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December 28th, 2016:

Cigarette Graphic Warning Labels Are Not Created Equal

Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers’ Quit Intentions Relative to Text-only Warnings

Abigail T. Evans, Ph.D. Ellen Peters, Ph.D. Abigail Shoben, Ph.D. Louise Meilleur, MS Elizabeth G. Klein, Ph.D. Mary Kate Tompkins, MS Daniel Romer, Ph.D. Martin Tusler, MS



Cigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.


Nationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over two weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling.


Participants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = .21; bTeen = .27, p’s<.004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -.18; bTeen = -.22, p’s<.018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult =.66; bTeen = .85, p’s<.001) and greater quit intentions among adults (bAdult = 1.00, p<.001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions.


Warning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions vs. text-only warnings.


This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions vs. text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions vs. text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers’ risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.

EU Comes Up With A Plan To Prevent Illicit Cigarette Trade

A draft report commissioned by the EU has stated a Europe-wide system should be developed to track cigarettes , which should be run by the industry together with independent third parties, according to the Financial Times. This new program should be up and running by May 2019 in order to prevent the smuggling and counterfeiting of cigarettes, which costs €10 billion a year, according to the European Commission. As per the new laws, European Union countries must ensure that all tobacco packets are “marked with a unique identifier,” as well as a security stamp, so that the packet can be tracked from the factory to the shop floor. The Commission is yet to decide whether the tracking and tracing program should be implemented by the tobacco industry itself, or if it should be given to a third party.

While the commission says that the tobacco companies must work with numerous third parties to implement this system, the tobacco industry has maintained that it should be allowed to run the system by itself, arguing that external influence would cause disruption. Meanwhile, anti-tobacco groups have asserted the need for outside help to tackle this problem, given past allegations that some tobacco groups have benefited as a result of smuggling of, and illicit trade in, cigarettes. This recommendation comes after the ending of a $1.25 billion tracing deal between the EU and Philip Morris International ( PM ) this year, which was agreed in 2004, following criticism by lawmakers.

What Are Illicit Cigarettes?

Illicit cigarettes enter or are sold in a market in violation of certain rules and regulations, such as without payment of import duties, excise tax, or VAT. Such products can be genuine products manufactured by a official tobacco company, and sold without payment of applicable taxes, or else counterfeit cigarettes, made without the consent of the trademark owner. A number of regulatory measures and actions have been taken up by the government in response to this. Such trade harms governments, consumers, and manufacturers. According to World Health Organization (WHO) estimates, the illegal, unregulated black market in cigarettes amounts to 11% of the global consumption. Tobacco manufacturers themselves have taken a series of measures to ensure their brands are protected and consumers receive genuine products.

How Bad Is The Situation?

Counterfeit and Contraband (C&C) cigarettes declined by 6% in 2015 in the EU, over the previous year. This was against a backdrop of improved economic conditions and increased measures undertaken to counter the illicit trade activities. According to the Economic Intelligence Unit, personal disposable income rose at an average of 2.6% in 2015 across all EU member states. This may have prompted consumers to increase the consumption of Legal Domestic Sales (LDS). Furthermore, after a rise in tobacco taxes to meet the minimum EU excise requirements in a number of countries in 2014, 2015 was a year of more stable prices, which contributed to the decline in the sales of C&C cigarettes; prices rose by three percentage points less in 2015 than in 2014.


However, C&C still accounts for close to 10% of the total consumption, with high consumption in countries such as Greece, Norway, UK, and Ireland, which have the highest prices within Europe. In Eastern EU, high levels of C&C were seen in those regions bordering non-EU countries, where average prices tended to be four times lower. France was noted to have the largest volume of C&C, though it did not have the highest level as a proportion of consumption.


The major source of C&C are non-EU countries, with Belarus being the largest contributor, followed by Ukraine, Algeria, and Russia. The volume of counterfeit cigarettes continued to decline from EU countries, accounting for just 12.2% of the total in 2015.


Illicit Whites (IW), which are cigarettes manufactured legally in one country, but which are smuggled across borders, accounted for over a third of C&C, of which 5.3 billion cigarettes has Belarusian labeling. These have grown as a proportion of total C&C from 7.8 billion in 2009, to 18.8 billion in 2015. Further, counterfeit cigarettes increased 28% during 2015, but remain less than 9% of the illicit consumption in Europe.


During 2015, Philip Morris reported revenue, net of excise, from its EU segment of $8.07 billion. If we consider the rate of illicit trade in EU to be 10%, this would amount to over $800 million in lost revenue for the company. In May, the company pledged $100 million to fund projects to confront this problem. The company has come up with a new initiative – PMI IMPACT – to combat illicit trade practices. Besides expending the aforementioned sum, the initiative will also raise funds from public and non-governmental organizations. Given the large amount of lost revenue annually for Philip Morris from just the EU region, this is definitely a move that would be beneficial to the company.



1) The purpose of these analyses is to help readers focus on a few important things. We hope such lean communication sparks thinking, and encourages readers to comment and ask questions on the comment section, or email

2) Figures mentioned are approximate values to help our readers remember the key concepts more intuitively. For precise figures, please refer to our complete analysis for Philip Morris International .