 2008 pictorial health warnings will start to appear on cigarette packs as new stock arrives in shops. Tobacco manufacturers have one year in which to ensure that all cigarettes carry pictorial warnings – i.e. the last date for compliance with the law is 30 September 2009. For other tobacco products the deadline for compliance is 30 September 2010.
The legal requirements with regard to the current written health warnings are set out in the EU Tobacco Products Directive (2001/37/EC). This stipulates that health warnings should cover at least 30% of the front and 40% of the back of cigarette packs, with a border to surround warnings.  The Directive states which warnings can be used: one of two general warnings on the front of the pack; and one of 14 more specific warnings on the reverse, with all of the warnings to be used regularly.
The Directive also obliged the European Commission to adopt rules for the use of colour photographs or other illustrations to depict and explain the health consequences of smoking. The UK’s new pictorial warnings will be placed on the back of cigarette packs and will occupy the space currently given to the text-only warnings. The UK is the first EU country to require pictorial warnings on all tobacco products. 
Action by Other Countries
The UK is the third EU country (after Belgium and Romania) to introduce picture warnings but the first to introduce them on all tobacco packaging.
Canada was the first country in the world to introduce picture warnings in 2001, followed by Brazil in 2002.
The following countries have laws requiring picture warnings. The list includes initial implementation date and, where appropriate, dates when new picture warnings were introduced. 
1. Canada (2001)
2. Brazil (2002; 2004; 2009)
3. Singapore (2004; 2006)
4. Thailand (2005, 2007)
5. Venezuela (2005)
6. Jordan (2005)
7. Australia (2006; rotation of Sets A, B every 12 months)
8. Uruguay (2006; 2008, 2009)
9. Panama (2006)
10. Belgium (2006)
11. Chile (2006, 2007, 2008)
12. Hong Kong (2007)
13. New Zealand (2008; rotation of Sets A, B every 12 months)
14. Romania (2008)
15. United Kingdom (2008)
16. Egypt (2008)
17. India (2008)
18. Brunei (2008)
19. Taiwan (2009)
20. Malaysia (2009)
21. Peru (2009)
22. Djibouti (2009)
23. Switzerland (2010, rotation of Sets 1, 2, 3 every 24 months)
Many other countries are in the process of implementing picture warnings or have stated that picture warnings are under consideration. They include: Finland, France, Iceland, Iran, Ireland, Latvia, Macao, Mongolia, Norway, Pakistan, Philippines, Portugal, Slovakia, South Africa, South Korea, the Gulf Cooperation Council (the GCC includes Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates and potentially Yemen), and the Caribbean Community (CARICOM, which includes Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago).
Effectiveness of the health warnings
Health warnings play an important role in informing consumers of the risks they are undertaking by using tobacco products. International studies have shown that they can help deter young people from taking up smoking and also help smokers to quit. However, to be effective, written warnings must be in large, clear text that stands out from the rest of the pack design. Pictorial warnings are even more effective.
Evidence from Canada and Australia shows that picture warnings attract the attention of smokers, increase awareness and understanding of the health risks of smoking and decrease cigarette consumption.  In Canada, for example, a survey  conducted a few months after new pictorial warnings were implemented in 2001 found that:
• 44% of smokers said the new warnings increased their motivation to quit smoking
• The new warnings made 58% of smokers think more about the health effects of smoking
• On one or more occasions, 21% of smokers who were tempted to have a cigarette decided not to because of the new warnings
• The new warnings have motivated 27% of smokers to smoke less inside their home
• Among both smokers and non-smokers, the two warnings identified as most effective at discouraging smoking were (1) the warning depicting a diseased mouth and (2) the warning depicting a lung tumour.
• In many aspects, the warnings have had greater impact on those with lower levels of education. This is the case for increased awareness of the health effects, increased concern about the health effects, thinking more about the health effects, and not smoking when tempted.
Next Steps / Review of the EU Directive
Evidence from the countries that have already introduced picture warnings suggests that they will have a strong impact on smokers in the UK and may also help dissuade some young people from starting to smoke. However, it is also clear that the images must be kept under review and surveys should be conducted to test their effectiveness.
One obvious disadvantage of the current EU law is that the picture warnings will only be printed on the reverse side of cigarette packs, and thus will be less visible than if they were on both the front and reverse sides.
The size of the warning is also important. The greater the warning, the less space is available for branding, making the packaging less attractive. ASH believes that there is a strong case to be made for increasing the area devoted to health warning to at least 90% of the back and 30% of the front, as is the case in Australia and New Zealand.
ASH is also lobbying the Government to introduce plain packaging, that is, the removal of all branding from tobacco packs as this would strengthen the impact of the health warning. Research conducted for ASH revealed that when presented with plain packaging, young people thought the packs less attractive and were also less likely to have misconceptions about the relative safety of differing brands. 
Deborah Arnott, Director of the health campaigning charity, ASH said:
“The introduction of picture warnings on tobacco products is a strong visual reminder of the horrendous illnesses caused by smoking, and the evidence is that they work.
But the evidence also shows that they would work better without pack branding, so we urge the Government to also implement plain packaging to maximise the impact of the picture warnings. In addition, we want the European Commission to amend the legislation as soon as possible to allow the warnings to be placed both on the front and back of the packs.”
Contact: Deborah Arnott 020 7739 5902 (w) 079 7693 5987 (m) ISDN available
Refs & Links
 EU Tobacco Products Directive http://europa.eu.int/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=EN&numdoc=32001L0037&model=guichett
The EU law was transposed into UK law as the Tobacco Products (Manufacture, Presentation and Sale) (Safety) Regulations 2002
 Tobacco Products (Manufacture, Presentation and Sale) (Safety) (amendment) regulations 2007 Statutory Instrument 2007 No. 2473 www.opsi.gov.uk/si/si2007/20072473.htm
 Information supplied by the Canadian Cancer Society
 Hammond, D et al. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 2006; 15 (suppl iii): 19-25.
 Evaluation of New Warnings on Cigarette Packages. Focus Canada Report 2001-3. Canadian Cancer Society, 2002.
 Forthcoming research to be published on 7 October.
The full library of EU pictures from which the UK chose its 14 images is included in the Department of Health’s consultation document here.
The 14 health warnings that will be used on the packs in the UK can be viewed here.
Tobacco Labelling Resource Centre – Includes examples of picture warnings from all countries with picture warnings and summaries of the regulations. www.tobaccolabels.org
ASH website page on health warnings is here.