Country tobacco laws and article 11 of the WHO Framework Convention on Tobacco Control: a review of tobacco packaging and labeling regulations of 25 countries
More details
Hide details
Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Ayodeji J Awopegba   

Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Publication date: 2013-11-06
Tobacco Induced Diseases 2013;11(November):23
Urgent, evidence-based tobacco control efforts have been advocated by the WHO through the Framework Convention on Tobacco Control (FCTC) articles and guidelines. The level of implementation of these guidelines varies by country and region. This paper identifies areas of alignment and non-alignment of country tobacco laws with respect to the FCTC’s article 11 requirements, which lists guidelines for regulating tobacco packaging and labeling.

Countries from each of the six WHO regions were ranked by number of smokers and 25 countries were selected, representing countries from all WHO regions with the highest number of smokers. A scoring guide based on the FCTC article 11 requirements was created and used to rank country tobacco laws and assess levels of alignment as well as identify common areas of weakness and strength.

Across the countries examined, laws were generally strong in mandating the display of health warning messages on the front and back of cigarette packs and cartons. However, they were deficient in prohibiting the display of emission yields, and placing warnings at the top of the principal display area, as well as requiring health messages on tobacco’s negative social and economic outcomes.

Country tobacco packaging and labeling laws can be strengthened by greater compliance with the FCTC article 11 guidelines.

WHO MPOWER: A Policy Package to Reverse the Tobacco Epidemic. 2008, Geneva: World Health Organization,
Guidelines for Implementation of Article 11 of the WHO Framework on Tobacco Control (Packaging and labeling of tobacco products).
Hulit M: Marketing issues corporate affairs conference May 27, 1994 Manila. 1994, Richmond, Virginia: Philip Morris, Bates No. 2504015017/5042.
Fooks G, Gilmore AB: International trade law, plain packaging and tobacco industry political activity: the trans-pacific partnership. Tob Control tobaccocontrol-2012-050869 Published Online First: 20. 2013, doi:10.1136/tobaccocontrol-2012-050869, June.
Vardavas CI, Connolly G, Karamanolis K, Kafatos A: Adolescents perceived effectiveness of the proposed European graphic tobacco warning labels. Eur J Public Health. 2009, 19: 212-217. 10.1093/eurpub/ckp015.
White V, Webster B, Wakefield M: Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours?. Addiction. 2008, 103: 1562-1571. 10.1111/j.1360-0443.2008.02294.x.
WHO: WHO Report on the Global Tobacco Epidemic: Warning about the dangers of tobacco. 2011,
Wade B, Merrill RM, Lindsay GB: Cigarette pack warning labels in Russia: how graphic should they be?. Eur J Public Health. 2011, 21: 366-372. 10.1093/eurpub/ckq098.
Abdullah AS, Yang T, Beard J: Predictors of women's attitudes toward world health organization framework convention on tobacco control policies in urban China. J Women's Health). 2010, 19: 903-909. 10.1089/jwh.2009.1613.
Yang T, Wu Y, Abdullah AS, Dai D, Li F, Wu J, Xiang H: Attitudes and behavioral response toward key tobacco control measures from the FCTC among Chinese urban residents. BMC Public Health. 2007, 7: 248-10.1186/1471-2458-7-248.
Miller CL, Hill DJ, Quester PG, Hiller JE: Response of mass media, tobacco industry and smokers to the introduction of graphic cigarette pack warnings in Australia. Eur J Public Health. 2009, 19: 644-649. 10.1093/eurpub/ckp089.
Wakefield MA, Hayes L, Durkin S, Borland R: Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ Open. 2013, 3 (7): doi: 10.1136/bmjopen-2013-003175. Print 2013.
Campaign for tobacco-free kids.http://www.tobaccocontrollaws.....
Glantz SA, Barnes DE, Bero L, Hanauer P, Slade J: Looking through a keyhole at the tobacco industry. The Brown and Williamson documents. JAMA. 1995, 274: 219-224. 10.1001/jama.1995.03530030039032.
US Department of Health and Human Services: The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 2006, Atlanta GA,
Romer D, Jamieson P, Ahern R: The catch 22 of smoking and quitting. Smoking: Risk, Perception, and Policy. Edited by: Slovic P. 2001, SAGE Publications.
Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong HH, Hosking W, Hastings G, Thrasher J, McNeill A: Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tob Control. 2009, 18: 358-364. 10.1136/tc.2008.028043.
Hammond D, Fong GT, McDonald PW, Cameron R, Brown KS: Impact of the graphic Canadian warning labels on adult smoking behaviour. Tob Control. 2003, 12: 391-395. 10.1136/tc.12.4.391.
Hammond D, Fong GT, McNeill A, Borland R, Cummings KM: Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the international tobacco control (ITC) four country survey. Tob Control. 2006, 15 (Suppl 3): iii19-25.
Hammond D, Fong GT, Borland R, Cummings KM, McNeill A, Driezen P: Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study. Am J Prev Med. 2007, 32: 202-209. 10.1016/j.amepre.2006.11.011.
Nimbarte A, Aghazadeh F, Harvey C: Comparison of current U.S. and Canadian cigarette pack warnings. Int Q Community Health Educ. 2005, 24: 3-27. 10.2190/9PX0-NBG1-0ALA-G5YH.
O'Hegarty M, Pederson LL, Nelson DE, Mowery P, Gable JM, Wortley P: Reactions of young adult smokers to warning labels on cigarette packages. Am J Prev Med. 2006, 30: 467-473. 10.1016/j.amepre.2006.01.018.
O'Hegarty M, Pederson LL, Yenokyan G, Nelson D, Wortley P: Young adults' perceptions of cigarette warning labels in the United States and Canada. Prev Chronic Dis. 2007, 4: A27.
Peters E, Romer D, Slovic P, Jamieson KH, Wharfield L, Mertz CK, Carpenter SM: The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers. Nicotine & Tobacco Research. 2007, 9: 473-481. 10.1080/14622200701239639.
Fong GT CA, Brown KS, et al: Effects of the Canadian graphic warning labels among high school students: A quasi-experimental longitudinal survey. Presentation at the 2002 National conference on Tobacco or Health. 2002, San Francisco,
Borland R, Yong HH, Wilson N, Fong GT, Hammond D, Cummings KM, Hosking W, McNeill A: How reactions to cigarette packet health warnings influence quitting: findings from the ITC four-country survey. Addiction. 2009, 104: 669-675. 10.1111/j.1360-0443.2009.02508.x.
Thrasher JF, Hammond D, Fong GT, Arillo-Santillan E: Smokers' reactions to cigarette package warnings with graphic imagery and with only text: a comparison between Mexico and Canada. Salud publica de Mexico. 2007, 49 (Suppl 2): S233-240.
Hammond D, McDonald PW, Fong GT, Brown KS, Cameron R: The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers. Can J Public Health. 2004, 95: 201-204.
Hammond D, Fong GT, McDonald PW, Brown KS, Cameron R: Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers. Am J of Public Health. 2004, 94: 1442-1445. 10.2105/AJPH.94.8.1442.
Datafolha Instituto de Pesquisas: 76% são a favor que embalagens de cigarros tragam imagens que ilustram males provocados pelo fumo; 67% dos fumantes que viram as imagens afirmam terem sentido vontade de parar de fumar [76% are in favor of pictures on cigarette packs that illustrate the problems caused by smoking; 67% of smokers saw the pictures and say they made them want to stop smoking]. 2002, Opinião pública.
Graphic health warnings on tobacco packaging inspire smokers to quit the habit.
The International Tobacco Control Policy Evaluation Project: Thailand. 2010, Waterloo, ON: The International Tobacco Control Policy Evaluation Project,
Biological and Environmental Hazards, Risks, and Disasters
Kirsten M.M. Beyer
Implementation of Cigarette Plain Packaging: Triadic Reactions of Consumers, State Officials, and Tobacco Companies—The Case of Saudi Arabia
Marwah Hassounah, Abdulmohsen Al-Zalabani, Mohammed AlAhmari, Afraa Murriky, Anwar Makeen, Abdullah Alanazi
International Journal of Environmental Research and Public Health