Effectiveness of text versus pictorial health warning labels and predictors of support for plain packaging of tobacco products within the European Union

Eur Addict Res. 2015;21(1):47-52. doi: 10.1159/000366019. Epub 2014 Nov 11.


Background: Tobacco product warning labels are a key health communication medium with plain packaging noted as the next step in the evolution of tobacco packaging. We assessed the self-reported impact of text versus pictorial health warnings and the determinants of support for plain packaging of tobacco products in the European Union (EU).

Methods: The Special Eurobarometer 385 survey was analyzed for 26,566 adults from 27 EU countries in 2012. The self-reported impact of warning labels (text or pictorial) and determinants of EU-wide support for plain packaging were assessed using multivariate logistic regression.

Results: Current smokers in countries where cigarette pictorial warnings were implemented had higher odds of reporting that health warning labels had any effect on their smoking behavior (making a quit attempt or reducing number of cigarettes smoked per day) compared to respondents in countries with text-only warning labels (adjusted odds ratio, aOR = 1.31; 95% confidence interval, 95% CI: 1.10-1.56). Population support for plain packaging of tobacco packs was higher in countries where cigarette pictorial warnings already existed (aOR = 1.17; 95% CI: 1.07-1.28).

Conclusions: These findings indicate that the implementation of pictorial warnings at an EU level may have a positive behavioral impact among smokers and pave the way for population support for plain packaging in the EU.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • European Union
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Product Labeling*
  • Product Packaging*
  • Smoking / psychology
  • Smoking Cessation / psychology
  • Smoking Cessation / statistics & numerical data*
  • Smoking Prevention*
  • Surveys and Questionnaires
  • Tobacco Products*
  • Tobacco Use / prevention & control
  • Tobacco Use / psychology
  • Tobacco Use Cessation / psychology
  • Tobacco Use Cessation / statistics & numerical data
  • Young Adult