Graphic health warnings on tobacco packs are credible and have high levels of public support both in Australia1,2 and internationally.3-8 There is also some evidence for public support of health warnings printed on cigarette sticks9,10 and for cigarette pack inserts containing messages promoting quitting.11
12A.9.1 Public support for tobacco health warnings in Australia
Public support for tobacco health warnings has been strong in the past and remains so in Australia.1,2 An Australian Government evaluation conducted two years after Australia’s first graphic health warnings were introduced in 2006 reported that 76% of people who don’t smoke, 70% of long-term former smokers, 68% of recent quitters and 53% of people who smoke thought it was ‘very important’ that such warnings were in place.1 Data from the International Tobacco Control Policy Evaluation study in 2007 showed that 62% of Australians who smoke thought the amount of information was about right and 25% would like more, leaving only 13% who thought it excessive.12 Additionally, there is evidence of support for inclusion of the Quitline number prominently on packets in Australia.1
Public support for graphic health warnings in Australia has remained strong after the roll-out of new warnings in 2012. A 2018 survey of 900 people in Australia reported that 80% of respondents supported the increased warning label size of cigarette packs introduced in 2012.13 According to a 2018 government sponsored survey of the impact of these warnings, approximately 81% of the population agreed or strongly agreed that the health warnings should be in place. This support varied across smoking status and was highest among people who don’t smoke (85%) and recent quitters (78%) with the lowest level of support among those who smoke (66%).2
12A.9.2 Public support for tobacco health warnings in other countries
Internationally, health warnings have proved similarly popular, including in countries such as Canada3,4 Brazil,6 United States14,15 and Thailand.5 In Brazil, three months after the introduction of pictorial health warnings in 2002, 73% of people who smoke approved of them and 67% said the warnings made them want to quit. The impact was especially strong in those with low incomes and education.6 Two years after large pictorial warnings were introduced in Uruguay, 62% of adults who smoke stated that they would like to see more information about health effects on the packet.7
In the US, as of 2025, graphic health warnings are mandated but have not yet been implemented due to continuing legal challenges by tobacco companies.16,17 Text-only warnings are currently used in the US. Multiple studies have found that the use of health warnings, including graphic health warnings, for tobacco is well supported amongst people in the US.15,18-20 This support is usually found to be more common among people who have never smoked, or former smokers, compared to those who currently smoke.18,20 There is also evidence that people of low socio-economic positions are supportive of the use of graphic health warnings in the US.21
A US study conducted in 2017 examined attitudes toward larger warning sizes on cigarette packages.14 Participants’ attitudes toward health warnings that covered 25%, 50%, or 75% of a cigarette pack were assessed. Nearly three-quarters (72%) of adults were supportive of larger warning labels on cigarette packs. Among the full sample, and the subset of people who smoke, the majority of adults had favorable attitudes toward labels that covered 25%, 50% or 75% of a cigarette pack.14
A study published in 2018 examined public support for graphic health warnings and the factors that influence public support for these warnings in the US.22 Adults who smoke were provided with pictorial warnings or text-only warnings on their cigarette packs for four weeks between 2014 and 2015. Although message reactance (i.e. an oppositional reaction to the warning) partially diminished the impact of pictorial warnings on policy support, support for pictorial warnings was high. Exposure to pictorial warnings increased policy support over time, which indicates that exposing people to a policy, educating them about its effectiveness, and stimulating conversations about the policy could increase public support.22
12A.9.3 Public support for on-stick messages and cigarette pack inserts
Health warnings are printed on the filters of cigarettes sold in Canada. Initially only king-size cigarettes required these warnings, with the rule becoming mandatory for all cigarettes on April 1st 2025. In 2024, 27% of people who smoked supported the use of these warnings. But support was higher among those who smoke other tobacco products (without the warnings) or those trying to quit.23
From 1st July 2025, all cigarettes sold in Australia are required to have on-stick health warnings printed on the filter (see Section 12A.1). A 2017 survey of adolescents aged 15 to 18 in Australia found that most (78.7%) agreed to the inclusion messages on individual cigarette sticks.9 Over 85% of first year university students in Australia agreed that individual cigarette sticks should include health warnings in a study published in 2020.10 A 2024 study also found strong support for on-stick health warnings in Saudi Arabia.24
Cigarette pack inserts are small cards placed inside a pack to provide information on the benefits of quitting and advice on how to quit. Cigarette pack inserts promoting quitting were first introduced in Canada in 2000, then updated to include graphics in 2012. There is some evidence that the Canadian inserts can promote efficacy beliefs and sustained smoking cessation attempts.25 From 1st July 2025, inserts are required in cigarette packs in Australia (see Section 12A.1). In one survey, over 63% of Australian adults supported the introduction of pack inserts.11 Similar to public support for graphic health warnings, support for inserts was higher among people who never smoked or who had quit, compared to those who smoked.11 There is also evidence to predict that littering of these inserts (which was raised as a concern prior to their introduction) should be minimal.26
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References
1. Shanahan P and Elliott D. Evaluation of the effectiveness of the graphic health warnings on tobacco product packaging 2008. Canberra, Australia: Australian Government Department of Health and Ageing, 2009. Available from: http://webarchive.nla.gov.au/gov/20140801094931/http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-tobacco-eval-graphic-health-warnings-exec-sum.
2. Essence Communications. Evaluation of effectiveness of graphic health warnings on tobacco product packaging: An Evaluation Report. Prepared for the Department of Health, 2018. Available from: https://beta.health.gov.au/resources/publications/evaluation-of-effectiveness-of-graphic-health-warnings-on-tobacco-product-packaging.
3. Hammond D, Fong GT, McDonald PW, Brown KS, and Cameron R. Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers. American Journal of Public Health, 2004; 94(8):1442-5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15284057
4. Canadian Cancer Society. Canadians overwhelmingly support graphic cigarette warnings, 2002, Canadian Cancer Society.
5. International Tobacco Control Policy Evaluation Survey. ITC South-East Asia Wave 2 Data. 2007.
6. Costa e Silva VL. Presentation to EU Commission/Brussels on the enforcement of health warnings in Brazil, 2002. Available from: https://assets.tobaccofreekids.org/global/pdfs/en/MPOWER_warning_en.pdf.
7. International Tobacco Control Policy Evaluation Survey. ITC Uruguay Project, Wave 1 Data. 2006.
8. Peters E, Romer D, Slovic P, Jamieson K, Wharfield L, et al. The impact and acceptability of Canadian-style cigarette warning labels among US smokers and nonsmokers. Nicotine & Tobacco Research 2007; 9(4):473–81. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17454702
9. Drovandi A, Teague PA, Glass B, and Malau-Aduli B. Australian school student perceptions of effective anti-tobacco health warnings. Front Public Health, 2018; 6:297. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30386764
10. Drovandi A, Teague PA, Glass B, and Malau-Aduli B. Australian university student perceptions of health messages on cigarette sticks. Health Communication, 2020; 35(4):456-64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30676104
11. Brennan E, Ilchenko E, Durkin SJ, and Wakefield MA. Public support for introducing cigarette pack inserts in Australia. Tobacco Control, 2021; 30(1):117-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32054727
12. Borland R. Personal communication, 2008.
13. No authors listed. Tobacco health warnings are burning out. This Money (UK), 2018. Available from: http://www.thisismoney.co.uk/wires/aap/article-5768337/Tobacco-health-warnings-burning-out.html
14. Kowitt SD, Noar SM, Ranney LM, and Goldstein AO. Public attitudes toward larger cigarette pack warnings: Results from a nationally representative U.S. sample. PLoS One, 2017; 12(3):e0171496. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28253257
15. Glasgow TE, Miller CA, McGuire KP, Freudenberger DC, and Fuemmeler BF. Support for cancer prevention public health policies: results from a nationally representative sample of residents in the United States. Transl Behav Med, 2022; 12(12):1124-32. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35972325
16. Raymond N. US judge blocks FDA graphic warning label requirement for cigarettes. Reuters 2025. Available from: https://www.reuters.com/legal/us-judge-blocks-fda-graphic-warning-label-requirement-cigarettes-2025-01-14/.
17. Food and Drug Administration. Cigarette labeling and health warning requirements. FDA, 2025. Available from: https://www.fda.gov/tobacco-products/labeling-and-warning-statements-tobacco-products/cigarette-labeling-and-health-warning-requirements.
18. Kaufman AR, D'Angelo H, Gaysynsky A, Seidenberg AB, Vollinger RE, et al. Public support for cigarette pack pictorial health warnings among US adults: A cross-sectional analysis of the 2020 Health Information National Trends survey. Nicotine & Tobacco Research, 2022; 24(6):924-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35060607
19. Kamyab K, Nonnemaker JM, and Farrelly MC. Public support for graphic health warning labels in the U.S. American Journal of Preventive Medicine, 2015; 48(1):89-92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25217818
20. Gravely S, Meng G, Hammond D, Driezen P, Thrasher JF, et al. Support for pictorial health warning labels on cigarette packages in the United States among adults who currently smoke or quit smoking: Findings from the ITC US Smoking and Vaping Surveys. Tobacco Induced Diseases, 2023; 21:84. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37360042
21. Vazquez-Otero C, Bekalu MA, Dhawan D, and Viswanath K. Tobacco-control policy support among people from low socioeconomic positions in Massachusetts. Preventive Medicine Reports, 2023; 35:102336. Available from: https://www.ncbi.nlm.nih.gov/pubmed/37564123
22. Hall MG, Marteau TM, Sunstein CR, Ribisl KM, Noar SM, et al. Public support for pictorial warnings on cigarette packs: an experimental study of US smokers. Journal of Behavioral Medicine, 2018; 41(3):398-405. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29411272
23. Hackworth EE, Petillo SL, Sun Y, Vidana-Perez D, Moodie C, et al. Pre-post implementation policy support for warnings on cigarette filters in Canada among adults who smoke cigarettes. Tobacco Control, 2024. Available from: https://www.ncbi.nlm.nih.gov/pubmed/39715677
24. Al-Ahmadi AF, Almatrafi MA, Ali AK, Alsaedi OH, and Al-Zalabani AH. Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey. Tobacco Induced Diseases, 2024; 22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38384733
25. Thrasher JF, Swayampakala K, Cummings KM, Hammond D, Anshari D, et al. Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada. Preventive Medicine, 2016; 88:59-65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26970037
26. Gascoyne C, Li R, Scollo M, Wakefield MA, and Brennan E. Tobacco packaging littering behaviours among Australian adults who smoke: findings from cross-sectional and observational studies to inform the implementation of cigarette pack inserts. Tobacco Control, 2024. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38448225