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.

Young adult waterpipe tobacco users’ perceived addictiveness of waterpipe tobacco

“…Additionally, conveying information such as nicotine content in waterpipe tobacco 13 would be consistent with participants' responses, which indicated they recognize common nicotine dependence symptoms. Some participants also indicated communications incorporating visual imagery, as is done with tobacco product warning labels 60 , and tobacco control media campaigns 61 , may also be effective. Such visual imagery has been shown to increase persuasive appeal and efficacy of tobacco-related messaging in prior research 62 .…”

Punching Above Their Weight Through Policy Learning: Tobacco Control Policies in Ireland

“…There is no rhetorical cover of 'made in Ireland' as one encounters, for instance, in some Canadian policy formulations that rely heavily on evidence and policy from abroad, especially the US (Studlar 2002). Diffusion has been recognised as an influence on tobacco policy in previous studies of tobacco policy elsewhere in the world (Studlar 2002;Hiilamo et al 2012;Cairney et al 2012). As Hiilamo et al (2012) argue, the tobacco industry made use of its globalised knowledge to try to block the spread of stronger health warning labels.…”

“…Diffusion has been recognised as an influence on tobacco policy in previous studies of tobacco policy elsewhere in the world (Studlar 2002;Hiilamo et al 2012;Cairney et al 2012). As Hiilamo et al (2012) argue, the tobacco industry made use of its globalised knowledge to try to block the spread of stronger health warning labels. But the case of Ireland clearly shows that diffusion is also a process that NGOs and government institutions, even (or perhaps especially) in a small but well-connected country can use to enhance their own policies and make them a leading tobacco control jurisdiction in the world.…”

“…While the 2004 workplace smoking ban, especially as it affected traditional 'pub culture', put Ireland on the tobacco control 'map', Ireland's policies were relatively restrictionist from the 1970s in instruments such as broadcast bans, rotating warning labels, minimum pricing, and advertising restrictions Hiilamo et al 2012), and they have consistently ranked among the stronger ones in Europe and in the world. Studlar et al (2011) show that, for 17 different instruments across five policy dimensions (advertising and promotion, sales, nonsmoking areas, cessation, and public education) in the period 1986-2007, Ireland consistently ranked in the top third of the 'old 15' EU member countries.…”

Analysis of the tobacco industry’s interference in the enforcement of health warnings on tobacco products in Brazil

“…Iceland faced similar interference to that in Brazil when it adopted pictorial warnings in 1985 28 . After heavy opposition by the industry, the country had to repeal the measure in 1996, leading countries like Norway to hold back on pictograms, adopting text-only messages 29 30 .…”