PHRC Phase 1 (2005-2011) projects – Projects related to smoking

A6-08: Evaluating the impact of picture health warnings on cigarette packets

Principle investigator

Heather Wardle, NatCen


Smoking is recognised to be the greatest single cause of preventable illness and premature death in the United Kingdom, with an estimated 86,500 deaths in England, directly attributable to smoking. The government is committed to reducing smoking prevalence and has set out a series of tobacco control strategies to achieve this, including the introduction of picture health warnings on tobacco products. From the 1st October 2008, all cigarettes manufactured in the UK must be packaged in packets that have a picture health warning on them and by the 1st October 2009, all packets sold in the UK must have pictorial warnings. Evidence from other countries, including Canada and Australia, suggests that picture health warnings have a greater impact on smoking behaviour and awareness of the negative effects of smoking than the current text warnings.

Aims, methods and contribution

The project aimed to assess the impact of the new picture health warnings, by testing the hypotheses (based on studies from other countries) that the new warnings would improve knowledge relating to a range of health risks associated with smoking and create an impetus for smokers to stop smoking, smoke fewer cigarettes and/or smoke less around others. This was assessed within a range of population sub-groups, including young people aged 13-17 and adult smokers. It further aim was to provide information representative of the English population about current levels of awareness of the full health risks of smoking. This was be achieved by following up participants to Health Survey for England (HSE) and administering a short questionnaire pre and post implementation of the policy. The sample consisedt of a core general population sample (aged 18+) and boost samples of current smokers (aged 18+, at time of HSE interview) and young people (aged 13-17), with the aim of achieving 2,225 interviews for each wave. Respondents were contacted and asked to take part in a short Computer Assisted Telephone Interview. The interview collected information on smoking behaviour, knowledge of the health risks associated with smoking and awareness of the health warnings on cigarette packets. There was a different sample for each wave of the survey, however the questionnaire was very similar for both. The results of the project can be used to assess the impact of the legislation, including the hypotheses that the introduction of the pictorial health warnings will lead to an increase in awareness of the range of health risks associated with smoking and encourage more people to stop smoking. They can also be used for the future planning of tobacco control strategies and assess areas where further health promotion campaigns may be need to be targeted. In particular, examining socio-demographic differences within knowledge and behaviour, namely routine and manual workers, to identify areas for further health promotion campaigns. The results provide subsidiary evidence in relation to the PSA target to reduce smoking prevalence among routine and manual groups to 26% by 2010 and provide further information about the impact of the picture health warnings in relation to knowledge, awareness and behaviour within this group.

Duration: June 2008 - September 2009 (16 months)