Factsheet 4. Tobacco labelling and packaging

Key Facts

• Smokers tend to underestimate the health risks of tobacco use.
• Effective health warnings on cigarette packs encourage smokers to quit and discourage non-smokers from starting.
• Health warnings use strong, clear and specific language, and include pictures.
• Governments need to prohibit misleading labelling and legislate for health warnings.
• Less than 25% of the world’s population has access to effective health warnings on tobacco packages.
• About half of the world’s population lives where misleading terms such as ‘light’ and ‘low-tar’ are not adequately restricted.

The need to adequately inform smokers of the health risks
Most smokers are unaware of the specific harms caused by tobacco use. They tend to underestimate the risks of tobacco use to themselves and others.⁽¹⁾ Most are also unaware of the harmful ingredients of tobacco products and their smoke emissions. This is because disclosure of this information on product packages is rarely required.

Smokers have been misled that so-called ‘low-tar’ or ‘light’ cigarettes are less harmful than ‘regular’ cigarettes. Instead of quitting they may have switched to a ‘low-tar’ cigarette. Effective health warnings, and disclosure of ingredients and emissions, motivate smokers to quit and remain non–smokers. They also discourage non-smokers from starting smoking.

Health warnings on cigarette packs are found in many countries worldwide⁽²⁾ but are often ineffective. Most offer only general information, are not in a local language, are in tiny print, or are not on all tobacco products. This is a particular problem in developing countries.⁽³⁾

Fortunately, significant progress has been made. However 77% of the world’s population does not have access to adequate health warnings, as defined by the World Health Organization (WHO). Seventy seven countries do not require any warnings at all, and more than half of the world’s population lives in countries that do not adequately restrict the use of misleading terms such as ‘light’ and ‘low-tar’.^{(1) (4)}

Effective health warnings
Health warnings need to use strong, clear and specific language.⁽⁵⁾ They should include graphics such as pictures, which vastly increase the impact of warnings, and which are an important source of information for children, younger smokers and people in countries with low literacy rates.⁽¹⁾ Warnings should be large, covering at least half of the display area on all main faces of the pack, and use a variety of messages including referring to specific diseases caused by tobacco.⁽¹⁾

Governments need to legislate for health warnings, specifying the warning size, content and design.⁽²⁾ However, only 15 of the 176 countries responding to a WHO questionnaire, 6% of the world’s population, mandate pictorial warnings covering at least 30% of the main display areas.⁽¹⁾

The first countries to implement large, graphic warnings were Canada and Brazil. In 2000 Canada introduced graphic warnings and strong ingredient-reporting requirements.⁽⁶⁾

The following countries or jurisdictions require graphic warnings: Australia, Belgium, Brazil, Canada, Chile, China (Hong Kong SAR), India, Jordan, New Zealand, Panama, Romania, Singapore, Thailand, UK, Uruguay and Venezuela. Australia and New Zealand have the largest warnings, which cover 30% of the front and 90% of the back of packs.^{(7) (8) (9)} Pictorial warnings have been very effective and their impact has been very similar across different countries.

For example:^{(10) (11)}

• In Canada more than one quarter of smokers said the warnings
  motivated them to smoke outdoors in order to protect their families
  from exposure to secondhand smoke
• In Brazil two thirds of smokers said the warnings made them want to quit⁽¹²⁾
  
• In Singapore 71% of smokers said they knew more about the health effects of smoking because of the warnings⁽¹³⁾

Misleading claims about tobacco ingredients and smoke emissions

The ISO method is used by many countries to measure tar, nicotine and carbon monoxide levels in cigarettes. It uses a smoking machine but, as this does not mimic smoker behaviour, it tends to underestimate the yields of these compounds in so-called ‘low-tar’ cigarettes.⁽¹⁴⁾ So the disclosure of tar, nicotine and carbon monoxide yields should be avoided.⁽¹⁵⁾

Many smokers who are considering quitting or reducing cigarette consumption have switched to ‘mild’ or ‘light’ cigarettes.⁽¹⁶⁾ Smokers believe that such tobacco products are safer when they are not. Internal documents have shown that the tobacco industry is responsible for developing the ISO standards for tobacco products, protecting the industry’s interests and not those of the smoker.⁽¹⁷⁾

Only 65 countries report having laws that ban the use of misleading and deceptive terms such as ‘light’ and ‘low-tar’ on packaging.⁽¹⁾ Furthermore, in some of the countries that ban deceptive terms, the use of numbers in branding is allowed, as is the use of misleading terms in promotion.

FCTC requirements
Under Article 11 of The WHO Framework Convention on Tobacco, parties must⁽¹⁸⁾ :

• require multiple rotating warnings in the country’s main languages - covering at least 30% of the main display areas, with a recommendation for warnings covering at least 50% of the main display areas.
• include information on government-defined constituents and emissions.
• ban misleading terms and package designs that suggest them.

Best practice

• Include graphic images to accompany textual messages.
• Include rotating text and graphical images in a country’s main languages.
• Ensure the health warning takes up at least 50% of the front and back of cigarette package – placed on the top half, enclosed in a black border.
• Use clear, simple, specific and strong text
  and images specified by the government – permanent and not obscured by other cigarette packaging.
• Require the disclosure of the constituents of tobacco products and tobacco smoke specified by the government, but not the quantities.
• Ban the use of misleading terms such as ‘light’ or ‘mild’. Ban any design elements that suggest these terms.
• Ensure that labelling laws do not protect tobacco manufacturers from liability for the risks caused by use of their products.
• Place a duty on the sellers of tobacco products to not sell packages that do not comply with labelling requirements.

For more information visit www.theunion.org www.tobaccofreeunion.org
tobaccofreeunion@theunion.org

⁽¹⁾ WHO report on the global tobacco epidemic, 2008. The MPOWER packgage. Geneva, World Health Organization, 2008. http://www.who.int/tobacco/mpower/en/index.html
⁽²⁾ Mackay J, Eriksen M, Shafey O. The Tobacco Atlas (2nd ed.). Atlanta, GA: American Cancer Society, 2006. http://www.cancer.org/docroot/AA/content/AA_2_5_9x_Tobacco_Atlas.asp
⁽³⁾ Macksood A, Kolben D, Lurie P. International cigarette labelling practices. Tob Control 1999;8:368-72
⁽⁴⁾ United National Population Fund 2007 UNFPA. http://www.unfpa.org/swp/2007/english/notes/indicators/e_indicator2.pdf
⁽⁵⁾ Canadian Cancer Society. Controlling the tobacco epidemic: selected evidence in support of banning all tobacco advertising and promotion, and requiring large, picture-based health warnings on tobacco packages. Ottawa: Canadian Cancer Society, International Union Against Cancer, 2001. http://globalink.org/tobacco/docs/packaging/
⁽⁶⁾ Tobacco products information regulations. Health Canada. http://www.hc-sc.gc.ca/hl-vs/pubs/tobac-tabac/rc/index_e.html
⁽⁷⁾ Picture based Cigarette Health Warnings Legislation and Regulations. Physicians for a smoke-free Canada http://www.smoke-free.ca/warnings/countries%20and%20laws.htm
⁽⁸⁾ Australian Government Department of Health and Ageing. Tobacco warnings cigarette packs set A http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-pubhlth-strateg-drugs-tobacco-warning-packs-Ahtm
⁽⁹⁾ Cunningham R. Package Warnings. Overview of international developments. Canadian Cancer Society 2007. http://www.smoke-free.ca/warnings/WarningsResearch/Release_WarningLabels_20070320.pdf
⁽¹⁰⁾ Hammond D, Fong G T, McDonald PW, Cameron R, Brown KS. Impact of the graphic Canadian warning labels on adult smoking behavior. Tob Control 2003;12:391-5. http://tobaccocontrol.bmj.com/cgi/content/abstract/12/4/391
⁽¹¹⁾ Evaluation of new warnings on cigarette packages. Focus Canada October 2001. Canadian Cancer Society. http://www.cancer.ca
⁽¹²⁾ Cavalcante T and World Health Organization. Labelling and Packaging in Brazil. (January 1, 2003). Tobacco Control. WHO Tobacco Control Papers. http://repositories.cdlib.org/tc/whotcp/Brazil2003/
⁽¹³⁾ Singapore Health Promotion Board Online http://www.hpb.gov.sg/hpb/default.asp?pg_id=2233
⁽¹⁴⁾ Scientific Advisory Committee on Tobacco Product Regulation. Recommendation on health claims derived from ISO/FTC method to measure cigarette yield. Geneva: World Health Organization, 2002. http://www.who.int/tobacco/sactob/recommendations/en/iso_ftc_en.pdf
⁽¹⁵⁾ Debunking myths around ‘light’ cigarettes and implications for ‘reduced risk’ products. Tob Control 2001; Vol 10, Supplement 1http://tobaccocontrol.bmj.com/cgi/content/abstract/12/4/391
⁽¹⁶⁾ Bates C, Rowell A. Tobacco explained: the truth about the tobacco industry...in its own words. London: Action on Smoking and Health, 2004. http://www.who.int/tobacco/media/en/TobaccoExplained.pdf
⁽¹⁷⁾ Bialous S, Yach D. Whose standard is it, anyway? How the tobacco industry determines the International Organization for Standardization (ISO) standards for tobacco and tobacco products. Tob Control 2001;10:96-104. http://tc.bmjjournals.com/cgi/content/abstract/10/2/96
⁽¹⁸⁾ Framework Convention Alliance for Tobacco Control. http://www.fctc.org