The Role of Pictorial Health Warning Labels (HWLs) in Controlling and Preventing Tobacco Habits - A Systematic Review

Background: Despite a significant decrease in smoking prevalence over the past ten years, cigarette smoking still represents the leading cause of preventable morbidity and mortality. Thus, countries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about the risks and make an informed decision. Objectives: 1. To assess perceptions and the impact of health warning labels regarding tobacco habits. 2. To look at the evidence for controlling and preventing tobacco habits. Search methodology: A systematic literature survey was carried out in electronic data bases like PubMed, Google scholar, etc, using "health warning labels and tobacco" and "pictorial warning and tobacco" as keywords looking for biomedical research from the past 5 years. Data collection and analysis: Three authors independently assessed all studies for inclusion criteria and for study quality (SS, MBC, AK). Results were not pooled due to the heterogeneity of the included studies. Main results: 293 articles were extracted, of which 13 articles met the inclusion criteria and were selected for the review. Outcome variables reported were credibility, relevance, warning salience, health risks of smoking and change in behaviour i.e. smoking status, motivational impact, association of HWLs with educational level, comparison between effectiveness of positive versus negative labels, misinterpretation of HWLs and country by time interaction effects for all label effectiveness. Author's conclusion: From the limited number of heterogeneous studie, there is weak evidence that pictorial health warning labels (HWLs) are effective in changing smoking behaviour. Parole chiave: health warning labels, pictorial warning, tobacco