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Cigarette Package Warning Labels and Interest in Quitting Smoking: The Global Adult Tobacco Survey in 14 Countries, 2008–2010

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May 27, 2011 / Vol. 60 / No. 20

MMWR Highlights



  • To assess the effects of cigarette package health warnings on interest in quitting smoking among smokers of manufactured cigarettes, this report examines data from the Global Adult Tobacco Survey (GATS) in 14 countries which are parties to the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC). These countries are Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Poland, the Russian Federation, Thailand, Turkey, Ukraine, Uruguay and Vietnam.
  • GATS was conducted once in each of the 14 countries between 2008–2010 by national governments, ministries of health, survey implementing agencies and international partners.
  • The GATS is a nationally representative household survey conducted among persons aged 15 years and older using a standardized questionnaire, sample design, data collection method and analysis protocol to ensure comparability across countries.
  • All GATS countries had warning labels describing harmful effects of smoking on cigarette packages at the time the survey was conducted.
  • At the time the surveys were conducted, Brazil, Egypt, Thailand and Uruguay had pictorial warnings. India had pictorial and text warnings at the time of the survey.
  • Since GATS surveys were conducted, four additional countries have passed legislation requiring pictorial warnings (Turkey, Mexico, Ukraine, and Philippines).



  • Across all 14 countries, adult usage of manufactured cigarettes varied widely, and men were more likely to smoker manufactured cigarettes than women.
    • Prevalence among men ranged from 9.6% (India) to 59.3% (Russia).
    • Prevalence among women was less than 25% in all countries and less than 2% in Bangladesh, China, Egypt, India, Thailand and Vietnam.
  • More than 90% of men who smoke manufactured cigarettes in 12 of the 14 countries reported noticing a package warning.
    • The other two countries are India (78.4%) and Mexico (83.5%).
  • More than 90% of women cigarette smokers in seven of the 14 countries reported noticing a package warning, and at least 75 percent in 12 of the 14 countries reported noticing a package warning.
    • The other two countries are China (60.1%) and India (18.9).
  • Among smokers who noticed a warning, the percentage of those who thought of quitting because of the warning was greater than 50% in six of the 14 countries: Bangladesh, Brazil, India, Thailand, Ukraine and Vietnam.