Toronto

When it comes to changing the behavior of smokers with warning labels on cigarette packages, it seems the bigger and more graphically in-your-face the better.

A four-year study that looked at differences in package warnings and their effects on smokers in Canada, the United Kingdom, Australia, and the United States found that Canada – with large warnings that include such photos as a mouthful of teeth with gums blackened by oral cancer and diseased lungs – leads the pack in getting the anti-tobacco message across to smokers.

To conduct the study, published today in the American Journal of Preventive medicine, researchers surveyed 15,000 adult smokers four times between 2002 and 2005. They asked a number of questions related to warnings on cigarette packages in participants four respective countries including whether they noticed them and how often they read them.

We also asked if they noticed cessation information on packages, whether it makes them more likely think about quitting, said co-author David Hammond, an assistant professor of health studies and gerontology at the University of Waterloo. And what we find is that certainly when we started, the Canadian warnings performed far better than all of the others.

In December 2000, Canada was the first country in the world to put photos on cigarettes to go along with 16 different text messages in English and french, such as Cigarettes Cause Lung Cancer and Cigarettes cause Strokes, that take up half the package, both front and back.